Multimorbidity matters in low and middle-income countries

Author:

Basto-Abreu Ana1ORCID,Barrientos-Gutierrez Tonatiuh1ORCID,Wade Alisha N2,Oliveira de Melo Daniela3,Semeão de Souza Ana S4,Nunes Bruno P5,Perianayagam Arokiasamy6,Tian Maoyi78,Yan Lijing L910,Ghosh Arpita111213,Miranda J Jaime7141516ORCID

Affiliation:

1. Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico

2. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

3. Department of Pharmaceutical Sciences, Universidade Federal de São Paulo, São Paulo, Brazil

4. Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil

5. Department of Nursing in Public Health, Universidade Federal de Pelotas, Pelotas, Brazil

6. International Institute for Population Sciences, Mumbai, India

7. The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia

8. School of Public Health, Harbin Medical University, Harbin, China

9. Global Health Research Center, Duke Kunshan University, Kunshan, China

10. School of Health Sciences, Wuhan University, Wuhan, China

11. The George Institute for Global Health, New Delhi, India

12. Manipal Academy of Higher Education, Manipal, India

13. University of New South Wales, Sydney, NSW, Australia

14. CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru

15. Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru

16. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK

Abstract

Multimorbidity is a complex challenge affecting individuals, families, caregivers, and health systems worldwide. The burden of multimorbidity is remarkable in low- and middle-income countries (LMICs) given the many existing challenges in these settings. Investigating multimorbidity in LMICs poses many challenges including the different conditions studied, and the restriction of data sources to relatively few countries, limiting comparability and representativeness. This has led to a paucity of evidence on multimorbidity prevalence and trends, disease clusters, and health outcomes, particularly longitudinal outcomes. In this paper, based on our experience of investigating multimorbidity in LMICs contexts, we discuss how the structure of the health system does not favor addressing multimorbidity, and how this is amplified by social and economic disparities and, more recently, by the COVID-19 pandemic. We argue that generating epidemiologic data around multimorbidity with similar methods and definition is essential to improve comparability, guide clinical decision-making and inform policies, research priorities, and local responses. We call for action on policy to refinance and prioritize primary care and integrated care as the center of multimorbidity.

Funder

Bloomberg Philanthropies

Emerging Global Leader Award

Wellcome Trust

Research Support Foundation of Rio Grande do Sul, Brazil

UKRI MRC/ESRC/DFID/WT, UK

National Natural Sciences Foundation of China

MetLife Foundation

Alliance for Health Policy and Systems Research

FONDECYT

DFID/MRC/Wellcome Global Health Trials

Fogarty International Center

Grand Challenges Canada

International Development Research Center Canada

Inter-American Institute for Global Change Research

National Cancer Institute

National Heart, Lung and Blood Institute

National Institute of Mental Health

Swiss National Science Foundation

UKRI BBSRC

UKRI EPSRC

UKRI MRC

Wellcome

World Diabetes Foundation

Publisher

SAGE Publications

Subject

Rehabilitation,Physical Therapy, Sports Therapy and Rehabilitation,General Medicine

Reference97 articles.

1. Making more of multimorbidity: an emerging priority

2. WHO. NCD global monitoring framework, https://www.who.int/nmh/global_monitoring_framework/en/ (2018, accessed 25 September 2019).

3. World Health Organization. Global status report on noncommunicable diseases 2014. Geneva, Switzerland: World Health Organization, http://books.google.com.pe/books/about/Global_Status_Report_on_Noncommunicable.html?hl=&id=INoOrgEACAAJ (2015, accessed 5 November 2021).

4. Understanding the rise of cardiometabolic diseases in low- and middle-income countries

5. United Nations, Department of Economic and Social Affairs, Population Division. World urbanization prospects: the 2018 revision [key facts], https://population.un.org/wup/Publications/Files/WUP2018-KeyFacts.pdf (accessed 4 August 2019).

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