Epidemiology of Multimorbidity in Africa: Findings from community studies in three countries

Problem

Multimorbidity-MM (co-occurrence of ≥2 chronic conditions) is a global health challenge. The majority of evidence in multimorbidity research has come from studies in high-income countries. The incidence and prevalence of chronic conditions in low and middle income countries (LMICs) is rising, however, epidemiology of multimorbidity in LMICs remains relatively unknown.

Approach

The study objective is to understand the prevalence of multimorbidity among adults in three separate community cohorts from Malawi, Uganda, and the Gambia, respectively. The study design involved secondary data analysis of three community survey/cohort studies: Health and Demographic Surveillance Site (HDSS) data from Malawi, General Population Cohort (GPC) survey data from Uganda, and Kiang West Longitudinal Population Study (KWLPS) data from the Gambia. The study cohorts included adult populations from urban and rural settings across three different African countries. Information on presence of Hypertension, Diabetes and Obesity was available in all three datasets; information on prevalence of hypercholesterolaemia, HIV and asthma were known in two datasets and prevalence of epilepsy was known only from one study. Data analysis included calculation of crude prevalence of multimorbidity-MM (defined as 2 or more chronic conditions), MM prevalence stratified across various demographic sub-groups, and cross-sectional association between presence of MM and demographic/lifestyle factors using regression modelling.

Findings

The mean age for participants in HDSS data-Malawi (N=30574) was 35 years, with 61.8% females. The prevalence of MM was 11.8% (2389 participants out of 20299), however chronic condition prevalence data was missing for 33.6% of participants. The mean age for participants in GPC data-Uganda (N=7833) was 34 years, with 56.2% females. The prevalence of MM was 7.2% (563 participants out of 7829). The mean age for participants in KWLPS data-Gambia (N=7917) was 38 years, with 60% females. The prevalence of MM was 4.1% (176 participants out of 4131), with chronic condition prevalence data missing in 46% of participants. Being female and from older age group was associated with higher prevalence of MM. This work is still in progress, and we will be able to present the full results at the time of the conference.

Consequences

Further research is needed to study MM epidemiology in LMIC countries, particularly in Africa. This can be only strengthened by robust data collection for a wide variety of chronic conditions from primary care populations in these countries.