Chronic multimorbidity among older adults in rural South Africa

Abstract

IntroductionThe rapid ageing of populations around the world is accompanied by increasing prevalence of multimorbidity. This study is one of the first to present the prevalence of multimorbidity that includes HIV in the complex epidemiological setting of South Africa, thus filling a gap in the multimorbidity literature that is dominated by studies in high-income or low-HIV prevalence settings.MethodsOut of the full sample of 5059 people aged 40+, we analysed cross-sectional data on 10 conditions from 3889 people enrolled in the Health and Ageing in Africa: A longitudinal study of an INDEPTH Community in South Africa (HAALSI) Programme. Two definitions of multimorbidity were applied: the presence of more than one condition and the presence of conditions from more than one of the following categories: cardiometabolic conditions, mental disorders, HIV and anaemia. We conducted descriptive and regression analyses to assess the relationship between prevalence of multimorbidity and sociodemographic factors. We examined the frequencies of the most prevalent combinations of conditions and assessed relationships between multimorbidity and physical and psychological functioning.Results69.4 per cent (95% CI 68.0 to 70.9) of the respondents had at least two conditions and 53.9% (52.4–55.5) of the sample had at least two categories of conditions. The most common condition groups and multimorbid profiles were combinations of cardiometabolic conditions, cardiometabolic conditions and depression, HIV and anaemia and combinations of mental disorders. The commonly observed positive relationships between multimorbidity and age and decreasing wealth were not observed in this population, namelydue to different epidemiological profiles in the subgroups, with higher prevalence of HIV and anaemia in the poorer and younger groups, and higher prevalence of cardiometabolic conditions in the richer and older groups. Both physical functioning and well-being negatively associated with multimorbidity.DiscussionMore coordinated, long-term integrated care management across multiple chronic conditions should be provided in rural South Africa.

Epidemiology of multimorbidity in conditions of extreme poverty: a population-based study of older adults in rural Burkina Faso

“…We were not able to capture information on all chronic conditions, for example, osteoarthritis or visual impairment, in our survey, meaning that our estimates should be considered a lower bound on the true prevalence of multimorbidity in this population. However, we intentionally captured as broad spectrum of conditions as possible, and reported on 11 common conditions, similar to that seen in other studies in similar settings 12…”

“…The Fried score was used to calculate frailty using the original five domains (weight loss, low grip strength, walk speed, activity levels and exhaustion). We chose to use the Fried score to calculate frailty as it can easily be deployed in a low resource setting, given that it uses just five parameters 12 39. The Fried score is a validated method which is shown to be feasible and comparable to other methods for calculating frailty 45 46.…”

“…Although there have been studies on multimorbidity in lower-middle income countries most of them have been done in upper-middle income countries. In sub-Saharan Africa, these have mainly been conducted in South Africa,12 13 which is an upper-middle-income country with a relatively well-developed health system 14. There is very little information about who is affected by multimorbidity in other countries in sub-Saharan Africa, where many of the least developed countries with the world’s poorest populations and most under-resourced health systems are found.…”

Map clusters of diseases to tackle multimorbidity

“…For example, a higher prevalence of multimorbidity is linked to low educational attainment (see 'The health benefits of learning'). In some low-to-middle income regions, such as parts of South Africa, physical conditions such as anaemia tend to group with infections such as HIV 5 . In rapidly developing Asia, diseases of affluence such as type-2 diabetes and coronary heart disease commonly co-occur with tuberculosis and other diseases of poverty 6 .…”

“…Middle-income countries such as China 6 and South Africa 15 , are also seeing a rise in multimorbidity in older people. In fact, the diseases that cluster here arise from the double burden of ageing and poverty, and could well be the most diverse.…”