Multimorbidity, Treatment, and Determinants among Chronic Patients Attending Primary Health Facilities in Tshwane, South Africa

Abstract

The growing burden of non-communicable diseases amidst the largest burden of HIV in South Africa leads to disease combinations of multimorbidity with the complexity of care. We conducted a cross-sectional study to assess multimorbidity, medication adherence, and associated factors among out-patients with chronic diseases in primary health care (PHC) facilities in Tshwane, South Africa. A structured questionnaire was used to collect data on comorbidities and medication adherence, along with socio-demographic and lifestyle factors. Logistic regression models were used to analyse the determinants of multimorbidity and medication adherence. In all 400 patients with chronic diseases (mean age: 47 ± 12 years) living in poor environments, common chronic conditions were hypertension (62%), diabetes (45%), HIV (44%), TB (33%), hypercholesterolemia (18%), and gout (13%). The proportion of concordant comorbidity (i.e., diseases with similar risk profiles and management) was 72%, more than 28% of discordant comorbidity (i.e., diseases not related in pathogenesis or management). Most patients had two coexisting chronic conditions (75%), while few had more than two chronic conditions (23%) and single-occurring conditions (2%). Prevalence rates for common multimorbidity patterns were 25% (HIV and TB), 17% (hypertension and diabetes), 9% (hypertension, diabetes, and hypercholesterolemia), and 2% (hypertension diabetes and HIV), while medication adherence was estimated at 74%. In multivariate analysis, multimorbidity was associated with an older age and lower socio-economic status, while medication non-adherence was associated with a younger age and socio-economic factors. The study highlights the presence of multimorbidity among primary care patients attributed to hypertension, diabetes, HIV, and TB in South Africa with non-adherence to medication in one-third of patients. Policies are needed for education on multimorbidity with a need to optimize lifestyle modifications, perhaps proactive outreach or nursing contact with high-risk patients with public-health-sensitive conditions, such as HIV and/or TB, as well as patients with a history of non-adherence to medications. Considerations should be given to the development of a medication adherence scale for multiple chronic conditions beyond assessing adherence to a single index medication.

A multilevel analysis of the prevalence and factors associated with multimorbidity in South Africa using 2016 Demographic and Health Survey data

“…This paper provides further evidence that age, obesity, being formerly married and sex are associated with multimorbidity in South Africa (Alaba & Chola, 2013; Mkhwanazi et al, 2023; Weimann et al, 2016). However, surprisingly no associations were identified with health behaviours such as smoking, drinking and dietary health.…”

“…The lowest estimate of multimorbidity prevalence, from the South Africa National Income Dynamic Surveys 2012, utilised only four conditions of which three were self-reported (Weimann et al, 2016). Whilst, in certain groups such as the older, rural, and black population from the HAALSI study and in a survey of chronic patients attending health facilities in Tshwane prevalence of multimorbidity was especially high (70.9% and 98%, respectively) (Mkhwanazi et al, 2023; Wade et al, 2021).…”

Exploring Barriers to Accessing Sexual and Reproductive Health Services among Adolescents and Young People with Physical Disabilities in South Africa

“…In South Africa, a country characterized by a burden of diseases [26,27], AYPWDs remain marginalized in various dimensions of their lives and are less likely to receive sexual and reproductive healthcare. This is despite the country having a progressive and liberal sexual and reproductive health policy framework, with the constitution being clear on equal access to services and opportunities [28,29].…”

The Wellbeing of Healthcare Workers during COVID-19 Era in Public Primary Health Facilities in Johannesburg, South Africa

“…Prior to the COVID-19 era [30], HCWs were already strained psychologically and physically, while the health system of South Africa was already burdened with the convergence of non-communicable diseases (NCDs) such as diabetes, hypertension, and communicable diseases (CDs) such as HIV and TB [40,41]. The pandemic worsened the pre-existing challenges in health service delivery, especially in the public sector [42,43].…”