Interdisciplinary perspectives on multimorbidity in Africa: Developing an expanded conceptual model

Justin Dixon^{1

2}, Ben Morton^{3

4}, Misheck J Nkhata⁵, Alan Silman⁶, Ibrahim G Simiyu⁴, Stephen A Spencer^{3

4}, Myrna Van Pinxteren⁷, Christopher Bunn^{8

9}, Claire Calderwood^{1

10}, Clare I R Chandler², Edith Chikumbu⁸, Amelia C Crampin^{8

11

12}, John R Hurst¹³, Modou Jobe¹⁴, Andre Pascal Kengne¹⁵, Naomi S Levitt⁷, Mosa Moshabela¹⁶, Mayowa Owolabi¹⁷, Nasheeta Peer¹⁵, Nozgechi Phiri⁸, Sally J Singh¹⁸, Tsaone Tamuhla¹⁹, Mandikudza Tembo^{1

10}, Nicki Tiffin¹⁹, Eve Worrall²⁰, Nateiya M Yongolo^{4

21}, Gift T Banda^{3

4}, Fanuel Bickton^{3

22}, Abbi-Monique Mamani Bilungula²³, Edna Bosire^{24

25}, Marlen S Chawani^{3

26}, Beatrice Chinoko³, Mphatso Chisala⁸, Jonathan Chiwanda²⁷, Sarah Drew²⁸, Lindsay Farrant²⁹, Rashida A Ferrand^{1

10}, Mtisunge Gondwe^{3

4}, Celia L Gregson^{1

28}, Richard Harding³⁰, Dan Kajungu³¹, Stephen Kasenda⁸, Winceslaus Katagira³², Duncan Kwaitana³³, Emily Mendenhall³⁴, Adwoa Bemah Boamah Mensah³⁵, Modai Mnenula³⁶, Lovemore Mupaza³⁷, Maud Mwakasungula³⁸, Wisdom Nakanga^{8

39}, Chiratidzo Ndhlovu⁴⁰, Kennedy Nkhoma³⁰, Owen Nkoka^{8

9}, Edwina Addo Opare-Lokko⁴¹, Jacob Phulusa³, Alison Price^{8

11}, Jamie Rylance^{3

4}, Charity Salima⁴², Sangwani Salimu^{3

4}, Joachim Sturmberg^{43

44}, Elizabeth Vale⁴⁵, Felix Limbani³

Affiliations

¹ The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
² Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
³ Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.
⁴ Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
⁵ SHLS Nursing and Midwifery, Teesside University, Middlesborough, United Kingdom.
⁶ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, United Kingdom.
⁷ Faculty of Health Sciences, Department of Medicine and Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa.
⁸ Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.
⁹ College of Social Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom.
¹⁰ Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
¹¹ Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
¹² School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
¹³ UCL Respiratory, University College London, London, United Kingdom.
¹⁴ MRC Unit The Gambia at LSHTM, Banjul, The Gambia.
¹⁵ Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, Durban, South Africa.
¹⁶ School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
¹⁷ Centre for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria.
¹⁸ Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.
¹⁹ South African National Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa.
²⁰ Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
²¹ Kilimanjaro Clinical Research Institute, Moshi, Tanzania.
²² Department of Rehabilitation Sciences, The Kamuzu University of Health Sciences, Blantyre, Malawi.
²³ Department of Physical Medicine and Rehabilitation, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
²⁴ Brain and Mind Institute, Aga Khan University, Nairobi, Kenya.
²⁵ SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
²⁶ Health Economics and Policy Unit, The Kamuzu University of Health Sciences, Blantyre, Malawi.
²⁷ Department of Non-communicable Diseases, Ministry of Health, Lilongwe, Malawi.
²⁸ Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
²⁹ Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
³⁰ Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, United Kingdom.
³¹ Makerere University Centre for Health and Population Research, Makerere University, Kampala, Uganda.
³² Makerere Lung Institute, Makerere University, Kampala, Uganda.
³³ Department of Family Medicine, The Kamuzu University of Health Sciences, Blantyre, Malawi.
³⁴ Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, United States of America.
³⁵ Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
³⁶ College of Medicine, University of Malawi, Blantyre, Malawi.
³⁷ Island Hospice and Healthcare, Harare, Zimbabwe.
³⁸ Malawi NCD Alliance, Lilongwe, Malawi.
³⁹ Deanery of Clinical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.
⁴⁰ Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
⁴¹ Greater Accra Regional Hospital, Faculty of Family Medicine, Ghana College of Physicians and Surgeons, Accra, Ghana.
⁴² Achikondi Women and Community Friendly Health Services, Lilongwe, Malawi.
⁴³ School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
⁴⁴ International Society of Systems and Complexity Sciences for Health, Waitsfield, VT, United States of America.
⁴⁵ University of the Witwatersrand, Johannesburg, South Africa.

