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Multimorbidity patterns and function among adults in low- and middle-income countries: a scoping review
Karina Berner1, Eugene Nizeyimana2, Diribsa Tsegaye Bedada3
1Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa kberner@sun.ac.za.
BMJ Open
|January 24, 2025
Summary
Evidence on multimorbidity patterns and functioning in low- and middle-income countries (LMICs) is limited and inconsistent. Future research needs standardized methods and diverse samples to understand these complex relationships.
Area of Science:
- Global Health
- Epidemiology
- Health Services Research
Background:
- Multimorbidity, the coexistence of two or more diseases, is a growing concern in low- and middle-income countries (LMICs).
- Understanding the patterns of multimorbidity and their impact on functioning is crucial for developing effective health strategies in these regions.
Purpose of the Study:
- To conduct a scoping review of existing evidence on the relationships between multimorbidity patterns and functioning in adults residing in LMICs.
- To identify and describe the methodologies employed in studies examining these associations.
Main Methods:
- A comprehensive scoping review was conducted using a five-step framework and PRISMA-ScR guidelines.
- Searches were performed across major databases (PubMed/MEDLINE, Scopus, CINAHL, Cochrane) from January 1976 to March 2023.
- Included studies were peer-reviewed articles in English or Afrikaans, focusing on adults in LMICs with multimorbidity and its association with functioning, using the International Classification of Functioning, Disability and Health (ICF) framework.
Main Results:
- Nine studies, primarily from upper-middle-income Asian countries, were included, totaling 62,003 participants.
- Significant methodological inconsistencies were found in defining multimorbidity, identifying patterns, and measuring functioning.
- Five main multimorbidity pattern domains were identified: Cardio-Metabolic/Coronary Atherosclerotic, Musculoskeletal, Respiratory/Digestive/Visceral, Degenerative, and Mental Health-Related.
- Mobility limitations, difficulties with instrumental activities of daily living, self-care, and bowel/bladder issues were consistently associated with all identified multimorbidity patterns.
Conclusions:
- The current body of evidence on multimorbidity patterns and functioning in LMICs is limited, geographically biased, and methodologically inconsistent.
- These limitations hinder a comprehensive understanding and the development of targeted interventions.
- Future research should prioritize context-specific multimorbidity definitions, transparent and standardized methodologies, and diverse study populations to inform policy and practice.
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