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.

Abstract

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 patients and carers take to maintain physical and mental health in this context. This review synthesized qualitative evidence that describes self-management of four chronic conditions- HIV, diabetes, chronic kidney disease, and hypertension, including multimorbidity among patients and their carers in SSA. We systematically searched five databases and grey literature for studies published between January 2000 and to March 2025 and conducted a thematic synthesis of findings. Twenty-three studies met inclusion criteria, three of which focused on multimorbidity. Across conditions, patients negotiated 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 and chronic kidney disease imposed the greatest treatment burden, making them the most challenging conditions for patients to manage. Temporal discontinuation of medications was 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. This review synthesised qualitative evidence on self-management of HIV, diabetes, hypertension, and chronic kidney disease in SSA, and considered insights for multimorbidity. Most studies focused on individual conditions, yet our findings reveal strikingly similar challenges across all four conditions: limited health literacy, low self-efficacy, and inadequate structural support. These barriers are likely amplified with multimorbidity, further complicating decision-making and self-management. Addressing these gaps will require context-sensitive interventions that strengthen patient literacy, build confidence to increase patient autonomy and expand the range of resources available to manage chronic disease.