Multimorbidity in South Africa: a systematic review of prevalence studies

Rifqah Abeeda Roomaney; Brian van Wyk; Eunice Bolanle Turawa; Victoria Pillay-van Wyk

doi:10.1136/bmjopen-2021-048676

Multimorbidity in South Africa: a systematic review of prevalence studies

BMJ Open. 2021 Oct 6;11(10):e048676. doi: 10.1136/bmjopen-2021-048676.

Authors

Rifqah Abeeda Roomaney^{1

2}, Brian van Wyk², Eunice Bolanle Turawa^{3

4}, Victoria Pillay-van Wyk³

Affiliations

¹ Burden of Disease Research Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa rifqah.roomaney@mrc.ac.za.
² School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa.
³ Burden of Disease Research Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa.
⁴ Faculty of Medicine and Health Sciences, Community Health, Stellenbosch University, Cape Town, Western Cape, South Africa.

Abstract

Objectives: To review prevalence studies of multimorbidity in South Africa to identify prevalence estimates, common disease clusters and factors associated with multimorbidity.

Design: Systematic review.

Setting: South Africa (general community and healthcare facilities).

Data sources: Articles were retrieved from electronic databases (PubMed, Web of Science, Scopus, CINAHL, Science Direct and JSTOR).

Eligibility criteria: Studies addressing the prevalence of multimorbidity in South Africa were eligible for inclusion. A systematic search was done in various databases up to December 2020. A risk of bias assessment was conducted for each article using a modified checklist.

Study selection: Two researchers independently screened titles and abstracts; assessed the risk of bias of each study and extracted data. Included studies were described using a narrative synthesis.

Results: In total, 1407 titles were retrieved; of which 10 articles were included in the narrative synthesis. Six studies had a low risk of bias and three had a moderate risk of bias. One study was not assessed for risk of bias, because there was no criteria that apply to routine health information systems. Three of the included studies were population-based surveys, four were community-based cohorts and three cross-sectional studies of health facility data. The prevalence of multimorbidity was low to moderate (3%-23%) in studies that included younger people or had a wide range of selected age groups; and moderate to high (30%-87%) in studies of older adults. The common disease clusters were hypertension and diabetes, hypertension and HIV, and TB and HIV.

Conclusion: All studies indicated that multimorbidity is a norm in South Africa, especially among older adults. Hypertension is the main driver of multimorbidity. Research on multimorbidity in South Africa needs to be strengthened with high-quality study designs.

Prospero registration number: CRD42020196895.

Keywords: epidemiology; public health.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Aged
Cross-Sectional Studies
Humans
Multimorbidity*
Prevalence
Research Design*
South Africa / epidemiology