Multimorbidity in South Africa: a systematic review of prevalence studies

Roomaney, Rifqah Abeeda; van Wyk, Brian; Turawa, Eunice Bolanle; Pillay-van Wyk, Victoria

OBJECTIVES: To review prevalence studies of multimorbidity in South Africa to identify prevalence estimates, common disease clusters and factors associated with multimorbidity. DESIGN: Systematic review. SETTING: South Africa (general community and healthcare facilities). DATA SOURCES: Articles were retrieved from electronic databases (PubMed, Web of Science, Scopus, CINAHL, Science Direct and JSTOR). ELIGIBILITY CRITERIA: Studies addressing the prevalence of multimorbidity in South Africa were eligible for inclusion. A systematic search was done in various databases up to December 2020. A risk of bias assessment was conducted for each article using a modified checklist. STUDY SELECTION: Two researchers independently screened titles and abstracts; assessed the risk of bias of each study and extracted data. Included studies were described using a narrative synthesis. RESULTS: In total, 1407 titles were retrieved; of which 10 articles were included in the narrative synthesis. Six studies had a low risk of bias and three had a moderate risk of bias. One study was not assessed for risk of bias, because there was no criteria that apply to routine health information systems. Three of the included studies were population-based surveys, four were community-based cohorts and three cross-sectional studies of health facility data. The prevalence of multimorbidity was low to moderate (3%–23%) in studies that included younger people or had a wide range of selected age groups; and moderate to high (30%–87%) in studies of older adults. The common disease clusters were hypertension and diabetes, hypertension and HIV, and TB and HIV. CONCLUSION: All studies indicated that multimorbidity is a norm in South Africa, especially among older adults. Hypertension is the main driver of multimorbidity. Research on multimorbidity in South Africa needs to be strengthened with high-quality study designs. PROSPERO REGISTRATION NUMBER: CRD42020196895.