IntroductionMultimorbidity is a major public health challenge, with a rising prevalence in low/middle-income countries (LMICs). This review aims to systematically synthesise evidence on the prevalence, patterns and factors associated with multimorbidity of non-communicable diseases (NCDs) among adults residing in LMICs.MethodsWe conducted a systematic review and meta-analysis of articles reporting prevalence, determinants, patterns of multimorbidity of NCDs among adults aged >18 years in LMICs. For the PROSPERO registered review, we searched PubMed, EMBASE and Cochrane libraries for articles published from 2009 till 30 May 2020. Studies were included if they reported original research on multimorbidity of NCDs among adults in LMICs.ResultsThe systematic search yielded 3272 articles; 39 articles were included, with a total of 1 220 309 participants. Most studies used self-reported data from health surveys. There was a large variation in the prevalence of multimorbidity; 0.7%–81.3% with a pooled prevalence of 36.4% (95% CI 32.2% to 40.6%). Prevalence of multimorbidity increased with age, and random effect meta-analyses showed that female sex, OR (95% CI): 1.48, 1.33 to 1.64, being well-off, 1.35 (1.02 to 1.80), and urban residence, 1.10 (1.01 to 1.20), respectively were associated with higher odds of NCD multimorbidity. The most common multimorbidity patterns included cardiometabolic and cardiorespiratory conditions.ConclusionMultimorbidity of NCDs is an important problem in LMICs with higher prevalence among the aged, women, people who are well-off and urban dwellers. There is the need for longitudinal data to access the true direction of multimorbidity and its determinants, establish causation and identify how trends and patterns change over time.PROSPERO registration numberCRD42019133453.

The pancreatic β-cell transcriptome is highly sensitive to external signals such as glucose oscillations and stress cues. MicroRNAs (miRNAs) have emerged as key factors in gene expression regulation. Here, we aimed to identify miRNAs that are modulated by glucose in mouse pancreatic islets. We identified miR-708 as the most upregulated miRNA in islets cultured at low glucose concentrations, a setting that triggers a strong stress response. miR-708 was also potently upregulated by triggering endoplasmic reticulum (ER) stress with thapsigargin and in islets of / mice. Low-glucose induction of miR-708 was blocked by treatment with the chemical chaperone 4-phenylbutyrate, uncovering the involvement of ER stress in this response. An integrative analysis identified neuronatin () as a potential glucose-regulated target of miR-708. Indeed, expression was inversely correlated with miR-708 in islets cultured at different glucose concentrations and in/ mouse islets and was reduced after miR-708 overexpression. Consistent with the role of Nnat in the secretory function of β-cells, miR-708 overexpression impaired glucose-stimulated insulin secretion (GSIS), which was recovered by overexpression. Moreover, miR-708 inhibition recovered GSIS in islets cultured at low glucose. Finally, miR-708 overexpression suppressed β-cell proliferation and induced β-cell apoptosis. Collectively, our results provide a novel mechanism of glucose regulation of β-cell function and growth by repressing stress-induced miR-708.

Objective The aim of this systematic review is to analyse existing evidence on prevalence, patterns, determinants, and healthcare challenges of communicable and non-communicable disease multimorbidity in low- and middle-income countries (LMICs). Methods PubMed, Cochrane, and Embase databases were searched from 1st January 2000 to 31st July 2020. The National Institute of Health (NIH) quality assessment tool was used to critically appraise studies. Findings were summarized in a narrative synthesis. The review was registered with PROSPERO (CRD42019133453). Results Of 3718 articles screened, 79 articles underwent a full text review of which 11 were included for narrative synthesis. Studies reported on 4 to 20 chronic communicable and non-communicable diseases; prevalence of multimorbidity ranged from 13% in a study conducted among 242,952 participants from 48 LMICS to 87% in a study conducted among 491 participants in South Africa. Multimorbidity was positively associated with older age, female sex, unemployment, and physical inactivity. Significantly higher odds of multimorbidity were noted among obese participants (OR 2.33; 95% CI: 2.19–2.48) and those who consumed alcohol (OR 1.44; 95% CI: 1.25–1.66). The most frequently occurring dyads and triads were HIV and hypertension (23.3%) and HIV, hypertension, and diabetes (63%), respectively. Women and participants from low wealth quintiles reported higher utilization of public healthcare facilities. Conclusion The identification and prevention of risk factors and addressing evidence gaps in multimorbidity clustering is crucial to address the increasing communicable and non-communicable disease multimorbidity in LMICs. To identify communicable and non-communicable diseases trends over time and identify causal relationships, longitudinal studies are warranted.

Objectives: Multimorbidity is a growing public health concern due to the increasing burden of non-communicable diseases, yet information about multimorbidity in low- and middle-income countries and migrant populations is scarce. We aimed to investigate the distribution and patterns of multimorbidity in rural and urban areas in Ghana and Ghanaian migrants in Europe.Methods: The RODAM cross-sectional study included 4,833 participants. Multimorbidity was defined as presence of multiple non-communicable chronic conditions. Patterns were determined from frequent combination of conditions. Prevalence ratios were estimated by logistic regression.Results: Prevalence of multimorbidity was higher in women and in urban Ghana and Europe. We observed a cardiometabolic pattern in all sites as well as circulatory-musculoskeletal and metabolic-musculoskeletal combinations in Ghana. Multimorbidity prevalence ratios were higher in Europe (men 1.47, 95% CI 1.34–1.59, women 1.18, 1.10–1.26) and urban Ghana (men 1.46, 1.31–1.59, women 1.27, 1.19–1.34).Conclusion: Distribution and patterns of multimorbidity differed by sex and site. With a higher burden of multimorbidity in urban areas, prevention strategies should focus on forestalling its increase in rapidly growing rural areas.