The Association Between Multimorbidity and Health-Related Quality of Life Among Clients Attending Chronic Outpatient Medical Care in Bahir Dar, Northwest Ethiopia: The Application of Partial Proportional Odds Model (original) (raw)
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BMJ Open
IntroductionMultimorbidity refers to the presence of two or more chronic non-communicable diseases (NCDs) in a given individual. It is associated with premature mortality, lower quality of life (QoL) and greater use of healthcare resources. The burden of multimorbidity could be huge in the low and middle-income countries (LMICs), including Ethiopia. However, there is limited evidence on the magnitude of multimorbidity, associated risk factors and its effect on QoL and functionality. In addition, the evidence base on the way health systems are organised to manage patients with multimorbidity is sparse. The knowledge gleaned from this study could have a timely and significant impact on the prevention, management and survival of patients with NCD multimorbidity in Ethiopia and in LMICs at large.Methods and analysisThis study has three phases: (1) a cross-sectional quantitative study to determine the magnitude of NCD multimorbidity and its effect on QoL and functionality, (2) a qualitat...
Frontiers in Medicine
BackgroundMultimorbidity is becoming more prevalent in low-and middle-income countries (LMICs). However, the evidence base on the burden and its longitudinal outcomes are limited. This study aimed to determine the longitudinal outcomes of patients with multimorbidity among a sample of individuals attending chronic outpatient non communicable diseases (NCDs) care in Bahir Dar, northwest Ethiopia.MethodsA facility-based longitudinal study was conducted among 1,123 participants aged 40+ attending care for single NCD (n = 491) or multimorbidity (n = 633). Data were collected both at baseline and after 1 year through standardized interviews and record reviews. Data were analyzed using Stata V.16. Descriptive statistics and longitudinal panel data analyzes were run to describe independent variables and identify factors predicting outcomes. Statistical significance was considered at p-value <0.05.ResultsThe magnitude of multimorbidity has increased from 54.8% at baseline to 56.8% at 1 y...
2021
Objective This study aimed to investigate the magnitude, pattern and associated factors of multimorbidity in Bahir Dar, Ethiopia. Methods A multi-centered facility based study was conducted among 1440 participants aged 40+ years attending chronic outpatient medical care. Two complimentary methods (interview and review of medical records) were employed to collect the data on socio-demographic, behavioral and disease related characteristics. The data were analyzed by STATA V.16 and R Software V.4.1.0. We run descriptive statistics and fitted logistic regression and latent class analyses (LCA) models to determine associated factors and patterns of multimorbidity. Statistical significance was considered at p-value ,<=0.05. Results The magnitude of individual chronic conditions ranged from 1.4% to 37.9%, and multimorbidity was identified in 54.8% (95% CI=52.2%-57.4%) of the sample. The likelihood of developing multimorbidity was higher among participants aged from 45-54 years (AOR: 1....
BMC Health Services Research
Background Multimorbidity-the simultaneous occurrence of two or more chronic Non-Communicable Diseases) in an individual is increasing globally and challenging health systems. Although individuals living with multimorbidity face a range of adverse consequences and difficulty in getting optimal health care, the evidence base in understanding the burden and capacity of the health system in managing multimorbidity is sparse in low-and middle-income countries (LMICs). This study aimed at understanding the lived experiences of patients with multimorbidity and perspective of service providers on multimorbidity and its care provision, and perceived capacity of the health system for managing multimorbidity in Bahir Dar City, northwest Ethiopia. Methods A facility-based phenomenological study design was conducted in three public and three private health facilities rendering chronic outpatient Non-Communicable Diseases (NCDs) care in Bahir Dar City, Ethiopia. Nineteen patient participants wit...
Multimorbidity of chronic diseases among adult patients presenting to an inner-city clinic in Ghana
Globalization and Health, 2013
Background: Very little is known about multimorbidity and chronic diseases in low and middle income countries, particularly Sub-Saharan Africa, and more information is needed to guide the process of adapting the health systems in these countries to respond adequately to the increasing burden of chronic diseases. We conducted a hospital-based survey in an urban setting in Ghana to determine the prevalence of multimorbidity and its associated risk factors among adult patients presenting to an inner city clinic. Methods: Between May and June 2012, we interviewed adult patients (aged 18 years and above) attending a routine outpatient clinic at an inner-city hospital in Accra using a structured questionnaire. We supplemented the information obtained from the interviews with information obtained from respondents' health records. We used logistic regression analyses to explore the risk factors for multimorbidity.
BMJ Open, 2019
IntroductionMultimorbidity is the coexistence of two or more chronic non-communicable diseases (NCDs) in a given individual. Multimorbidity is increasing in low- and middle-income countries (LMICs) and challenging health systems. Individuals with multimorbidity are facing the risk of premature mortality, lower quality of life and greater use of healthcare services. However, despite the huge challenge multimorbidity brings in LMICs, gaps remain in mapping and synthesising the available knowledge on the issue. The focus of this scoping review will be to synthesise the extent, range and nature of studies on the epidemiology and models of multimorbidity care in LMICs.MethodsPubMed (MEDLINE) will be the main database to be searched. For articles that are not indexed in the PubMed, Scopus, PsycINFO and Cochrane databases will be searched. Grey literature databases will also be explored. There will be no restrictions on study setting or year of publication. Articles will be searched using ...
