Background The prevalence of multimorbidity (the presence of two or more chronic health conditions) is rapidly increasing in sub–Saharan Africa. Hospital care pathways that focus on single presenting complaints do not address this pressing problem. This has the potential to precipitate frequent hospital readmissions, increase health system and out-of-pocket expenses, and may lead to premature disability and death. We aim to present a description of inpatient multimorbidity in a multicentre prospective cohort study in Malawi and Tanzania. Primary objectives Clinical: Determine prevalence of multimorbid disease among adult medical admissions and measure patient outcomes. Health Economic: Measure economic costs incurred and changes in health-related quality of life (HRQoL) at 90 days post-admission. Situation analysis: Qualitatively describe pathways of patients with multimorbidity through the health system. Secondary objectives Clinical: Determine hospital readmission free survival and markers of disease control 90 days after admission. Health Economic: Present economic costs from patient and health system perspective, sub-analyse costs and HRQoL according to presence of different diseases. Situation analysis: Understand health literacy related to their own diseases and experience of care for patients with multimorbidity and their caregivers. Methods This is a prospective longitudinal cohort study of adult (≥18 years) acute medical hospital admissions with nested health economic and situation analysis in four hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Malawi; 3) Hai District Hospital, Boma Ng’ombe, Tanzania; 4) Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Follow-up duration will be 90 days from hospital admission. We will use consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites. We will use point-of-care tests to refine estimates of disease pathology. We will conduct qualitative interviews with patients, caregivers, healthcare providers and policymakers; focus group discussions with patients and caregivers, and observations of hospital care pathways.

Background: Due to the high prevalence of human immunodeficiency virus (HIV) in Tanzania, provider-initiated HIV testing for patients attending any health care setting is recommended. However, follow-up and linkage to care by those tested remain poor. We determined the feasibility and efficacy of text messaging to promote follow-up among otherwise healthy trauma patients who underwent provider-initiated HIV testing and counseling at an emergency department (ED) in Tanzania. Material and methods: This randomized controlled trial (RCT) was conducted at Muhimbili National Hospital (MNH) ED between September 2019 and February 2020. Adult trauma patients consenting to HIV testing and follow-up text messaging were randomized to standard care (pre-test and post-test counseling) or standard care plus a series of three short message service (SMS) text message reminders for follow-up in an HIV clinic, if positive, or for retesting, if negative. Investigators blinded to the study assignment called participants 2 months after the ED visit if HIV-positive or 4 months if HIV-negative. We compared the proportion of people in the intervention and control groups completing recommended follow-up. Secondary outcomes were the proportion of patients agreeing to testing, proportion of patients agreeing to receiving text messages, and the proportion of HIV-positive and HIV-negative patients in each study arm who followed up. Results: Of the 290 patients approached, 255 (87.9%) opted-in for testing and agreed to receive a text message. The median age of the study population was 29 [IQR 24–40] years. There were 127 patients randomized to the intervention group and 128 to the control group. The automated SMS system verified that 381 text messages in total were successfully sent. We traced 242 (94.9%) participants: 124 (51.2%) in the intervention group and 18 (488%) in the control group. A total of 100 (39.2%) subjects reported completing a follow-up visit, of which 77 (60.6%) were from the intervention group and 23 (17.9%) were from the control group (RR = 3.4, 95% CI 2.3–5.0). This resulted in a number needed to treat (NNT) of 2.3. Of the 246 HIV-negative participants, 37% underwent repeat screening: 59% of those in the intervention group and 16% in the control group (RR = 3.7, P = < 0.0001, NNT 2.3). Among the nine positive patients, all five in the intervention group and only three in the controls had follow-up visits. Conclusion: Automated text message is a feasible and effective way to increase follow-up in HIV-tested individuals in a limited income country.

Introduction: Timely access to emergency care services (ECS) is vital for reducing morbidity and mortality from acute conditions. While global barriers to ECS are well documented, little attention has been paid to access within primary healthcare (PHC) in low- and middle-income countries. This study assessed access to ECS at PHC in Tanzania, offering insights relevant to similar contexts. Methods: We conducted a community-based, mixed-methods study in December 2021 across four villages in three Tanzanian regions. A structured questionnaire based on WHO-ECS indicators was administered to 673 randomly selected community members, covering healthcare access, awareness and barriers. Additionally, 12 in-depth interviews were conducted with village leaders and healthcare providers, and 4 focus group discussions with village health committee members explored systemic issues. Quantitative data were summarised using descriptive statistics, while qualitative data were analysed thematically. The primary outcome was the proportion accessing ECS, assessed across availability, acceptability, physical accessibility and affordability. Secondary outcomes included general healthcare access and perceived challenges, analysed using both quantitative and qualitative methods. Results: Among 673 participants, median age was 43 years (IQR 31–55); 55% were female, 68% had primary education and 89% were self-employed, mostly subsistence farmers. While 91% sought healthcare, only 27% sought ECS; of those, 73% obtained it. Most found ECS available (79%), affordable (64%), acceptable (59%) and accessible (57%). Barriers included long travel distances (48%), long waiting times (74%), medication shortages (64%), poor customer service (56%) and inability to pay (56%). Qualitative data revealed systemic issues such as poor infrastructure, low trust in facilities and preference for traditional healers. Conclusion: Our findings underscore significant barriers to access to ECS at the PHC level. These barriers are systemic, infrastructural and sociocultural. Addressing them requires coordinated, multisectoral interventions involving policy makers, healthcare providers, decision-makers at national and local levels, and communities.

Background: Animal-related injuries remain a neglected public health issue in rural Tanzania, exacerbated by limited access to care and varied occupational exposures. While some studies have examined bite management in tertiary hospitals, little is known about the situation at the primary healthcare (PHC) level. This study explored clinical presentations, management and outcomes of animal-related injuries in a rural Tanzanian setting, using Mkinga District as a case study. Methods: A mixed-methods study was conducted in February 2024 across 29 PHC facilities in Mkinga, Tanzania. The quantitative component involved a retrospective audit of animal-related injury records from 2019 to 2023. The qualitative component comprised 10 interviews with facility in-charges to explore clinical decision-making, treatment approaches, and outcomes. Quantitative data were analyzed using SPSS; thematic analysis was applied to the qualitative transcript. Results: A total of 351 cases were documented. Symptom data were missing in over 70% of records, limiting clinical profiling. Among recorded cases, corticosteroids (55%) and antihistamines (53%) were commonly used, especially for insect and dog bites. Antibiotics were administered in insect stings (26%) and dog bites (23%), and analgesics were frequently used for insect bites. Antidotes were most common in dog (58%) and snake bites (26%). Of two cat bite cases, only one received antibiotics; neither received tetanus toxoid, despite the known infection risk. Qualitative findings highlighted three themes: clinical presentations, treatment modalities, and outcomes. Respondents described primary (e.g., bleeding, pain) and systemic (e.g., respiratory distress, neurological signs) symptoms. Treatment involved a mix of pharmacological, non-pharmacological, and traditional methods. While most patients recovered, some experienced complications or death. Conclusion: PHC facilities manage most animal-related injuries effectively, but gaps in documentation, guideline adherence, and referral systems remain. Strengthening provider training, improving resources, and engaging traditional healers may enhance timely care. Broader surveillance and community education are critical to reducing preventable harm.

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.