Stephen Spencer

Self-management of chronic conditions including multimorbidity in sub-Saharan Africa: A systematic and meta-synthesis review with focus on diabetes, hypertension, chronic kidney disease, and HIV The increasing prevalence of multimorbidity in sub-Saharan Africa (SSA) is an urgent concern for health service delivery, yet little is known about how best to support self-management- the tasks patie...

Congratulations to Sangwani Salimu on publication of the first paper from her PhD thesis with support from
@lstmlibrary.bsky.social . She's also successfully submitted her thesis for examination @lstmnews.bsky.social - looking forward to a positive outcome!

journals.plos.org/globalpublic...

Breathlessness increases long-term mortality risk, Malawi study finds Research led by Liverpool School of Tropical Medicine and the Malawi-Liverpool-Wellcome Programme shows that over half of hospital patients with breathlessness had died within a year of admission

New research shows that people in Malawi admitted to hospital with breathlessness are much more likely to die within a year than other patients.

Read more: lstm.ac/4n4gC8i

https://thorax.bmj.com/content/early/2025/09/09/thorax-2025-223623

Congratulations to @sspencer.bsky.social for publishing the final paper of his PhD! This describes the complexity of patients with breathlessness in Malawi. Whilst vertical programmes are important for individual diseases like TB, more integrated approaches are urgently required

🧪🩺 #ansky #idsky

And now, after 7 months of baking, the shiny @lancetgh.bsky.social manuscript has emerged!

Very excited to share this as the culmination of a huge amount of work and fantastic/constructive peer review process.

www.thelancet.com/journals/lan...

🧪🩺 #IDsky #icusky

New study shows almost half of hospital patients Malawi and Tanzania have multiple health conditions The Multilink Consortium, a NIHR-funded partnership between the Liverpool School of Tropical Medicine, the Malawi-Liverpool-Wellcome Programme, Muhimbili University of Health and Allied Sciences and

A new study conducted in Malawi and Tanzania has found that almost half of patients admitted to hospital had multiple long-term health conditions, which was associated with significantly increased risk of death and disability.

Read more: lstm.ac/3TFwxN4.

Many many people and institutions involved:
@benmorton.bsky.social @darknatter.bsky.social +others not on bluesky

@lstmnews.bsky.social; Malawi Liverpool Wellcome; Muhimbili National Hospital; KCMC @dukepress.bsky.social @manchester.ac.uk

🙏Funded by @nihr.bsky.social @wellcometrust.bsky.social

What’s next:
We've incorporated these findings into a cluster RCT across Malawi and Tanzania to evaluate a complex intervention to:
- Improve recognition and control of chronic disease
- Reduce readmission
- Improve survival

More info: multilinknihr.com

We pre-published the protocol for our study:
openresearch.nihr.ac.uk/articles/4-2

This work builds on our earlier systematic review @whobulletin.bsky.social:
- We found lots of data on individual diseases in SSA hospitals (and estimated their prevalence and disease control)
- But evidence on multimorbidity in this context was sparse

pmc.ncbi.nlm.nih.gov/articles/PMC...

Most common long-term conditions were:
• Hypertension (44%)
• HIV (31%)
• Diabetes (27%)

📉 Disease control was poor, particularly for NCDs
• Across both countries, participants had low baseline HRQoL, high disability & frailty.

Our adapted UpSet plot presents a rich description of multimorbidity patterns:
- Combinations and prevalence of HIV, diabetes, hypertension, CKD, etc.
- We also found a correlation between the number of conditions and 90-day mortality.

Key findings:
- 47% of adults admitted acutely to medical wards had multimorbidity (≥2 long-term conditions).
- This was linked to higher mortality, poorer health-related quality of life, and greater financial burden.

#Multimorbidity #NCDs

This work represents the culmination of 3+ years of collaborative work by the NIHR Multilink Consortium: multilinknihr.com.

We assessed health and economic outcomes of multimorbidity across 4 hospitals in Malawi and Tanzania

🧵
Thrilled to share our latest paper @lancetgh.bsky.social on multimorbidity-related hospital admissions in Malawi & Tanzania.

Increased medical complexity in sub–Saharan African hospitals requires urgent interventions to address population needs.

www.thelancet.com/journals/lan...

Have your say - an invitation to complete this important survey to inform UK implementation sespsis patient care research in PCT-guided antibiotic duration. www.qualtrics.manchester.ac.uk/jfe/preview/... @benmorton.bsky.social @ics-updates.bsky.social @criticalcarereviews.com

Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security “Oxygen delayed is life denied.”—Person who survived COVID-19, Kenya

"5 billion people—ie, 60% of the world's population—do not have access to affordable, high-quality medical oxygen services"

www.thelancet.com/journals/lan...

🧪🩺 What causes breathlessness in patients who require acute hospital admission in Malawi? This protocol paper by @sspencer.bsky.social sets out a systematised approach to address this question: wellcomeopenresearch.org/articles/9-2....

Interdisciplinary perspectives on multimorbidity in Africa: Developing an expanded conceptual model Multimorbidity is an emerging challenge for health systems globally. It is commonly defined as the co-occurrence of two or more chronic conditions in one person, but its meaning remains a lively area ...

How should the concept of #multimorbidity apply in a sub Saharan African context? Our new interdisciplinary piece starts to consider key drivers and health systems implications: doi.org/10.1371/jour...

#globalhealth #medsky #malawi