Ethiopian Journal of Health Sciences, 2011
BACKGROUND: Chronic Non-Communicable Diseases are among the major causes of morbidity and mortality worldwide. However, access to and quality of health care for patients is very low in developing countries including Ethiopia. Hospitals and Health Centers are the main sources of health care for such patients in Ethiopia. In this study we assessed the quality of care patients with Chronic Non-Communicable Diseases received in hospital and health center setups. METHODS: A retrospective multi-setup study was conducted in Jimma University Specialized Hospital and four Health Centers in Jimma Zone from February to March 2010. A total of 52 process indicators of quality covering three disease conditions: Diabetes, Hypertension and Epilepsy were measured by reviewing randomly selected medical records. Quality of care was measured as a proportion of recommended components of care actually provided to patients. And also outcome and structural measures were assessed to supplement process measures of quality. RESULTS: Six hundred seventy four medical records were reviewed. Recommended care components were actually provided to patients in 35.1% (95%CI:34.1%,36.0%), 38.5% (95%CI:37.5%,39.5%) and 60.1% (95%CI:59.3%,61.0%) of times on which patients were eligible, among patients with Diabetes, Hypertension and Epilepsy, respectively. After case mix adjustment, it was found that 45.9% (95%CI:45.4%,46.5%) of recommended components of care was actually provided to patients. This was 45.1% (95%CI:44.4%,45.8%) in the hospital and 30.5% (95%CI:29.7%,31.3%) in the health centers. Among patients for whom outcome data was available, optimal level of disease control was achieved only for 47 (30.5%), 40(38.5%) and 193 (52.9%) of patients with Diabetes, Hypertension and Epilepsy, respectively. CONCLUSION: The quality of care provided to patients with Chronic Non-Communicable Diseases is very low in both settings though it is relatively better in Jimma University Specialized Hospital. Therefore, a continuous process of quality improvement is recommended in both settings.
Quality of Life Research
Purpose The aim of this study was to investigate treatment burden and its relationship with health-related quality of life (HRQoL) among patients with multimorbidity (two or more chronic diseases) who were taking prescription medications and attending the outpatient department of the University of Gondar Comprehensive Specialized Teaching Hospital. Methods A cross-sectional study was conducted between March 2019 and July 2019. Treatment burden was measured using the Multimorbidity Treatment Burden Questionnaire (MTBQ), while HRQoL was captured using the Euroqol-5-dimensions-5-Levels (EQ-5D-5L). Results A total of 423 patients participated in the study. The mean global MTBQ, EQ-5D index, and EQ-VAS scores were 39.35 (± 22.16), 0.83 (± 0.20), and 67.32 (± 18.51), respectively. Significant differences were observed in the mean EQ-5D-Index (F [2, 81.88] 33.1) and EQ-VAS (visual analogue scale) scores (F [2, 75.48] = 72.87) among the treatment burden groups. Follow up post-hoc analyses d...
Public Health, 2018
Objective: The objective was to analyze possible inequalities by gender in the utilization of health services (general practitioner [GP] and hospital), among people with noncommunicable diseases (NCDs) in the Republic of Serbia, with special reference to multimorbidity. In addition, we examined the prevalence patterns of NCDs by sociodemographic characteristics of the population. Study design: This study is a population-based, cross-sectional survey. Methods: A secondary analysis from the 2013 Serbian National Health Survey included 13,765 adults aged 20 years. Multivariable logistic and linear regression analyses were performed to assess the association between NCDs and health care utilization. Results: Multimorbidity was present in 30.2% of the total sample. An increased number of NCDs was associated with a higher utilization of both primary (odds ratio [OR] for having any GP visit is 3.17 in males and 3.14 in females; unstandardized coefficient [B] for number of GP visits is 0.33 for both gender) and secondary health care services (OR for having any hospitalization is 2.45 in males and 1.97 in females; B for number of overnight stays in hospital is 1.62 in males and 0.97 in females) in Serbia. Conclusions: Our study provided strong evidence that an increased number of NCDs was significantly associated with a higher utilization of health care services in Serbia. There is a need for wise, decisive, and integrated care interventions for effective management of NCDs and their risk factors. Further research is necessary with special emphasis on the role of the health system in satisfying needs of such patients.
PLOS ONE, 2017
Multimorbidity is increasingly the primary concern of healthcare systems globally with substantial implications for patient outcomes and resource cost. A critical knowledge gap exists as to the magnitude of multimorbidity in primary care practice in low and middle income countries with available information limited to prevalence. In India, primary care forms the bulk of the health care delivery being provided through both public (community health center) and private general practice setting. We undertook a study to identify multimorbidity patterns and relate these patterns to severity among primary care attendees in Odisha state of India. A total of 1649 patients attending 40 primary care facilities were interviewed using a structured multimorbidity assessment questionnaire. Multimorbidity patterns (dyad and triad) were identified for 21 chronic conditions, functional limitation was assessed as a proxy measure of severity and the mean severity score for each pattern, was determined after adjusting for age. The leading dyads in younger age group i.e. 18-29 years were acid peptic disease with arthritis/ chronic back ache/tuberculosis /chronic lung disease, while older age groups had more frequent combinations of hypertension + arthritis/ chronic lung disease/ vision difficulty, and arthritis + chronic back ache. The triad of acid peptic disease + arthritis + chronic backache was common in men in all age groups. Tuberculosis and lung diseases were associated with significantly higher age-adjusted mean severity score (poorer functional ability). Among men, arthritis, chronic backache, chronic lung disease and vision impairment were observed to have highest severity) whereas women reported higher severity for combinations of hypertension, chronic back ache and arthritis. Given the paucity of studies on multimorbidity patterns in low and middle income countries, future studies should seek to assess the reproducibility of our findings in other populations and settings. Another task is the potential implications of different multimorbidity clusters for designing care protocols, as currently the protocols are disease specific, hardly taking comorbidity into account.