Research has found that half of the people who visits the hospitals in Malawi and Tanzania have multiple health problems than just the one they went to the hospital for.
The Multilink Consortium, a NIHR-funded partnership between the Liverpool School of Tropical Medicine, the Malawi-Liverpool-Wellcome Programme, Muhimbili University of Health and Allied Sciences and Kilimanjaro Christian Medical University College have established, through a study, that there are high multimorbidity rate in Malawi and Tanzanian hospitals.
This simply means that many people have multiple health problems than what what they go to the hospital for.
Multimorbidity is defined as the presence of two or more long-term health conditions in the same individual. These conditions can be physical, mental, or infectious diseases of long duration. The term “multiple long-term conditions” is also used, particularly by patient groups, according to Nice CKS
The Consortium has published the first-of-its-kind research in sub-Saharan Africa to examine the scale and impact of ‘multimorbidity’ in patients admitted acutely to hospital. Multimorbidity refers to the presence of two or more chronic diseases.
Such conditions increase the risk of end-organ diseases such as heart failure, stroke and chronic kidney disease, and premature death.
Researchers discovered that of 1007 patients admitted to four hospitals in Malawi and Tanzania, 47% had multimorbidity, most commonly hypertension, diabetes or HIV.
Patients with multimorbidity were significantly more likely to die within 90 days of entering hospital (41.7%), compared to those with one long-term condition (28.3%) or no long-term conditions (13.5%).
The study, published in Lancet Global Health, also showed the economic cost of multimorbidity, with patients with acute illness reporting income loss, poorer quality of life, and higher medical bills, especially in Tanzania where healthcare is not free at the point of use.
The findings demonstrate the significant burden of multimorbidity in healthcare systems that do not typically screen for long-term conditions.
This unfortunately often means that the initial diagnosis is made after complications have occurred.
Dr. Stephen Spencer, Wellcome Trust Clinical PhD Fellow at Liverpool School of Tropical Medicine and the Malawi-Liverpool-Wellcome Programme (MLW), and co-first author on the paper, said:
“Multimorbidity is a growing problem in sub-Saharan Africa, where there are very high rates of both infectious diseases (such as HIV and TB), but also an increasing burden from chronic, non-communicable diseases, like high blood pressure, diabetes, or heart disease, and we see multimorbidity in young adults as well as older adults.
“When someone with undiagnosed or uncontrolled multimorbidity comes to hospital, we have an opportunity to detect and treat all the conditions they may suffer from, but this is a challenge in resource limited hospitals that are already under strain.
Dr. Spencer highlighted that hospital care pathways also traditionally focus on a single presenting disease, which risks overlooking multimorbidity.”
He said: “We now need to design, implement, and evaluate effective and efficient integrated models of care that meet the needs of people and the health system, to try to sustainably reduce the risk of preventable death and disability.”
Researchers argue that their findings demonstrate how multimorbidity is an urgent public health threat that requires changes to healthcare delivery to address population needs.
Further research is now required to test context-sensitive health systems models to identify and control chronic disease, prevent complications, reduce disability and mortality, and ensure financial protection for patients.
Professor Eve Worrall, Professor of Health Economics at LSTM and Multilink co-lead, said: “I’m proud of the Multilink team for the evidence presented in this paper.
“Not only does it highlight some of the critical challenges faced by people living with multimorbidity, and the health systems that are trying to deliver adequate care under severe resource constraints, but it represents a brilliant example of inter-disciplinary and international collaboration through a partnership which strives to be equitable.
Added Professor Worrall: “The paper shows how multimorbidity is underdiagnosed in Malawi and Tanzania, which likely impacts health system costs, patient costs, and health related quality of life, and leads to avoidable mortality.”
Professor Worrall said given that many people living with multimorbidity are of working age, it likely has serious economic consequences beyond the health sector and could profoundly affect Africa’s economic growth potential over the coming decades.
She said: “We are calling for action to improve prevention, diagnosis and management of multimorbidity in Africa and the next phase of the Multilink study will explore the feasibility of strategies to achieve this.”
Multimorbidity is a growing global concern, affecting patient outcomes and healthcare costs.
In low- and middle-income countries, data on multimorbidity in primary care beyond prevalence is limited – the study explored the demographic and clinical characteristics of multimorbidity among older people attending primary health care in Malawi.
In Malawi, the overall prevalence of multimorbidity, defined across 17 recorded chronic conditions, is 19.6% and among the 2,941 cases of multimorbidity, 2,708 (92.0%) involved two chronic conditions, while 233 (8.0%) involved three.
While most conditions have increased steadily in prevalence with age, diabetes followed a different pattern, with higher prevalence among individuals aged 50-59 years (53.9%) and 60-69 years (52.4%) compared to those 70 years and older (40.3%).
“We are calling for action to improve prevention, diagnosis and management of multimorbidity in Africa.”
Professor Eve Worrall
Professor of Health Economics at LSTM