PMID: 39078807
PMCID: PMC11288440
DOI: 10.1371/journal.pgph.0003434

Interdisciplinary perspectives on multimorbidity in Africa: Developing an expanded conceptual model

Justin Dixon et al. PLOS Glob Public Health. 2024.

. 2024 Jul 30;4(7):e0003434.

doi: 10.1371/journal.pgph.0003434. eCollection 2024.

Authors

Affiliations

¹ The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
² Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
³ Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.
⁴ Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
⁵ SHLS Nursing and Midwifery, Teesside University, Middlesborough, United Kingdom.
⁶ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, United Kingdom.
⁷ Faculty of Health Sciences, Department of Medicine and Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa.
⁸ Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.
⁹ College of Social Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom.
¹⁰ Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
¹¹ Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
¹² School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
¹³ UCL Respiratory, University College London, London, United Kingdom.
¹⁴ MRC Unit The Gambia at LSHTM, Banjul, The Gambia.
¹⁵ Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, Durban, South Africa.
¹⁶ School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
¹⁷ Centre for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria.
¹⁸ Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.
¹⁹ South African National Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa.
²⁰ Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
²¹ Kilimanjaro Clinical Research Institute, Moshi, Tanzania.
²² Department of Rehabilitation Sciences, The Kamuzu University of Health Sciences, Blantyre, Malawi.
²³ Department of Physical Medicine and Rehabilitation, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
²⁴ Brain and Mind Institute, Aga Khan University, Nairobi, Kenya.
²⁵ SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
²⁶ Health Economics and Policy Unit, The Kamuzu University of Health Sciences, Blantyre, Malawi.
²⁷ Department of Non-communicable Diseases, Ministry of Health, Lilongwe, Malawi.
²⁸ Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
²⁹ Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
³⁰ Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, United Kingdom.
³¹ Makerere University Centre for Health and Population Research, Makerere University, Kampala, Uganda.
³² Makerere Lung Institute, Makerere University, Kampala, Uganda.
³³ Department of Family Medicine, The Kamuzu University of Health Sciences, Blantyre, Malawi.
³⁴ Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, United States of America.
³⁵ Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
³⁶ College of Medicine, University of Malawi, Blantyre, Malawi.
³⁷ Island Hospice and Healthcare, Harare, Zimbabwe.
³⁸ Malawi NCD Alliance, Lilongwe, Malawi.
³⁹ Deanery of Clinical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.
⁴⁰ Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
⁴¹ Greater Accra Regional Hospital, Faculty of Family Medicine, Ghana College of Physicians and Surgeons, Accra, Ghana.
⁴² Achikondi Women and Community Friendly Health Services, Lilongwe, Malawi.
⁴³ School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
⁴⁴ International Society of Systems and Complexity Sciences for Health, Waitsfield, VT, United States of America.
⁴⁵ University of the Witwatersrand, Johannesburg, South Africa.

PMID: 39078807
PMCID: PMC11288440
DOI: 10.1371/journal.pgph.0003434

Abstract

Multimorbidity is an emerging challenge for health systems globally. It is commonly defined as the co-occurrence of two or more chronic conditions in one person, but its meaning remains a lively area of academic debate, and the utility of the concept beyond high-income settings is uncertain. This article presents the findings from an interdisciplinary research initiative that drew together 60 academic and applied partners working in 10 African countries to answer the questions: how useful is the concept of multimorbidity within Africa? Can the concept be adapted to context to optimise its transformative potentials? During a three-day concept-building workshop, we investigated how the definition of multimorbidity was understood across diverse disciplinary and regional perspectives, evaluated the utility and limitations of existing concepts and definitions, and considered how to build a more context-sensitive, cross-cutting description of multimorbidity. This iterative process was guided by the principles of grounded theory and involved focus- and whole-group discussions during the workshop, thematic coding of workshop discussions, and further post-workshop development and refinement. Three thematic domains emerged from workshop discussions: the current focus of multimorbidity on constituent diseases; the potential for revised concepts to centre the priorities, needs, and social context of people living with multimorbidity (PLWMM); and the need for revised concepts to respond to varied conceptual priorities amongst stakeholders. These themes fed into the development of an expanded conceptual model that centres the catastrophic impacts multimorbidity can have for PLWMM, families and support structures, service providers, and health systems.

Copyright: © 2024 Dixon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

**Fig 1. Regional* and disciplinary expertise represented by workshop participants.**
*Base map produced using R[28] with shape files obtained from the World Bank (https://datacatalog.worldbank.org/search/dataset/0038272/World-Bank-Official-Boundaries) and Humanitarian Data Exchange (for Western Sahara only) (https://data.humdata.org/dataset/cod-ab-esh).

**Fig 2. An expanded conceptual model of multimorbidity.**

See this image and copyright information in PMC

References

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Interdisciplinary perspectives on multimorbidity in Africa: Developing an expanded conceptual model

Affiliations

Interdisciplinary perspectives on multimorbidity in Africa: Developing an expanded conceptual model

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources