Identifying the prevalence and correlates of multimorbidity in middle-aged men and women: a cross-sectional population-based study in four African countries
Lisa K Micklesfield,
Shane A Norris,
Francesc Xavier Gómez-Olivé,
Chodziwadziwa Kabudula,
June Fabian,
Alisha N Wade,
Gershim Asiki,
Shukri F Mohamed,
Nigel J Crowther,
Engelbert A Nonterah,
Michèle Ramsay,
Richard Munthali,
Hermann Sorgho,
Godfred Agongo,
Palwende Boua,
Solomon SR Choma,
Eric Maimela,
Frederick J Raal,
Furahini D Tluway
Affiliations
Lisa K Micklesfield
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Shane A Norris
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Francesc Xavier Gómez-Olivé
South African Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Chodziwadziwa Kabudula
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Acornhoek, South Africa
June Fabian
clinical researcher and honorary lecturer
Alisha N Wade
South African Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Gershim Asiki
African Population and Health Research Center, Nairobi, Kenya
Shukri F Mohamed
Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
Nigel J Crowther
Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Engelbert A Nonterah
Navrongo Health Research Centre, Ghana Health Service, Accra, Ghana
Michèle Ramsay
Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Richard Munthali
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Hermann Sorgho
Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
Godfred Agongo
Department of Biochemistry and Forensic Sciences, School of Chemical and Biochemical Sciences, C.K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana
Palwende Boua
Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
Solomon SR Choma
Department of Public Health, University of Limpopo, Sovenga, South Africa
Eric Maimela
Department of Public Health, University of Limpopo, Sovenga, South Africa
Frederick J Raal
Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Furahini D Tluway
Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Objectives To determine the prevalence of multimorbidity, to identify which chronic conditions cluster together and to identify factors associated with a greater risk for multimorbidity in sub-Saharan Africa (SSA).Design Cross-sectional, multicentre, population-based study.Setting Six urban and rural communities in four sub-Saharan African countries.Participants Men (n=4808) and women (n=5892) between the ages of 40 and 60 years from the AWI-Gen study.Measures Sociodemographic and anthropometric data, and multimorbidity as defined by the presence of two or more of the following conditions: HIV infection, cardiovascular disease, chronic kidney disease, asthma, diabetes, dyslipidaemia, hypertension.Results Multimorbidity prevalence was higher in women compared with men (47.2% vs 35%), and higher in South African men and women compared with their East and West African counterparts. The most common disease combination at all sites was dyslipidaemia and hypertension, with this combination being more prevalent in South African women than any single disease (25% vs 21.6%). Age and body mass index were associated with a higher risk of multimorbidity in men and women; however, lifestyle correlates such as smoking and physical activity were different between the sexes.Conclusions The high prevalence of multimorbidity in middle-aged adults in SSA is of concern, with women currently at higher risk. This prevalence is expected to increase in men, as well as in the East and West African region with the ongoing epidemiological transition. Identifying common disease clusters and correlates of multimorbidity is critical to providing effective interventions.
