The work of this study is primarily exploratory but it will promote development of a new collaboration looking at multimorbidity in Sub-Saharan Africa and serves to highlight data gaps and opportunities that the team plans to address in future funding applications. 

Multimorbidity, the presence of 2 or more long-term conditions (LTCs), is an increasing global health challenge. Multimorbidity is increasingly common among younger and middle-aged as well as older people and is associated with adverse effects on health outcomes. Although multimorbidity is increasingly common in low and middle-income countries (LMICs), we have insufficient information on patterns, trends or determinants of multimorbidity in LMICs. Such information is crucial to inform health and social service planning across different LMIC health care systems.

Equally important is the call by the Academy of Medical Sciences to undertake research that includes ‘studies of the experiences and preferences of patients with different types of multimorbidity’ in LMICs.  Living with multiple LTCs is hard work and requires people to assume an increasing workload of self-managment, something referred to as ‘Treatment Burden’. Treatment burden refers to the work that people and their wider support network have to undertake. It covers a variety of activities ranging from: a) the work done to gain an understanding of conditions; b) the effort needed to navigate health and social care systems; c) the work of operationalising self-management such as attending appointments and taking medicines; and d) undertaking self-monitoring activities, such as checking blood sugars. The concept of treatment burden in those with multimorbidity is yet to be investigated in Sub Saharan Africa (SSA).

People can vary in their capacity to cope with any given level of treatement burden depending on a range of factors such as socioeconomic status, health literacy, language, level of educational attainment, location, personal beliefs and physical and mental abilities.  As well as personal or individual resources, it is important to consider the role of the persons’ wider social support network as well as healthcare organisations and health policy. Gaining an understanding of these concepts in SSA context and enhancing understanding of the challenges faced by patients and practitioners would inform development of interventions to improve management of multimorbidity. Treatment burden and capacity issues are important as overwhelmed patients are less likely to adhere to therapies, resulting in wasted resources and poor outcomes. This proposal addresses important evidence gaps in multimorbidity research in SSA. Our project will involve 3 work-packages (WPs) and use data sources from 3 African nations (Malawi, Gambia and Uganda). The work represents a collaboration led by the University of Glasgow, which has particular expertise in multimorbidity research, using both data science and qualitative methods, along with partners in Malawi, the MRC Units in Gambia and Uganda and the London School of Hygiene and Tropical Medicine.

As part of this proect, we will be analysing 30 interviews on patient experience of multimorbidity in Malawi as well as conducting 30 interviews with healthcare professionals across SSA, ten each in Malawi, Gambia and Uganda. These interviews will explore how healthcare professionals approach the treatment of patients living with multimorbidity, the challenges they face, and their perceptions of potential for improvement.