Multimorbidity of chronic non-communicable diseases: burden, care provision and outcomes over time among patients attending chronic outpatient medical care in Bahir Dar, Ethiopia—a mixed methods study protocol

• Published in: BMJ open Vol. 11; no. 9; p. e051107
• Main Authors: Eyowas, Fantu Abebe, Schneider, Marguerite, Alemu, Shitaye, Getahun, Fentie Ambaw
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 08.09.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Protocol
• Subjects: Chronic illnesses; Clinical outcomes; Comorbidity; Coronaviruses; COVID-19; Disease; epidemiology; general medicine (see internal medicine); Health care; Health services; Health Services Research; HIV; Human immunodeficiency virus; Mixed methods research; Mortality; Patients; Population; public health; Quality of life; Risk factors; Ethiopia
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-051107

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 qualitative study to explore organisation of care for patients with multimorbidity, and (3) a longitudinal quantitative study to investigate disease progression and patient outcomes over time. A total of 1440 patients (≥40 years) on chronic care follow-up will be enrolled from different facilities for the quantitative studies. The quantitative data will be collected from multiple sources using the KoBo Toolbox software and analysed by STATA V.16. Multiple case study designs will be employed to collect the qualitative data. The qualitative data will be coded and analysed by Open Code software thematically.Ethics and disseminationEthical clearance has been obtained from the College of Medicine and Health Sciences, Bahir Dar University (protocol number 003/2021). Subjects who provide written consent will be recruited in the study. Confidentiality of data will be strictly maintained. Findings will be disseminated through publications in peer-reviewed journals and conference presentations.