Article Text

Prevalence and outcomes of multimorbidity in South Asia: a systematic review
  1. Sanghamitra Pati1,
  2. Subhashisa Swain1,
  3. Mohammad Akhtar Hussain2,
  4. Marjan van den Akker3,4,
  5. Job Metsemakers3,
  6. J André Knottnerus3,
  7. Chris Salisbury5
  1. 1Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, Odisha, India
  2. 2Division of Epidemiology and Biostatistics, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
  3. 3Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
  4. 4Department of General Practice, KU Leuven, Leuven, Belgium
  5. 5Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr Sanghamitra Pati; sanghamitra.pati{at}


Objective To systematically review the studies of prevalence, patterns and consequences of multimorbidity reported from South Asia.

Design Systematic review.

Setting South Asia.

Data sources Articles were retrieved from two electronic databases (PubMed and Embase) and from the relevant references lists. Methodical data extraction according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was followed. English-language studies published between 2000 and March 2015 were included.

Eligibility criteria Studies addressing prevalence, consequences and patterns of multimorbidity in South Asia. Articles documenting presence of two or more chronic conditions were included in the review. The quality and risk of bias were assessed using STROBE criteria.

Data selection Two reviewers independently assessed studies for eligibility, extracted data and assessed study quality. Due to heterogeneity in methodologies among reported studies, only narrative synthesis of the results was carried out.

Results Of 11 132, 61 abstracts were selected and 13 were included for final data synthesis. The number of health conditions analysed per study varied from 7 to 22, with prevalence of multimorbidity from 4.5% to 83%. The leading chronic conditions were hypertension, arthritis, diabetes, cardiac problems and skin diseases. The most frequently reported outcomes were increased healthcare utilisation, lowered physical functioning and quality of life, and psychological distress.

Conclusions Our study, a comprehensive mapping of multimorbidity research in South Asia, reveals the insufficient volume of work carried out in this domain. The published studies are inadequate to provide an indication of the magnitude of multimorbidity in these countries. Research into clinical and epidemiological aspects of multimorbidity is warranted to build up scientific evidence in this geographic region. The wide heterogeneity observed in the present review calls for greater methodological rigour while conducting these epidemiological studies.

Trial registration number CRD42013005456.


This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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