Abstract
BackgroundVery little is known about multimorbidity and chronic diseases in low and middle income countries, particularly Sub-Saharan Africa, and more information is needed to guide the process of adapting the health systems in these countries to respond adequately to the increasing burden of chronic diseases. We conducted a hospital-based survey in an urban setting in Ghana to determine the prevalence of multimorbidity and its associated risk factors among adult patients presenting to an inner city clinic.MethodsBetween May and June 2012, we interviewed adult patients (aged 18 years and above) attending a routine outpatient clinic at an inner-city hospital in Accra using a structured questionnaire. We supplemented the information obtained from the interviews with information obtained from respondents’ health records. We used logistic regression analyses to explore the risk factors for multimorbidity.ResultsWe interviewed 1,527 patients and retrieved matching medical records for 1,399 (91.6%). The median age of participants was 52.1 years (37–64 years). While the prevalence of multimorbidity was 38.8%, around half (48.6%) of the patients with multimorbidity were aged between 18–59 years old. The most common combination of conditions was hypertension and diabetes mellitus (36.6%), hypertension and musculoskeletal conditions (19.9%), and hypertension and other cardiovascular conditions (11.4%). Compared with patients aged 18–39 years, those aged 40–49 years (OR 4.68, 95% CI: 2.98–7.34), 50–59 years (OR 12.48, 95% CI: 8.23–18.92) and 60 years or older (OR 15.80, 95% CI: 10.66–23.42) were increasingly likely to present with multimorbidity. While men were less likely to present with multimorbidity, (OR 0.71, 95% CI: 0.45–0.94, p = 0.015), having a family history of any chronic disease was predictive of multimorbidity (OR 1.43, 95% CI: 1.03–1.68, p = 0.027).ConclusionsMultimorbidity is a significant problem in this population. By identifying the risk factors for multimorbidity, the results of the present study provide further evidence for informing future policies aimed at improving clinical case management, health education and medical training in Ghana.
Highlights
Very little is known about multimorbidity and chronic diseases in low and middle income countries, Sub-Saharan Africa, and more information is needed to guide the process of adapting the health systems in these countries to respond adequately to the increasing burden of chronic diseases
Prevalence of multimorbidity The top three conditions among the 13 pre-selected conditions used for defining multimorbidity were hypertension (52.8%), diabetes mellitus (25.4%) and musculoskeletal conditions (17.9%)
This study is the first to explore multimorbidity in Ghana, and its results will be of importance to health managers in adapting medical education curricula, clinical case management guidelines and the structure of the health system in general to respond to the health transition currently taking place in Ghana
Summary
Very little is known about multimorbidity and chronic diseases in low and middle income countries, Sub-Saharan Africa, and more information is needed to guide the process of adapting the health systems in these countries to respond adequately to the increasing burden of chronic diseases. Much of the information currently available on multimorbidity has been obtained from work undertaken in developed countries. One study of approximately 900 patients conducted in family practices in Canada showed that the prevalence of multimorbidity (based on the presence of 2 or more chronic health problems) among those aged 18–44 years, 45–64 years, and 65 years and older was 68%, 95% and 99% respectively among female patients, and 72%, 89% and 98% among male patients [3]. Considering that there is evidence of a positive association between low socio-economic status and multimorbidity coupled with an earlier age of disease onset [5] even in in developed countries, this work needs to be extended to include developing countries and all population subgroups
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