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Multimorbidity and acute infectious diseases in urban and semi-urban settings in Peru: A mixed-methods study
Cecilia Anza-Ramirez1, Lizzete Najarro1, Antonio Bernabé-Ortiz1
1CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
Background:
The co-occurrence of chronic diseases and acute infectious events exacerbates disability and diminishes quality of life, yet research in Low- and Middle-Income countries is scarce. We aimed to investigate the relationship between infectious events and multimorbidity in resource-constrained settings.
Methods:
We conducted a sequential mixed-method study in Lima and Tumbes, Peru, with participants having multimorbidity from the CRONICAS Cohort Study. They completed a questionnaire on the occurrence, treatment, and health-seeking behaviour related to acute infectious events. Qualitative interviews explored the perceptions and links between multimorbidity and acute infectious events for a subgroup of participants.
Findings:
Among individuals with multimorbidity, low awareness of chronic conditions and poor medication adherence. The cumulative incidence for respiratory and gastrointestinal infections, the most reported acute conditions, was 2.0 [95%CI: 1.8-2.2] and 1.6 [1.2-1.9] events per person per year, respectively. Individuals with cancer (6.4 [1.6-11.2] events per person per year) or gastrointestinal reflux (7.2 [4.4-10.1] events per person per year) reported higher cumulative incidence of infectious events than others, such as those with cardiovascular and metabolic conditions (5.2 [4.6-5.8] events per person per year). Those with three or more chronic conditions had a slightly higher cumulative incidence compared with individuals with two conditions (5.7 [4.4-7.0] vs 5.0 [4.4-5.6] events per person per year). Around 40% of individuals with multimorbidity sought healthcare assistance, while others chose drugstores or didn't seek help. Our qualitative analysis showed diverse perceptions among participants regarding the connections between chronic and acute conditions. Those who recognized a connection emphasized the challenges in managing these interactions.
Interpretation:
Our study advances understanding of multimorbidity challenges in resource-limited settings, highlighting the impact of acute infections on patients' existing multimorbidity burden.
Insights
Acute infections worsen chronic disease burden in low-income settings. Patients with multimorbidity face challenges managing infections, impacting their quality of life and healthcare access.
Area of Science:
- Global Health
- Epidemiology
- Public Health
Background:
- Research on chronic diseases and acute infections in low- and middle-income countries (LMICs) is limited.
- The co-occurrence of chronic diseases and acute infections significantly increases disability and reduces quality of life.
Purpose of the Study:
- To investigate the relationship between acute infectious events and multimorbidity in resource-constrained settings.
- To understand the impact of acute infections on individuals managing multiple chronic conditions in Peru.
Main Methods:
- A sequential mixed-method study was conducted in Lima and Tumbes, Peru.
- Participants with multimorbidity completed questionnaires on infectious events and qualitative interviews explored their perceptions.
Main Results:
- The cumulative incidence of respiratory and gastrointestinal infections was 2.0 and 1.6 events per person per year, respectively.
- Individuals with cancer or gastrointestinal reflux reported higher infectious event incidence.
- Approximately 40% sought formal healthcare, with others using drugstores or no assistance.
Conclusions:
- Acute infections pose a significant challenge for individuals with multimorbidity in resource-limited settings.
- Understanding these interactions is crucial for improving patient outcomes and healthcare strategies in LMICs.
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