Kaluvu Lucy, Asogwa Ogechukwu Augustina, Marzà-Florensa Anna, Kyobutungi Catherine, Levitt Naomi S, Boateng Daniel, Klipstein-Grobusch Kerstin
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK.
J Multimorb Comorb. 2022 Sep 1;12:26335565221112593. doi: 10.1177/26335565221112593. eCollection 2022 Jan-Dec.
The aim of this systematic review is to analyse existing evidence on prevalence, patterns, determinants, and healthcare challenges of communicable and non-communicable disease multimorbidity in low- and middle-income countries (LMICs).
PubMed, Cochrane, and Embase databases were searched from 1 January 2000 to 31 July 2020. The National Institute of Health (NIH) quality assessment tool was used to critically appraise studies. Findings were summarized in a narrative synthesis. The review was registered with PROSPERO (CRD42019133453).
Of 3718 articles screened, 79 articles underwent a full text review of which 11 were included for narrative synthesis. Studies reported on 4 to 20 chronic communicable and non-communicable diseases; prevalence of multimorbidity ranged from 13% in a study conducted among 242,952 participants from 48 LMICS to 87% in a study conducted among 491 participants in South Africa. Multimorbidity was positively associated with older age, female sex, unemployment, and physical inactivity. Significantly higher odds of multimorbidity were noted among obese participants (OR 2.33; 95% CI: 2.19-2.48) and those who consumed alcohol (OR 1.44; 95% CI: 1.25-1.66). The most frequently occurring dyads and triads were HIV and hypertension (23.3%) and HIV, hypertension, and diabetes (63%), respectively. Women and participants from low wealth quintiles reported higher utilization of public healthcare facilities.
The identification and prevention of risk factors and addressing evidence gaps in multimorbidity clustering is crucial to address the increasing communicable and non-communicable disease multimorbidity in LMICs. To identify communicable and non-communicable diseases trends over time and identify causal relationships, longitudinal studies are warranted.
本系统评价旨在分析低收入和中等收入国家（LMICs）中传染病和非传染病共病的患病率、模式、决定因素及医疗挑战方面的现有证据。
检索了2000年1月1日至2020年7月31日期间的PubMed、Cochrane和Embase数据库。使用美国国立卫生研究院（NIH）质量评估工具对研究进行严格评价。研究结果通过叙述性综合进行总结。该评价已在国际系统评价注册库（PROSPERO）注册（注册号：CRD42019133453）。
在筛选的3718篇文章中，79篇进行了全文审查，其中11篇纳入叙述性综合分析。研究报告了4至20种慢性传染病和非传染病；共病患病率在一项针对来自48个低收入和中等收入国家的242,952名参与者的研究中为13%，在一项针对南非491名参与者的研究中为87%。共病与年龄较大、女性、失业和缺乏身体活动呈正相关。肥胖参与者（比值比[OR] 2.33；95%置信区间[CI]：2.19 - 2.48）和饮酒者（OR 1.44；95% CI：1.25 - 1.66）的共病几率显著更高。最常见的二元组和三元组分别是艾滋病毒和高血压（23.3%）以及艾滋病毒、高血压和糖尿病（63%）。来自低财富五分位数的女性和参与者报告使用公共医疗设施的比例更高。
识别和预防风险因素以及解决共病聚集方面的证据空白对于应对低收入和中等收入国家日益增加的传染病和非传染病共病至关重要。为了确定传染病和非传染病随时间的趋势并确定因果关系，有必要开展纵向研究。
