Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Sep 1:12:26335565221112593.
doi: 10.1177/26335565221112593. eCollection 2022 Jan-Dec.

Multimorbidity of communicable and non-communicable diseases in low- and middle-income countries: A systematic review

Lucy Kaluvu  1   2 , Ogechukwu Augustina Asogwa  3 , Anna Marzà-Florensa  1 , Catherine Kyobutungi  4 , Naomi S Levitt  5 , Daniel Boateng  1   6 , Kerstin Klipstein-Grobusch  1   7
Affiliations
Review

Multimorbidity of communicable and non-communicable diseases in low- and middle-income countries: A systematic review

Lucy Kaluvu et al. J Multimorb Comorb. .

Abstract

Objective: The aim of this systematic review is to analyse existing evidence on prevalence, patterns, determinants, and healthcare challenges of communicable and non-communicable disease multimorbidity in low- and middle-income countries (LMICs).

Methods: PubMed, Cochrane, and Embase databases were searched from 1st January 2000 to 31st July 2020. The National Institute of Health (NIH) quality assessment tool was used to critically appraise studies. Findings were summarized in a narrative synthesis. The review was registered with PROSPERO (CRD42019133453).

Results: Of 3718 articles screened, 79 articles underwent a full text review of which 11 were included for narrative synthesis. Studies reported on 4 to 20 chronic communicable and non-communicable diseases; prevalence of multimorbidity ranged from 13% in a study conducted among 242,952 participants from 48 LMICS to 87% in a study conducted among 491 participants in South Africa. Multimorbidity was positively associated with older age, female sex, unemployment, and physical inactivity. Significantly higher odds of multimorbidity were noted among obese participants (OR 2.33; 95% CI: 2.19-2.48) and those who consumed alcohol (OR 1.44; 95% CI: 1.25-1.66). The most frequently occurring dyads and triads were HIV and hypertension (23.3%) and HIV, hypertension, and diabetes (63%), respectively. Women and participants from low wealth quintiles reported higher utilization of public healthcare facilities.

Conclusion: The identification and prevention of risk factors and addressing evidence gaps in multimorbidity clustering is crucial to address the increasing communicable and non-communicable disease multimorbidity in LMICs. To identify communicable and non-communicable diseases trends over time and identify causal relationships, longitudinal studies are warranted.

Keywords: communicable diseases; health systems; low- and middle-income countries; multimorbidity; non-communicable diseases.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram illustrating the article selection process.
Figure 2.
Figure 2.
Patterns of CD and NCD multimorbidity (dyads).
See this image and copyright information in PMC

References

    1. The Academy of Medical Sciences . Multimorbidity: a priority for global health research. Academy of Medical Sciences, 2018. Available at: https://acmedsci.ac.uk/file-download/82222577 (Accsessed 16 March 2021).
    1. Oni T, Unwin N. Why the communicable/non-communicable disease dichotomy is problematic for public health control strategies: implications of multimorbidity for health systems in an era of health transition. Int Health 2015; 7(6): 390–399. - PMC - PubMed
    1. Oni T, McGrath N, BeLue R, et al. Chronic diseases and multi-morbidity--a conceptual modification to the WHO ICCC model for countries in health transition. BMC Public Health 2014; 14: 575. - PMC - PubMed
    1. Remais JV, Zeng G, Li G, et al. Convergence of non-communicable and infectious diseases in low- and middle-income countries. Int J Epidemiol 2013; 42(1): 221–227. Available at: https://pubmed.ncbi.nlm.nih.gov/23064501 - PMC - PubMed
    1. Stubbs B, Koyanagi A, Veronese N, et al. Physical multimorbidity and psychosis: comprehensive cross sectional analysis including 242, 952 people across 48 low- and middle-income countries. BMC Med 2016; 14(1): 189. - PMC - PubMed

LinkOut - more resources