Prevalence of chronic conditions and multimorbidity among healthcare workers in Zimbabwe: Results from a screening intervention

Non-communicable diseases (NCDs) are the leading causes of death globally, with most deaths occurring in low and middle income countries [1]. In particular, diabetes, hypertension, and their consequences, are among the top five causes of death and disability, with their prevalence and impact projected to increase dramatically in the coming decades. In southern Africa, the rapidly increasing impact of NCDs on mortality and years lived with disability is occurring in a context of ongoing high prevalence of HIV, tuberculosis (TB) and nutritional disorders, and a persisting substantial burden of other infections [2]. This presents considerable challenges to fragile health systems.

Shared social and structural risk factors, together with shared biological pathways, mean that chronic conditions coexist within individuals: this phenomenon of multimorbidity, commonly defined as two or more physical or mental health conditions of long duration, magnifies the physical, psychological, social and financial consequences of ill health [3]. The last decade has seen growing awareness of multimorbidity with a suggestion of high prevalence of multimorbidity in Africa (pooled prevalence among adults 28% from a systematic review) [4]. However, population-based data are only available from a few countries and have usually relied on self-reported conditions [4,5], an approach which is likely to underestimate prevalence given that many conditions are undiagnosed [6,7].

The healthcare workforce is the core of any health system: maintaining staff wellbeing is critically important for population health generally, for achieving Sustainable Development Goals, and for our ability to combat future pandemics [8]. Africa faces a healthcare workforce crisis, with a projected shortfall of 6.1 million healthcare workers by 2030 [9]. Alongside a severe HIV epidemic, Zimbabwe has experienced a sustained economic crisis that has severely impacted the health system and resulted in a mass exodus of health workers [10]. The infrastructure for identifying and managing NCDs is weak, resulting in underdiagnosis and undertreatment [11]. As a result of a depleted healthcare workforce, Zimbabwe has been added to the WHO health workforce support and safeguards list [12].

It is likely that chronic diseases and multimorbidity impact on the ability of healthcare workers to continue to work, resulting in illness-related absences, requiring adjustment of work roles, or leading to early retirement. In countries affected by economic migration, staff who remain are generally older and therefore likely to be at higher risk of multimorbidity; increasing the impact of multimorbidity on human resources for health [13]. There are no studies on the prevalence or impact of multimorbidity among healthcare workers in Africa nor of multimorbidity among the general Zimbabwean population. One small study reported on the prevalence of hypertension among healthcare workers in Africa; whilst more reports have considered mental health in the context of the COVID-19 pandemic. Zimbabwean NCD prevalence estimates are either almost 20 years old or restricted to people attending HIV clinics [14].

In the context of the COVID-19 pandemic, we implemented comprehensive health check-ups for healthcare workers in Zimbabwe, to provide access to SARS-CoV-2 testing and to address underlying risk factors for severe COVID-19 (ICAROZ [Impact of the COVID-19 pandemic on healthcare workers and the healthcare system in Zimbabwe]). In this analysis, we aimed to describe the epidemiology of both multimorbidity and the prevalence of individual chronic conditions, among healthcare workers in Zimbabwe.