Research Aims and Impact of the Multilink Project

The multilink project aims to research ways to identify multimorbidity (such as high blood pressure, diabetes and HIV) by improving diagnostic tests in emergency departments in hospitals in Malawi and Tanzania.

Working with patients and healthcare professionals, we will investigate how improved diagnostic testing could be most effectively acted on in hospital and how much this would cost. With the help of community groups and primary healthcare facilities we will find how best to link patients with long-term care.

After mapping how the health system works, we will work with policymakers and patients to find the most efficient and preferred approach to testing and clinical management pathways.


Dr Rylance explained: “When patients come to hospital, they frequently have multiple chronic diseases (“multimorbidity”). Doctors often focus on treating the immediate and biggest problem. This is important, as missing opportunities to manage multimorbidity can lead to frequent hospital readmissions, high costs to patients, and preventable disability and death.”

Main research areas

As part of this programme of work, the Multilink consortium have funded four multidisciplinary PhDs, who will lead the main research areas in the disciplines of clinical medicine; health economics; health systems; and social science.

Clinical medicine: Context Relevant Approaches for Acute Multimorbid Disease

A robust clinical approach is key to deliver this project. We will deliver a prospective cohort study to measure the rates of multimorbidity across four hospitals in Malawi and Tanzania. The researchers will develop a pragmatic guidance to effectively link patient clinical status with their diagnostic results to recommend defined algorithmic clinical actions.

This system needs to be robust and easily implementable by junior healthcare workers. We will co-create this system with key stakeholders including nurses, junior and senior doctors, administrators and policy makers. In addition, we need to develop processes to effectively follow up patients after hospital discharge in an outpatient setting to measure outcomes and effectively manage their multimorbid disease.

Health systems: Treatment pathways for multimorbidity in secondary care

A robust health systems approach is key to deliver this project. Specifically, we need to evaluate secondary care health systems delivery for patients with multimorbidity to understand care pathways and potential nodes for intervention. We will conduct a prospective observational study to evaluate the prevalence of multimorbidity in four hospitals in Malawi and Tanzania.

Nested within this will be process evaluation work to identify bottlenecks to diagnosis and management of multimorbidity, to observe healthcare interactions and to develop a structured understanding of healthcare delivery along the continuum of care.

The health systems researchers will work collaboratively with clinical, social science and health economic teams to inform the development of a virtual implementation model, based on care pathways, to understand the potential trade-offs of proposed interventions to improve outcomes for patients with multimorbidity.

Health economics: Cost effective delivery of multimorbidity in secondary care

 A robust health economic approach is key to inform this project. Specifically, we plan to collect health economic data within a prospective cohort study to understand the impact of multimorbidity on patients and their carers.

We will seek to synthesise this data using a virtual implementation (operational) model. This will require strong integration with the wider multidisciplinary team to incorporate health systems, clinical and social science data on how care is delivered and could potentially be modified in this context.

Social science: Care delivery for multimorbidity in secondary settings

A robust social science approach is key to deliver this project. Specifically, we need to develop our conceptual understanding of patient and carers needs and priorities related to multimorbid disease, community care for multimorbidity and to co-create educational materials to improve health literacy for chronic disease management.

Through the theoretical underpinnings, perspectives, and priorities of communities of multimorbid disease care, we aim to improve our understanding of how multimorbidity affects patients and communities, and how patients can be identified and supported.

Social scientists will engage flexibly with multidisciplinary partners including patients, carers, clinical staff, administrators, and policy makers using robust social science methodology to inform pragmatic and implementable interventions that interface between community and health systems and are nested within local health systems.


Dr Limbani said: “Just as the diseases are multiple in individuals, addressing multimorbidity requires a multidisciplinary approach. Our study has brought together experts across different disciplines including patient representatives to design and test the most effective and context relevant ways of identifying and treating patients with multimorbidity in low-income settings.”