Article Text
Abstract
Introduction Multimorbidity is a health issue of increasing importance worldwide, and is likely to become particularly problematic in low-income countries (LICs) as they undergo economic, demographic and epidemiological transitions. Knowledge of the burden and consequences of multimorbidity in LICs is needed to inform appropriate interventions.
Methods A cross-sectional household survey collected data on morbidities and frailty, disability, quality of life and physical performance on individuals aged over 40 years of age living in the Nouna Health and Demographic Surveillance System area in northwestern Burkina Faso. We defined multimorbidity as the occurrence of two or more conditions, and evaluated the prevalence of and whether this was concordant (conditions in the same morbidity domain of communicable, non-communicable diseases (NCDs) or mental health (MH)) or discordant (conditions in different morbidity domains) multimorbidity. Finally, we fitted multivariable regression models to determine associated factors and consequences of multimorbidity.
Results Multimorbidity was present in 22.8 (95% CI, 21.4 to 24.2) of the study population; it was more common in females, those who are older, single, more educated, and wealthier. We found a similar prevalence of discordant 11.1 (95% CI, 10.1 to 12.2) and concordant multimorbidity 11.7 (95% CI, 10.6 to 12.8). After controlling for age, sex, marital status, education, and wealth, an increasing number of conditions was strongly associated with frailty, disability, low quality of life, and poor physical performance. We found no difference in the association between concordant and discordant multimorbidity and outcomes, however people who were multimorbid with NCDs alone had better outcomes than those with multimorbidity with NCDs and MH disorders or MH multimorbidity alone.
Conclusions Multimorbidity is prevalent in this poor, rural population and is associated with markers of decreased physical performance and quality of life. Preventative and management interventions are needed to ensure that health systems can deal with increasing multimorbidity and its downstream consequences.
- chronic conditions
- multimorbidity
- global health
- frailty
- low income country
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Footnotes
Handling editor Sanni Yaya
Twitter @harlingg, @drjackoids
Contributors TB and GH conceived and designed the overall CSRN CHAS study. MB, GH, LO and AS co-ordinated baseline data collection and preparation. JID, CP, JM, PG, MS and MDW contributed to the design of the CSRN CHAS household survey. JID, CP, MS and MDW designed the current study. MLO conducted the analysis, wrote and revised the manuscript. JID supervised the analysis, write up and development of the manuscript. All authors substantively reviewed manuscripts, inputted into revisions and approved the final manuscript.
Funding Support for the CRSN Heidelberg Aging Study and for TB was provided by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award to Till Bärnighausen, funded by the German Federal Ministry of Education and Research. CFP is supported by the ANU Futures Scheme. Professor Witham acknowledges support from the NIHR Newcastle Biomedical Research Centre. MJS receives research support from the National Institutes of Health (R01 HL141053 and R01 AG 059504 and P30AI060354). GH is supported by a fellowship from the Wellcome Trust and Royal Society 210479/Z/18/Z. JMG was supported by Grant Number T32 AI007433 from the National Institute of Allergy and Infectious Diseases.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval Ethical approval was obtained from Ethics Commission I of the medical faculty Heidelberg (S-120/2018), the Burkina Faso Comité d’Ethique pour la Recherche en Santé (CERS) in Ouagadougou (2018-4-045) and the Institutional Ethics Committee (CIE) of the CRSN (2018-04). Oral assent was sought from all village elders. Written informed consent was obtained from each participant and a literate witness assisted in cases of illiteracy. All participants with test results indicating hypertension, diabetes, dyslipidaemia or anaemia were contacted and provided with referral to the appropriate level of care.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. Data are not publicly available as consent was not given by participants for this to take place. This is in part because entire age cohorts of some villages are included in the data set, potentially allowing for deductive disclosure with sufficient local information. For this reason, anonymised data are available from CHAS study data controllers only following signature of a data use agreement restricting onward transmission. Anyone wishing to replicate the analyses presented, or conduct further collaborative analyses using CHAS (which are welcomed and considered based on a letter of intent), should contact Dr Guy Harling (g.harling@ucl.ac.uk) in the first instance.