Multimorbidity in Africa - Increasing Understanding of the Patient Experience and Epidemiology (MAfricaEE)

多发病，即存在2种或2种以上长期疾病（LTC），是一个日益严重的全球健康挑战。多发性硬化症在年轻人和中年人以及老年人中越来越常见，并与对健康结果的不利影响有关。虽然多重死亡在低收入和中等收入国家越来越普遍，但我们对低收入和中等收入国家多重死亡的模式、趋势或决定因素的信息不足。这些信息对于为不同LMIC卫生保健系统的卫生和社会服务规划提供信息至关重要。同样重要的是，医学科学院呼吁在中低收入国家开展研究，包括“研究不同类型多发性硬化症患者的经历和偏好”。与多个LTC一起生活是一项艰苦的工作，需要人们承担越来越多的自我管理工作量，这被称为“治疗负担”。“治疗负担是指人们及其更广泛的支持网络必须承担的工作。它涵盖了各种活动，包括：a）为了解病情所做的工作; B）在卫生和社会护理系统中导航所需的努力; c）实施自我管理的工作，如参加预约和服药;以及d）开展自我监测活动，如检查血糖。在撒哈拉以南非洲（SSA），治疗负担的概念尚待研究。人们科普任何特定水平的治疗负担的能力可能各不相同，这取决于一系列因素，如社会经济地位、卫生知识、语言、教育程度、地点、个人信仰以及身心能力。除了个人或个人资源之外，还必须考虑到个人更广泛的社会支持网络以及保健组织和保健政策的作用。在SSA背景下了解这些概念并增强对患者和从业者面临的挑战的了解将为制定干预措施以改善多发病的管理提供信息。治疗负担和能力问题很重要，因为不堪重负的患者不太可能坚持治疗，导致资源浪费和结果不佳。这项建议解决了重要的证据差距，在撒哈拉以南非洲地区的多morphology研究。我们的项目将涉及3个工作包（WP），并使用来自3个非洲国家（马拉维，冈比亚和乌干达）的数据源。这项工作是由格拉斯哥大学领导的一项合作，该大学在多形态研究方面具有特殊的专业知识，使用数据科学和定性方法，沿着马拉维的合作伙伴，冈比亚和乌干达的MRC单位以及伦敦卫生和热带医学学院。马拉维、乌干达和冈比亚不同数据集的多重死亡率和模式是什么？2.在马拉维、乌干达和冈比亚，人口统计学和生活方式因素与多发性硬化症的流行率和模式之间的横向关系是什么？3.在这3个国家观察到的结果中，有哪些关键的相似性和差异？4.患者对多重情感对自我管理工作的影响以及他们科普自我管理需求的能力有何体验？5.在每个国家，医疗保健专业人员治疗和管理多发性硬化症患者的经验是什么？他们认为提供最佳护理的主要障碍是什么？6.未来研究的主要目标是什么？虽然这项工作主要是探索性的，但它将促进发展一种新的合作，着眼于撒哈拉以南非洲的多形态，并有助于突出该小组计划在未来的资金申请中解决的数据差距和机会。

Multimorbidity, the presence of 2 or more long-term conditions (LTCs), is an increasing global health challenge. Multimorbidity is increasingly common among younger and middle-aged as well as older people and is associated with adverse effects on health outcomes. Although multimorbidity is increasingly common in low and middle-income countries (LMICs), we have insufficient information on patterns, trends or determinants of multimorbidity in LMICs. Such information is crucial to inform health and social service planning across different LMIC health care systems. Equally important is the call by the Academy of Medical Sciences to undertake research that includes "studies of the experiences and preferences of patients with different types of multimorbidity" in LMICs. Living with multiple LTCs is hard work and requires people to assume an increasing workload of self-management, something referred to as 'Treatment Burden.' Treatment burden refers to the work that people and their wider support network have to undertake. It covers a variety of activities ranging from: a) the work done to gain an understanding of conditions; b) the effort needed to navigate health and social care systems; c) the work of operationalising self-management such as attending appointments and taking medicines; and d) undertaking self-monitoring activities, such as checking blood sugars. The concept of treatment burden in those with multimorbidity is yet to be investigated in Sub Saharan Africa (SSA). People can vary in their capacity to cope with any given level of treatment burden depending on a range of factors such as socioeconomic status, health literacy, language, level of educational attainment, location, personal beliefs and physical and mental abilities. As well as personal or individual resources, it is important to consider the role of the persons' wider social support network as well as healthcare organisations and health policy. Gaining an understanding of these concepts in a SSA context and enhancing understanding of the challenges faced by patients and practitioners would inform development of interventions to improve management of multimorbidity. Treatment burden and capacity issues are important as overwhelmed patients are less likely to adhere to therapies, resulting in wasted resources and poor outcomes. This proposal addresses important evidence gaps in multimorbidity research in SSA. Our project will involve 3 work-packages (WPs) and use data sources from 3 African nations (Malawi, Gambia and Uganda). The work represents a collaboration led by the University of Glasgow, which has particular expertise in multimorbidity research, using both data science and qualitative methods, along with partners in Malawi, the MRC Units in Gambia and Uganda and the London School of Hygiene and Tropical MedicineOur project will address the following questions: 1. What is the prevalence and pattern of multimorbidity across different datasets in Malawi, Uganda and Gambia? 2. What is the cross-sectional relationship between demographic and lifestyle factors with prevalence and pattern of multimorbidity in Malawi, Uganda and Gambia?3. What are the key similarities and differences in the observed findings across the 3 countries? 4. What are patients' experiences of the effects of multimorbidity on the work of self-management and their capacity to cope with self-management demands? 5. What are healthcare professionals' experiences of treating and managing patients with multimorbidity in each country and what do they see as the main barriers to optimal care provision?6. What are the key targets for future research?While this work is primarily exploratory, it will promote development of a new collaboration looking at multimorbidity in SSA and serve to highlight data gaps and opportunities that the team plans to address in future funding applications.