Use of hospital services by patients with chronic conditions in sub-Saharan Africa: a systematic review and meta-analysis

Spencer, Stephen ORCID: https://orcid.org/0000-0001-8451-7514, Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611, Quint, Jennifer. K, Gordon, Stephen, Dark, Paul and Morton, Ben ORCID: https://orcid.org/0000-0002-6164-2854 (2023) 'Use of hospital services by patients with chronic conditions in sub-Saharan Africa: a systematic review and meta-analysis'. Bulletin of the World Health Organization, Vol 101, Issue 9, pp. 558-570.

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Abstract

Objective
To estimate the prevalence of individual chronic conditions and multimorbidity among adults admitted to hospital in sub–Saharan Africa.

Methods
We systematically searched MEDLINE®, Embase®, Global Index Medicus, Global Health and SciELO for publications reporting on patient cohorts recruited between 1 January 2010 and 12 May 2023. We included articles reporting prevalence of pre-specified chronic diseases within unselected acute care services (emergency departments or medical inpatient settings). No language restrictions were applied. We generated prevalence estimates using random-effects meta-analysis alongside 95% confidence intervals, 95% prediction intervals and I2 statistics for heterogeneity. To explore associations with age, sex, country-level income status, geographical region and risk of bias, we conducted pre-specified meta-regression, sub-group and sensitivity analyses.

Findings
Of 6976 identified studies, 61 met the inclusion criteria, comprising data from 20 countries and 376 676 people. None directly reported multimorbidity, but instead reported prevalence for individual conditions. Among medical admissions, the highest prevalence was: human immunodeficiency virus infection (36.4%; 95% CI: 31.3–41.8), hypertension (24.7%; 95% CI: 17.4–33.7), diabetes (11.9%; 95% CI: 9.914.3), heart failure (8.2%; 95% CI: 5.6–11.9), chronic kidney disease (7.7%; 95% CI: 3.9–14.7) and stroke (6.8%; 95% CI: 4.7–9.6).

Conclusion
Among patients seeking hospital care in sub-Saharan Africa, multimorbidity remains poorly described despite high burdens of individual chronic diseases. Prospective public health studies of multimorbidity burden are needed to generate integrated and context specific health system interventions that act to maximize patient survival and wellbeing.

Item Type:	Article
Subjects:	WT Geriatrics. Chronic Disease > Chronic Disease > WT 500 General works
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.2471/BLT.22.289597
Depositing User:	Rachel Dominguez
Date Deposited:	19 Sep 2023 08:40
Last Modified:	19 Sep 2023 08:50
URI:	https://archive.lstmed.ac.uk/id/eprint/22979

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