Understanding Multimorbidity of Older Adults in Niger State North Central Nigeria.

Abstract

Background: Multimorbidity is defined as the co-occurrence of at least two chronic diseases in the same person. With advancing epidemiological and demographic transitions, the burden of multi-morbidity is expected to increase globally, and Nigeria is not an exemption. Overall objectives: The aim of the study was to develop a better understanding of multimorbidity among elderly Nigerians. Methods: A multi-methods (systematic literature review, quantitative and qualitative) survey was conducted. The systematic review was preceded by a designed priori protocol following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the PRISMA Protocols statement. Data for the quantitative, and qualitative were administered on a cross-section of 734 and 12 multimorbid participants selected from 4 secondary hospitals and the communities respectively in Niger state over 5 months. SPSS and NVivo were used to analyze the quantitative and qualitative phases data respectively. Results: The prevalence of multimorbidity in Niger state north central Nigeria was 51.9% with multimorbidity prevalence ranging from 27% to 74% across Nigeria. Chronic disease conditions like hypertension, diabetes, and acid peptic diseases were the commonly occurring clusters of multimorbidity. A positive association between adverse childhood experiences (AECs) and multimorbidity was observed. The study also observed an association between adverse childhood experiences (ACEs) and behavioral risk factors. A Positive moderate association was observed between age and multimorbidity and a negative association was found between multimorbidity and levels of education and income. Using Donabedian’s model of healthcare quality revealed the process component of the model to be the primary component in determining the perceived quality of healthcare services among elderly multimorbid patients in Niger state north central Nigeria. Conclusion: There is a need to recognize ACEs and their consequences as a public health problem in Nigeria and commence the practice of public health surveillance to reduce the occurrence of ACEs and their effects. The prevention of multimorbidity should begin from childhood by preventing ACEs through the creation of a positive setting for both children and families and a system that supports healthy families. Additionally, identifying the common pattern of multimorbidity will provide insight to develop more integrative multidisciplinary preventive and better management approach for multimorbidity. Finally, access to and quality of health care can be improved by improving patient-physician relationships, reducing waiting times for seeing physicians and reducing financial cost of medical treatment. improving the These findings are important to better inform policymakers and related stakeholders, in order to ensure equitable access and improve the health outcomes of multimorbid patients and the overall population’s health. Although the result of this study has the potential to illuminate some of the weaknesses of the current multimorbidity care among the elderly, the sample selection is limited to 4 hospitals and some communities in Niger state, thus the findings cannot be generalized for the country. Nevertheless, the study can be replicated elsewhere in the country to increase its impact.