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.

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.

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

This includes developing an understanding the existing policies, structures and challenges in managing and treating patients with multi-morbidity and engaging with key stakeholders in each region.