Multimorbidity: its prevalence and impact in middle income countries. A multicountry comparison using household surveys and qualitative methods

Abstract

Multimorbidity, defined as the co-occurrence of two or more chronic conditions within an individual, is characteristic of an elderly population. Tackling multimorbidity remains one of the key challenges faced by the global community, particularly for many low and middle income countries (LMICs) facing a rapidly ageing population and an onset of non-communicable disease (NCDs) earlier in adulthood than in high income countries (HICs). Using a mixed methods approach, this thesis aimed to understand the prevalence and impact of multimorbidity in LMICs through four studies. The first study examined the prevalence of multimorbidity across 28 LMICs, and its association with socioeconomic status (SES) using education as a proxy. Multimorbidity was found to be positively associated with the female sex and with age, although it was common among younger adults in LMICs. Regional SES analyses also suggested a negative association of multimorbidity with SES. The second study further examined these relationships using the Study of Global Ageing (SAGE Wave 1, 2007-2010), with an additional focus on understanding the effect of urban living in a set of five key MICs: China, Ghana, India, Russia and South Africa. The study findings were consistent with the first study and, in China, points to a pathway of association between urban living and multimorbidity, acting through social, economic, behavioural and demographic risk factors. Using the SAGE, the third study examined the impact of multimorbidity on activities of daily living and functional disability, and found disability to be associated with age and dependent on the chronic conditions included in the multimorbidity count. Drawing on earlier findings, the final qualitative study was carried out within Greater Accra, Ghana. In total, 20 women were recruited from 3 polyclinics across urban, rural and peri-urban areas; and their experiences of living with multimorbidity were explored.

The findings highlighted their reliance on the healthcare system in spite of inconsistent coverage, complexity and treatment burden; and their need for social support and holistic care. The aims of this thesis are wide-reaching, and consider evidence for better health planning, policy, and community interventions; particularly for LMICs facing a multimorbidity burden.

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ORCID for Paul Roderick: orcid.org/0000-0001-9475-6850

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