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

• Published in: Bulletin of the World Health Organization Vol. 101; no. 9; pp. 558 - 570G
• Main Authors: Spencer, Stephen A, Rylance, Jamie, Quint, Jennifer K, Gordon, Stephen B, Dark, Paul, Morton, Ben
• Format: Journal Article
• Language: English
• Published: Geneva World Health Organization 01.09.2023
• Subjects: Acute services; Adults; Chronic conditions; Chronic illnesses; Comorbidity; Confidence intervals; Congestive heart failure; Diabetes; Diabetes mellitus; Disease; Emergency medical care; Emergency medical services; Emergency services; Global health; Health care access; Heart failure; Heterogeneity; HIV; Hospitalization; Hospitals; Human immunodeficiency virus; Hypertension; Immune system; Inpatient care; Kidney diseases; Life expectancy; Meta-analysis; Patient admissions; Patients; Prevalence; Primary care; Public health; Sensitivity analysis; Services; Statistical analysis; Statistics; Stroke; Systematic review; Systematic Reviews; Waivers; Sub-Saharan Africa; Africa
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.22.289597

Objective To estimate the prevalence of individual chronic conditions and multimorbidity among adults admitted to hospital in countries in sub-Saharan Africa.Methods We systematically searched MEDLINE8, Embase8, 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 P 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 376676 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 (24.4%; 95% CI: 16.7-34.2); diabetes (11.9%; 95% CI: 9.9-14.3); 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 well-being.