Epidemiology of multimorbidity in conditions of extreme poverty: a population-based study of older adults in rural Burkina Faso

Abstract

IntroductionMultimorbidity is a health issue of increasing importance worldwide, and is likely to become particularly problematic in low-income countries (LICs) as they undergo economic, demographic and epidemiological transitions. Knowledge of the burden and consequences of multimorbidity in LICs is needed to inform appropriate interventions.MethodsA cross-sectional household survey collected data on morbidities and frailty, disability, quality of life and physical performance on individuals aged over 40 years of age living in the Nouna Health and Demographic Surveillance System area in northwestern Burkina Faso. We defined multimorbidity as the occurrence of two or more conditions, and evaluated the prevalence of and whether this was concordant (conditions in the same morbidity domain of communicable, non-communicable diseases (NCDs) or mental health (MH)) or discordant (conditions in different morbidity domains) multimorbidity. Finally, we fitted multivariable regression models to determine associated factors and consequences of multimorbidity.ResultsMultimorbidity was present in 22.8 (95% CI, 21.4 to 24.2) of the study population; it was more common in females, those who are older, single, more educated, and wealthier. We found a similar prevalence of discordant 11.1 (95% CI, 10.1 to 12.2) and concordant multimorbidity 11.7 (95% CI, 10.6 to 12.8). After controlling for age, sex, marital status, education, and wealth, an increasing number of conditions was strongly associated with frailty, disability, low quality of life, and poor physical performance. We found no difference in the association between concordant and discordant multimorbidity and outcomes, however people who were multimorbid with NCDs alone had better outcomes than those with multimorbidity with NCDs and MH disorders or MH multimorbidity alone.ConclusionsMultimorbidity is prevalent in this poor, rural population and is associated with markers of decreased physical performance and quality of life. Preventative and management interventions are needed to ensure that health systems can deal with increasing multimorbidity and its downstream consequences.

Depressive symptoms and cardiovascular disease: a population-based study of older adults in rural Burkina Faso

“… 47 According to a recent study conducted in the same HDSS as this study, multimorbidity is highly prevalent in this sample. 48 Whether experiencing other non-communicable diseases in addition to CVD—for instance cancer, chronic obstructive pulminary disorder (COPD), musculoskeletal disorders and other mental illnesses—has an effect on the relationship between depressive symptoms and CVD has not been examined and could be subject to further investigations. Use of antidepressants is linked to a higher risk of obesity, diabetes and CVD 49 and could thus act as a confounding factor in studies in HIC investigating the association between depressive symptoms and cardiometabolic risk.…”

Prevalence and socio-demographic associations of diet and physical activity risk-factors for cardiovascular disease in Bo, Sierra Leone

“…Multivariable logistic regression models were fitted using forced entry with covariables selected based on their known relationship with the dependent variables [24][25][26][27][28]. P-values less than 0.05 were considered to indicate statistical significance.…”

Estimating the burden of cardiovascular risk in community dwellers over 40 years old in South Africa, Kenya, Burkina Faso and Ghana

“…It is possible that certain known CVD risk factors confer different levels of risk, depending on context and underlying genetics. 41 42 However, there is a paucity of research on this topic on the African continent that hopefully studies like AWI-Gen, the CRSN Heidelberg Aging Study 43 and the Health and Aging in Africa: A Longitudinal Study in an INDEPTH community 12 44 can begin to address.…”