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Spencer, Stephen 
ORCID: https://orcid.org/0000-0001-8451-7514, Rutta, Alice, Hyuha, Gimbo, Banda, Treighcy, Choko, Augustine, Dark, Paul, Hertz, Julian, Mbaga, Blandina, Mfinanga, Juma, Mijumbi, Rhona, Muula, Adamson, Nyirenda, Mulinda, Laura, Rosu, Rubach, Matthew, Salimu, Sangwani, Sakita, Francis, Salima, Charity, Sawe, Hendry, Simiyu, Ibrahim, Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536, Urasa, Sarah, White, Sarah ORCID: https://orcid.org/0000-0001-5535-8075, Yongolo, Nateiya, Rylance, Jamie, Morton, Ben ORCID: https://orcid.org/0000-0002-6164-2854, Worrall, Eve ORCID: https://orcid.org/0000-0001-9147-3388 and Limbani, Felix
(2024)
'Multimorbidity-associated emergency hospital admissions: a “screen and link” strategy to improve outcomes for high-risk patients in sub-Saharan Africa: a prospective multicentre cohort study protocol'. NIHR Open Research, Vol 4, Issue 2.
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Abstract
Background
The prevalence of multimorbidity (the presence of two or more chronic health conditions) is rapidly increasing in sub–Saharan Africa. Hospital care pathways that focus on single presenting complaints do not address this pressing problem. This has the potential to precipitate frequent hospital readmissions, increase health system and out-of-pocket expenses, and may lead to premature disability and death. We aim to present a description of inpatient multimorbidity in a multicentre prospective cohort study in Malawi and Tanzania.
Primary objectives
Determine prevalence of multimorbid disease among adult medical admissions and measure patient outcomes. Health Economic: Measure economic costs incurred and changes in health-related quality of life (HRQoL) at 90 days post-admission. Situation analysis: Qualitatively describe pathways of patients with multimorbidity through the health system.
Secondary objectives
Determine hospital readmission free survival and markers of disease control 90 days after admission. Health Economic: Present economic costs from patient and health system perspective, sub-analyse costs and HRQoL according to presence of different diseases. Situation analysis: Understand health literacy related to their own diseases and experience of care for patients with multimorbidity and their caregivers.
Methods
This is a prospective longitudinal cohort study of adult (≥18 years) acute medical hospital admissions with nested health economic and situation analysis in four hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Malawi; 3) Hai District Hospital, Boma Ng’ombe, Tanzania; 4) Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Follow-up duration will be 90 days from hospital admission. We will use consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites. We will use point-of-care tests to refine estimates of disease pathology. We will conduct qualitative interviews with patients, caregivers, healthcare providers and policymakers; focus group discussions with patients and caregivers, and observations of hospital care pathways.
| Item Type: | Article |
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| Additional Information: | This article has been updated. The revised protocol manuscript includes changes based on the important feedback included in the reviewer reports. In the introduction, we have provided further explanation regarding the definition of multimorbidity, emphasizing its variability across literature to the context and setting. In this study, our focus lies on diseases that are important to the study population (HIV, hypertension, diabetes, and chronic kidney disease), and which treatment and control can be modifiable within the existing health systems. Our objectives now elaborate on our focus to gather baseline data on these four pre-selected diseases to inform the design of our planned trial. We have also clarified that both self-reported and clinically reported chronic diseases will be documented. In the eligibility criteria, we have detailed our approach to include participants with acute medical diagnoses identified from medical records using ICD codes; and provided justification for the exclusion of participants with trauma, as other research groups are addressing health system interventions for these patients. The analysis section now includes a statement that pre-designed statistical analysis plans will be developed will be published as a component of our reporting. These revisions enhance the clarity and comprehensiveness of our protocol manuscript. New version https://doi.org/10.3310/nihropenres.13512.2 |
| Subjects: | WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > WA 4 Works on general hygiene |
| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department |
| Digital Object Identifer (DOI): | https://doi.org/10.3310/nihropenres.13512.1 |
| Depositing User: | Christy Littlejohn |
| Date Deposited: | 15 Feb 2024 15:44 |
| Last Modified: | 23 Jul 2024 11:04 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/23814 |
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