Self-management of multimorbidity in sub-Saharan Africa: a systematic review and meta-synthesis with focus on diabetes, hypertension, chronic kidney disease and HIV infection

BackgroundThe increasing prevalence of multimorbidity in sub-Saharan Africa (SSA) is an urgent concern for health systems delivery. It is uncertain how best to promote self-management approaches or the actions that patients and carers take to maintain physical and mental health, in this context. This review aims to identify, critically appraise, and synthesize qualitative evidence that describes self-management of multimorbidity among patients and their carers in SSA. MethodsWe systematically searched PubMed, MEDLINE, CINAHL Global Health, Google Scholar and grey literature for studies on self-management of multimorbidity or common individual chronic diseases (HIV, diabetes, hypertension or chronic kidney disease) in SSA published between 1 January 2000 and 28 to 15th September 2024. Using qualitative meta-synthesis techniques to formulate the questions and synthesize findings. We used a 10-point Critical Appraisal Skills Program (CASP)-Qualitative-Checklist to assess the quality of the studies and NVivo 12 software to facilitate a thematic analysis approach. ResultsWe screened 2010 articles for inclusion and 20 studies met inclusion criteria. We identified themes related to medical, diet, emotional and physical self-management activities. Patients negotiate self-management based on immediacy of needs and available family support. Patients are motivated to apply biomedical management but are limited by factors such as drug stock-outs and out-of-pocket expenditure. Limited knowledge and low self-efficacy toward self-management of multimorbidity impact decision making and problem solving. We found that diabetes mellitus presents the biggest stressor in terms of burden of treatment; temporal discontinuation of medications is more prevalent amongst patients with hypertension; and patients with multimorbidity are frequently hypervigilant about their health, more likely to suffer from stress and to seek healthcare. ConclusionsWe found that there is relative lack of data on self-management of multimorbidity among patients and their carers in SSA. Where data exists, we observed significant health literacy gaps, low health literacy support and limited self-efficacy as barriers to implementation of self-management. Context sensitive programmes are required to improve health literacy to increase patient autonomy and their toolkit of options to manage chronic disease.