Social determinants of multimorbidity in older adults in sub-saharan Africa: A systematic review.

Background: Multimorbidity is increasingly common among older adults in Sub-Saharan Africa (SSA), yet the role of social determinants in shaping its prevalence and outcomes remains underexplored.

Objectives: This review aimed to (a) identify the prevalence, types, and patterns of multimorbidity among older adults in SSA; (b) examine the influence of social determinants such as income, education, healthcare access, and geographic location; (c) evaluate current approaches for prevention and management; and (d) propose directions for future research.

Methods: A systematic search of six databases (PubMed, EMBASE, PsycINFO, Google Scholar, CINAHL, and Global Index Medicus) was conducted to identify quantitative studies published between 2000 and 2024 on adults aged 50 and above. Of 841 records screened, 16 studies met inclusion criteria and passed quality appraisal. The review protocol was registered in PROSPERO (CRD42024607875).

Results: Multimorbidity ranged from 5.4% in Botswana to 71% in Nigeria. Cardiometabolic conditions often co-occurred with infectious and mental disorders. Poverty and low education significantly increased risk (OR: 1.44-7.44). Rural residents faced limited healthcare access, while urban dwellers had higher risks from lifestyle factors. Obesity and food insecurity further heightened vulnerability, especially among women and older adults.

Significance of results: Findings indicate that social determinants critically shape multimorbidity risk and outcomes in SSA. Integrated care models, targeted interventions, and policies addressing structural inequalities are urgently needed. Future research should apply longitudinal and qualitative approaches to clarify causal pathways and inform context-sensitive strategies.