ArticleThe Lancet. Global health2025
The burden of multimorbidity-associated acute hospital admissions in Malawi and Tanzania: a prospective multicentre cohort study.
Article in The Lancet. Global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Cause of Death and Risk of Death for People Living With HIV Admitted to Hospital: A Systematic Review and Meta-Analysis.Journal of the International AIDS Society · 2026Pooled it
- Joint effects of depression, lipid metabolic dysfunction, and their trajectories on incident cardiometabolic multimorbidity: a prospective multi-cohort analysis from two national cohorts.Lipids in health and disease · 2026Article
- Article
- One-year follow-up of survival and health-related quality of life in patients with medical conditions admitted acutely to hospital in Malawi and Tanzania.Anaesthesia · 2026Article
- The association between disease status and health-related quality of life: evidence from a cross-sectional survey across mainland China.Health and quality of life outcomes · 2026Article
- Pathways of health care for people living with multimorbidity in two Southern African countries.PloS one · 2026Article
- An exploratory study of context and factors shaping policies for integrated management of multimorbidity in Malawi.Health research policy and systems · 2025Article
- Socioeconomic inequalities, substance use, and chronic multimorbidity in Kiambu and Nakuru counties in Kenya.PLOS global public health · 2025Article
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28 authors.
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Abstract
backgroundThe global burden of multimorbidity-the coexistence of two or more long-term conditions-is increasing. Limited access to primary care in sub-Saharan Africa means acute hospital admission is often the sentinel multimorbidity presentation. This prospective multicentre cohort study aimed to describe the burden, constituent diseases, and outcomes of multimorbidity among patients acutely admitted to hospital in Malawi and Tanzania.
methodsAdults (ie, those aged ≥18 years) admitted to four hospitals (two tertiary and two district hospitals) with acute medical conditions were consecutively recruited within 24 h of presentation and followed up for 90 days. We estimated the prevalence of HIV infection, diabetes, hypertension, and chronic kidney disease using commercially available point-of-care tests, and captured self-reported and clinical diagnoses (n/N [%]). Health economic data were summarised by median and IQR and modelled using generalised linear models. All-cause 90-day mortality was summarised with Kalplan-Meier plots and analysed using Cox regression models.
findings1407 adults (657 [46·7%] were female and 750 [53·3%] were male; mean age was 52·3 years [SD 18·4]) were recruited. We examined multimorbidity prevalence in 1007 participants admitted to three hospitals that accept admissions directly from the community. Multimorbidity was found in 473 (47·0%) of 1007 participants and 292 (29·0%) had a single long-term condition. Outcomes at 90 days were determined for 1317 (93·6%) of 1407 participants. Adjusted 90-day mortality was higher in participants with multimorbidity (335 [41·7%] of 804; hazard ratio 1·5 [95% CI 1·1-2·1]) and those with one long-term condition (80 [28·3%] of 283; 1·5 [1·0-2·1]); compared with those with no long-term conditions (31 [13·5%] of 230). Health-related quality of life was lower in participants with multimorbidity compared with those with one long-term condition (median 0·402 [IQR -0·037 to 0·644] vs 0·557 [0·140 to 0·730]; p=0·005) at baseline, and at final observation (0·858 [0·667 to 1·00] vs 1·00 [0·589 to 1·00] respectively; p=0·01). In Tanzania, medical costs incurred by patients were higher in participants with multimorbidity compared with those with one long-term condition (relative effect 5·77 [95% CI 2·99-11·15]; p<0·0001).
interpretationMultimorbidity is common in patients admitted to hospital in Malawi and Tanzania and associated with worse survival and increased cost. Multimorbidity is an urgent public health threat that requires fundamental health-care delivery reform to address population needs.
fundingNational Institute for Health and Care Research and Wellcome Trust. TRANSLATIONS: For the Chichewa and Kiswahili translations of the abstract see Supplementary Materials section.
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