Partnerships

This is a prospective longitudinal cohort study of adult acute medical hospital admissions with nested situation analysis and health economic measures, to screen and link for multimorbidity in Africa.

We will recruit adults 18 years or over that have been admitted to hospital as a medical emergency. We aim to register 1548 participants and the follow-up duration will be 90 days from hospital admission. The study is planned for 18 months starting in September 2022. We will use deferred emergency recruitment with retrospective consenting procedures, consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites to ensure balance and mitigate against recruitment bias.

In parallel with quantitative data collection from tablet based structured questionnaire using standardised tools, we will use point of care blood and urine tests to refine estimates of disease pathology, making these available to the medical teams. We will use qualitative interviews with healthcare workers in a portion of treating providers after patient discharge. Qualitative interviews will also take place with a proportion of patients after follow-up visits at 90 days.

The following hospitals have been chosen for the cohort study within Malawi and Tanzania, different sites will be involved in the actual trials.

Muhimbili National Hospital, (MNH) Dar-es-Salaam, Tanzania

The Hospital is a National Referral Hospital, Research Centre and University teaching Hospital with 1,500 bed capacity and attending 2,000 outpatients per day. It has 2,800 employees which includes doctors, nurses, pharmacists and other supporting staff. It is organised into eight directorates which are Medical Services, Surgical Services, Nursing & Quality Services, Clinical Support Services, Human Resources, Finance and Planning, Technical Services, and Information & Communications Technology.  It has 33 departments.

The Multilink Project aims to engage with local stakeholders, policy makers and experts in the Multimorbidity field.   An initial 2-day launch meeting was organised at the beginning of the project. Participants included study investigators, study staff, academicians, policy makers, civil society, and community representatives. The aim of this event was to plan for the study and consider the roles of individuals involved in the project.

Four hospitals have been identified for the planned first stage cohort study centres These are: Queen Elizabeth Central and Chiradzulu hospitals (Malawi) and Hai District Hospital and Muhimbili National Hospital (Tanzania). Multilink staff have met with hospital directors, research committees and heads of departments i.e. emergency departments and meeting with wider hospital staff in respective departments where the cohort study will be implemented, will be ongoing.

Multilink partners have held introductory country specific engagement meetings with Ministries of Health (MOH), the Director of Noncommunicable diseases (Malawi) focused on prevalent Noncommunicable diseases to consider in the cohort study as well as the Tanzania NCD Alliance and local MOH representative, regional (Resident Medical Officers (RMO) and national level (MOH).

The project is also developing a policy engagement strategy in both locations to facilitate Policy Impact of this research by enabling;

• Policy makers to input to the research design and implementation​ to order align to national priorities/ policy questions​
• ​Research translation and use in policy-making process

Malawi Ministry of Health (MoH) Technical Working group on NCDs in session.