Acute multimorbid hospital presentations and breathlessness in sub-Saharan Africa

With increasing life expectancy, the number of patients with more than one chronic condition (multimorbidity) is increasing globally. Under-diagnosis and under-treatment of multimorbidity leads to frequent hospital admission and premature mortality.

However, to date, no studies have investigated the prevalence or outcomes of multimorbidity in hospitals in sub-Saharan Africa (sSA).

My PhD objectives address this research gap: 1) Define which chronic diseases are most common in patients admitted to hospital in sSA, using a systematic search of the scientific literature. 2) Determine the prevalence of multimorbidity and whether multimorbid conditions group together in specific clusters.

This will be achieved through developing statistical models and working within the NIHR-funded MultiLink cohort study team researching multimorbidity in Malawi and Tanzania. These findings will inform the design of an acute care pathway intervention to diagnose and treat multimorbidity.

Targets for further investigation for my PhD will be delineating causes of acute breathlessness, which is a common clinical presentation.

In sSA, limited access to diagnostic equipment and expertise impedes clinician ability to differentiate between conditions, and therefore initiate appropriate treatment.

My third objective is: 3) Describe the causes of acute breathlessness, and assess whether context appropriate clinical and biochemical tools can differentiate between causes.