The Social Determinants of Multimorbidity in Sub-Saharan Africa: a narrative review
1
Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
2
Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
3
School of Public, University of the Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Sub-Saharan Africa (SSA) is currently experiencing an increase in multimorbidity (MM) prevalence, posing a threat to already strained healthcare systems1. It is vital to identify social determinants of MM to tailor evidence-based interventions for MM and alleviate the strain on healthcare systems2. However, there exists a paucity of SSA specific reviews. This narrative review aims to identify existing knowledge on social determinants of MM in the SSA region.
METHODS:
A review of etiology was carried out3. PubMed, ISI Web of Science, and Scopus were systematically searched for primary studies using pre-defined search terms, including: SSA (population), risk factors (exposure) and MM (outcome). Titles, abstracts, and full texts were independently screened by two reviewers from a pool of four. Data extraction was carried out using an Excel template and data were summarized in a narrative synthesis. The AXIS4 and NOS5 tools were used to assess risk of bias for cross sectional and cohort studies, respectively.
RESULTS:
The initial search yielded 2547 primary publications, 27 of which were eligible for analysis. Increasing age, being divorced/widowed, food insecurity, and family history of noncommunicable diseases (NCDs) were associated with MM while male gender, fruit/vegetable consumption, and receiving a salary were protective against MM. Variables associated with socioeconomic status (SES) showed mixed results across the 27 publications.
CONCLUSIONS:
Primary studies report clear relationships between physical and demographic factors and MM, while socio-economic factors present mixed associations with MM. A seminal study found evidence supporting a theory that developing nations experience a “reversal” in the association between SES and NCD prevalence over time6. This theory may explain our findings as various populations in the SSA region are experiencing different stages of development. These findings provide vital evidence needed to direct programmatic interventions to tackle MM in SSA. These should include both structural and behavioural interventions.
Sub-Saharan Africa (SSA) is currently experiencing an increase in multimorbidity (MM) prevalence, posing a threat to already strained healthcare systems1. It is vital to identify social determinants of MM to tailor evidence-based interventions for MM and alleviate the strain on healthcare systems2. However, there exists a paucity of SSA specific reviews. This narrative review aims to identify existing knowledge on social determinants of MM in the SSA region.
METHODS:
A review of etiology was carried out3. PubMed, ISI Web of Science, and Scopus were systematically searched for primary studies using pre-defined search terms, including: SSA (population), risk factors (exposure) and MM (outcome). Titles, abstracts, and full texts were independently screened by two reviewers from a pool of four. Data extraction was carried out using an Excel template and data were summarized in a narrative synthesis. The AXIS4 and NOS5 tools were used to assess risk of bias for cross sectional and cohort studies, respectively.
RESULTS:
The initial search yielded 2547 primary publications, 27 of which were eligible for analysis. Increasing age, being divorced/widowed, food insecurity, and family history of noncommunicable diseases (NCDs) were associated with MM while male gender, fruit/vegetable consumption, and receiving a salary were protective against MM. Variables associated with socioeconomic status (SES) showed mixed results across the 27 publications.
CONCLUSIONS:
Primary studies report clear relationships between physical and demographic factors and MM, while socio-economic factors present mixed associations with MM. A seminal study found evidence supporting a theory that developing nations experience a “reversal” in the association between SES and NCD prevalence over time6. This theory may explain our findings as various populations in the SSA region are experiencing different stages of development. These findings provide vital evidence needed to direct programmatic interventions to tackle MM in SSA. These should include both structural and behavioural interventions.
| eISSN: | 2654-1459 |
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