Multimorbidity of non-communicable diseases in low-income and middle-income countries: a systematic review and meta-analysis
Open accessAbstract
Introduction: Multimorbidity is a major public health challenge, with a rising prevalence in low/middle-income countries (LMICs). This review aims to systematically synthesise evidence on the prevalence, patterns and factors associated with multimorbidity of non-communicable diseases (NCDs) among adults residing in LMICs. Methods: We conducted a systematic review and meta-analysis of articles reporting prevalence, determinants, patterns of multimorbidity of NCDs among adults aged >18 years in LMICs. For the PROSPERO registered review, we searched PubMed, EMBASE and Cochrane libraries for articles published from 2009 till 30 May 2020. Studies were included if they reported original research on multimorbidity of NCDs among adults in LMICs. Results: The systematic search yielded 3272 articles; 39 articles were included, with a total of 1 220 309 participants. Most studies used self-reported data from health surveys. There was a large variation in the prevalence of multimorbidity; 0.7%–81.3% with a pooled prevalence of 36.4% (95% CI 32.2% to 40.6%). Prevalence of multimorbidity increased with age, and random effect meta-analyses showed that female sex, OR (95% CI): 1.48, 1.33 to 1.64, being well-off, 1.35 (1.02 to 1.80), and urban residence, 1.10 (1.01 to 1.20), respectively were associated with higher odds of NCD multimorbidity. The most common multimorbidity patterns included cardiometabolic and cardiorespiratory conditions. Conclusion: Multimorbidity of NCDs is an important problem in LMICs with higher prevalence among the aged, women, people who are well-off and urban dwellers. There is the need for longitudinal data to access the true direction of multimorbidity and its determinants, establish causation and identify how trends and patterns change over time. PROSPERO registration number: CRD42019133453.
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As wearable device costs continue to fall, fitness trackers may become a scalable and cost-effective option for disease prevention in LMICs.
“As wearable device costs continue to fall, fitness trackers may become a scalable and cost-effective option for disease prevention in LMICs, where the burden of non-communicable diseases such as diabetes is growing rapidly [61].”
From Economic evaluation of wearable fitness trackers versus metformin for preventing type 2 diabetes in the UK population (2025) · cites this paper as [61]
The burden of non-communicable diseases such as diabetes is growing rapidly in LMICs.
“where the burden of non-communicable diseases such as diabetes is growing rapidly [61]”
From Economic evaluation of wearable fitness trackers versus metformin for preventing type 2 diabetes in the UK population (2025) · cites this paper as [61]
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- Authors
- Asogwa, O. A., Boateng, D., Marzà-Florensa, A., Peters, S., Levitt, N., van Olmen, J., & Klipstein-Grobusch, K.
- Affiliations
- University Medical Center Utrecht (NL)
- Kwame Nkrumah University of Science and Technology (GH)
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
- The George Institute for Global Health (GB)
- University of Cape Town (ZA)
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, Belgium
- Corresponding author
- Boateng, Daniel
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2022-01
- Volume
- 12
- Issue
- 1
- Pages
- e049133
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC8785179
- OpenAlex
- W4206905511
- Cited by
- 221
- References
- 84
- Citations by year
- 2026: 47 · 2025: 52 · 2024: 55 · 2023: 48 · 2022: 19
- FWCI
- 6.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- multimorbidity, non-communicable diseases, low- and middle-income countries, prevalence, risk factors, cardiometabolic disease, cardiorespiratory conditions, sex differences, urban residence, socioeconomic status, age
- MeSH terms
- Noncommunicable Diseases, Multimorbidity, Adolescent, Adult, Developing Countries, Female, Humans, Income, Poverty, Prevalence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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