title: Prevalence and outcomes of multimorbidity in South Asia: a systematic review.
abstract: OBJECTIVE
  To systematically review the studies of prevalence, patterns and consequences of multimorbidity reported from South Asia.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  South Asia.
  
  
  METHODS
  Articles were retrieved from two electronic databases (PubMed and Embase) and from the relevant references lists. Methodical data extraction according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was followed. English-language studies published between 2000 and March 2015 were included.
  
  
  METHODS
  Studies addressing prevalence, consequences and patterns of multimorbidity in South Asia. Articles documenting presence of two or more chronic conditions were included in the review. The quality and risk of bias were assessed using STROBE criteria.
  
  
  METHODS
  Two reviewers independently assessed studies for eligibility, extracted data and assessed study quality. Due to heterogeneity in methodologies among reported studies, only narrative synthesis of the results was carried out.
  
  
  RESULTS
  Of 11,132, 61 abstracts were selected and 13 were included for final data synthesis. The number of health conditions analysed per study varied from 7 to 22, with prevalence of multimorbidity from 4.5% to 83%. The leading chronic conditions were hypertension, arthritis, diabetes, cardiac problems and skin diseases. The most frequently reported outcomes were increased healthcare utilisation, lowered physical functioning and quality of life, and psychological distress.
  
  
  CONCLUSIONS
  Our study, a comprehensive mapping of multimorbidity research in South Asia, reveals the insufficient volume of work carried out in this domain. The published studies are inadequate to provide an indication of the magnitude of multimorbidity in these countries. Research into clinical and epidemiological aspects of multimorbidity is warranted to build up scientific evidence in this geographic region. The wide heterogeneity observed in the present review calls for greater methodological rigour while conducting these epidemiological studies.
  
  
  BACKGROUND
  CRD42013005456.
authors.affiliation: Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, Odisha, India.
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Pati
authors.affiliation: Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, Odisha, India.
authors.forename: Subhashisa
authors.initials: S
authors.lastname: Swain
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Mohammad Akhtar
authors.initials: MA
authors.lastname: Hussain
authors.affiliation: Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands Department of General Practice, KU Leuven, Leuven, Belgium.
authors.forename: Marjan
authors.initials: M
authors.lastname: van den Akker
authors.affiliation: Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: Metsemakers
authors.affiliation: Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors.forename: J André
authors.initials: JA
authors.lastname: Knottnerus
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Chris
authors.identifier: http://orcid.org/0000-0002-4378-3960
authors.initials: C
authors.lastname: Salisbury
mesh_terms: D001208:Asia / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity / Q000639:trends; D006801:Humans; D015995:Prevalence; D011788:Quality of Life
keywords: PRIMARY CARE; PUBLIC HEALTH