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. 2022 Feb 22:12:26335565221076254.
doi: 10.1177/26335565221076254. eCollection 2022.

Patterns of comorbidity and multimorbidity among middle-aged and elderly women in peri-urban Tanzania

Laura-Marie Stieglitz  1 , Till Bärnighausen  1 , Germana H Leyna  2 , Patrick Kazonda  3 , Japhet Killewo  2 , Julia K Rohr  4 , Stefan Kohler  1
Affiliations

Patterns of comorbidity and multimorbidity among middle-aged and elderly women in peri-urban Tanzania

Laura-Marie Stieglitz et al. J Multimorb Comorb. .

Abstract

Background: Multimorbidity poses an increasing challenge to health care systems in Sub-Saharan Africa. We studied the extent of multimorbidity and patterns of comorbidity among women aged 40 years or older in a peri-urban area of Dar es Salaam, Tanzania.

Methods: We assessed 15 chronic conditions in 1528 women who participated in a cross-sectional survey that was conducted within the Dar es Salaam Urban Cohort Study (DUCS) from June 2017 to July 2018. Diagnoses of chronic conditions were based on body measurements, weight, blood testing, screening instruments, and self-report.

Results: The five most prevalent chronic conditions and most common comorbidities were hypertension (49.8%, 95% CI 47.2 to 52.3), obesity (39.9%, 95% CI 37.3 to 42.4), anemia (36.9%, 95% CI 33.3 to 40.5), signs of depression (32.5%, 95% CI 30.2 to 34.9), and diabetes (30.9%, 95% CI 27.6 to 34.2). The estimated prevalence of multimorbidity (2+ chronic conditions) was 73.8% (95% CI 71.2 to 76.3). Women aged 70 years or older were 4.1 (95% CI 1.5 to 10.9) times mores likely to be affected by multimorbidity and had 0.7 (95% CI 0.3 to 1.2) more chronic conditions than women aged 40 to 44 years. Worse childhood health, being widowed, not working, and higher food insecurity in the household were also associated with a higher multimorbidity risk and level.

Conclusion: A high prevalence of multimorbidity in the general population of middle-aged and elderly women suggests substantial need for multimorbidity care in Tanzania. Comorbidity patterns can guide multimorbidity screening and help identify health care and prevention needs.

Keywords: Sub-Saharan Africa; chronic morbidity; infectious diseases; mental health; multiple chronic conditions; older women; physical health; urbanicity.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Comorbidity patterns among middle-aged and elderly women in peri-urban Tanzania. N = 1528 after multiple imputation of missing data. Off-diagonal values represent the conditional prevalence of a comorbidity given the presence of the index condition. Top-left to bottom-right diagonal values represent the unconditional prevalence of the chronic condition. Comorbidity patterns by age-group are provided in Supplementary Figure S1. Data with 95% confidence intervals are provided in Supplementary Table S2.
Figure 2.
Figure 2.
Extent of multimorbidity among middle-aged and elderly women in peri-urban Tanzania. (a) Number of chronic conditions. (b) Number of affected health areas. N = 1528 after multiple imputation of missing data. Red areas indicate (a) multimorbidity, that is, being affected by 2+ chronic conditions, and (b) discordant multimorbidity, that is, chronic conditions in 2+ health areas. Data is provided in Supplementary Tables S3(a)–(b).
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