Multimorbidity in adolescents in sub-Saharan Africa: a systematic review

Individuals living with two or more long-term health conditions, known as multimorbidity, experience poorer physical and mental well-being due to the incremental effect of co-existing conditions. Research on multimorbidity mainly focuses on adults and rarely on adolescents (10-19 years), especially in Africa. We aimed to describe the prevalence of adolescent multimorbidity in Sub-Saharan Africa.

We conducted a PROSPERO-registered systematic review (CRD42024513430), searching five databases (Medline, EMBASE, Global Health, SCOPUS, PsycINFO, PsycEXTRA, and Africa Index Medicus) for observational studies published in 2000-2024. Studies were eligible if they assessed the prevalence of two or more chronic co-existing conditions (multimorbidity) in adolescents from the general population in Sub-Saharan Africa. Two reviewers independently screened studies, extracted data, and assessed risk of bias.

Here we show that 12 studies meet the inclusion criteria, out of 2824 potential studies. Most studies have a low to moderate risk of bias and were conducted within the last decade in community and/or school settings. The studies only measure multimorbidity from a limited set of conditions: allergic, malnutrition, cardiometabolic diseases, e.g. hypertension and diabetes only and cardiometabolic diseases plus HIV/tuberculosis. No study includes common mental disorders. Most individual conditions are objectively measured and have low prevalences ( < 10%). Multimorbidity prevalence ranges from 0.0 to 13.8% and varies by the conditions measured.

This systematic review identified only 12 eligible studies, with substantial methodological heterogeneity limiting the comparability and generalizability of multimorbidity estimates. Further adolescent-specific research focusing on enhancing the measurement of multimorbidity of conditions commonly affecting adolescents is required to allow accurate estimates and to inform healthcare provision.