A multi-country qualitative study among hospital patients and carers perspectives on living with multimorbidity: a case of Malawi and Tanzania

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Abstract Background Multimorbidity is an urgent public health threat in sub-Saharan Africa (SSA). However, data on the experiences of people living with multimorbidity (PLWMM) in this context are limited. We explored patient and carer experiences of living with (or caring for) multimorbidity to inform the development of patient-centred interventions for managing multimorbidity. Methods This qualitative study is nested within a broader programme of multimorbidity research conducted in Malawi and Tanzania across four hospitals. We recruited patients recently discharged from hospital with known two or more combinations of hypertension (HTN), diabetes mellitus (DM), HIV and chronic kidney disease (CKD) and their carers. We conducted primary in-depth interviews at discharge and follow-up interviews 90 days after initial hospital admission to explore longitudinal experiences and care trajectories. FGDs were conducted after hospital discharge. Data were analysed thematically and presented through the lens of an existing Expanded Conceptual Model on Multimorbidity for SSA. Results We conducted 32 in-depth-interviews (IDI) and 8 focus group discussion (FGDs) with PLWMM and carers in Malawi; and 21 IDIs and 7 FGDs in Tanzania. We identified, and present findings under three key crosscutting themes: experiences of living with multimorbidity; self-management and adaptation; and prioritisation of individual diseases within the multimorbidity paradigm. Age, sex, disease combinations and settings impacted on experiences living with multimorbidity. Out-of-pocket expenditure and poor quality of care dominated both settings with CKD and DM comorbidities exerting the heaviest burden on PLWMM and carers. Treatment discontinuation was common for HTN in Malawi and CKD in Tanzania, whilst living with HTN was linked to emotional distress in both. Older PLWMM reported greater family disruption due to loss of independence. Health crises, health literacy, and financial constraints were major drivers of disease management. Individuals particularly experienced stigma when conditions caused visible signs, and described moral and spiritual concerns. Conclusions Multimorbidity experiences in Malawi and Tanzania reflect complex interactions between individual, socioeconomic, and health system factors. Effective interventions require multidisciplinary, patient-centred approaches addressing structural barriers, improving health literacy, and promoting collaborative care involving patients, carers, and peers.