Multimorbidity research in Sub-Saharan Africa: Proceedings of an interdisciplinary workshop

Abstract

As life expectancies rise globally, the number of people living with multiple chronic health conditions – commonly referred to as ‘multimorbidity’ – is rising. Multimorbidity has been recognised as especially challenging to respond to in countries whose health systems are under-funded, fragmented, and designed primarily for acute care, including in sub-Saharan Africa. A growing body of research in sub-Saharan Africa has sought to better understand the particular challenges multimorbidity poses in the region and to develop context-sensitive responses. However, with multimorbidity still crystallising as a subject of enquiry, there remains considerable heterogeneity in conceptualising multimorbidity across disciplines and fields, hindering coordinated action. In June 2022, 60 researchers, practitioners, and stakeholders with regional expertise from nine sub-Saharan African countries gathered in Blantyre, Malawi to discuss ongoing multimorbidity research across the region. Drawing on insights from disciplines including epidemiology, public health, clinical medicine, anthropology, history, and sociology, participants critically considered the meaning, singular potential, and limitations of the concept of multimorbidity in sub-Saharan Africa. The workshop emphasised the need to move beyond a disease-centred concept of multimorbidity to one foregrounding patients’ values, needs, and social context; the importance of foregrounding structures and systems rather than behaviour and lifestyles; the value of a flexible (rather than standard) definition of multimorbidity; and the need to leverage local knowledge, expertise, resources, and infrastructure. The workshop further served as a platform for exploring opportunities for training, writing, and ongoing collaboration.

Interdisciplinary perspectives on multimorbidity in Africa: developing an expanded conceptual model

“…We used an inductive, co-productive research design. Guided by the principles of grounded theory,(21) the research process involved a three-day concept-building workshop in Blantyre, Malawi (June 22-24, 2022),(22) thematic ‘open coding’ of workshop discussions, and further iterative development of a conceptual model following the workshop. Our approach follows the growing interest in “collective experimentation”(23) to address issues of transdisciplinary concern in public and global health,(23–25) of which multimorbidity is arguably a paradigmatic example.…”

“…Potential participants were identified through purposive and snowballing methods between June 2021-March 2022, which are described in greater detail elsewhere. (22) The collaborator group drew together 60 researchers, clinicians, health planners, and policymakers (HIC-based n=19, LMIC-based (n=41), together representing a wide range of disciplinary perspectives, including from (sub-)fields of epidemiology, public health, clinical medicine, and the social sciences ( Figure 1). Given the current concentration of multimorbidity research, and the location of the workshop in Malawi, the regional expertise among the collaborator group stemmed primarily from countries within Southern Africa, with the greatest concentration of experience from Malawi (n=33), South Africa (n=13), and Zimbabwe (n=9).…”

“…A detailed account of the workshop design is published elsewhere. (22) The workshop was designed to optimise opportunities for cross-disciplinary discussion. Sessions were organised around four provisional thematic ‘domains’: (1) concepts and framings of multimorbidity; (2) population-level health data; (3) risk, prevention, and sites of intervention; (4) health systems and care models.…”

“…A detailed account of workshop proceedings, ratified and co-authored by all participants, has been published elsewhere. (22)…”

Multimorbidity-associated emergency hospital admissions: a “screen and link” strategy to improve outcomes for high-risk patients in sub-Saharan Africa: a prospective multicentre cohort study protocol

“…Although multimorbidity is commonly defined as the co-existence of two or more chronic conditions in a single person, there are recognised limitations in the utility of this definition requiring to different settings and disciplines 19,20 .…”