The problem
The African population is growing, partly due to greater longevity, but more people are now living with disabilities, multimorbidity (living with two or more long-term health conditions), and frailty (loss of resilience). While disability is a well-known concept in Zimbabwe, multimorbidity and frailty are newly emerging, in a setting which has historically focused on infectious disease.
Thanks to a Knowledge Mobilisation (KM) Catalyst Award, I, Anthony Manyara, travelled to Harare, Zimbabwe in June this year to join colleagues at The Health Research Unit Zimbabwe (THRU-Zim), part of the Biomedical Research and Training Institute (BRTI), for a KM workshop. Our workshop aimed to present findings to, and seek feedback from, key stakeholders on these three concepts and how they co-exist and impact quality of life. Stakeholders included Ministry of Health and Child Care (MoHCC) representatives, clinicians, non-governmental organisation representatives, academics, and a patient and their carer. We discussed with stakeholders the priorities, research gaps, and potential interventions for disability, multimorbidity, and frailty. We used mentimeter and panel discussions to involve stakeholders throughout the workshop.
Summary of findings presented
Briefly, the Wellcome Trust funded Fractures-E3 study was conducted in three suburbs in Harare, Zimbabwe’s capital city and recruited 1109 people aged 40 years and above. The study found that disability, multimorbidity and frailty increased with age, with each affecting 20%, 55%, and 10% of the study population respectively. Frailty was more noticeable in people aged 70 years and older. The three conditions often overlapped, for example, 42% of people who were frail were also disabled and 83% of people who were frail had multimorbidity. Finally, co-existence of the three conditions was associated with a lower quality of life.
Integration of services for multimorbidity for better patient care
A key moment before the panel discussion was hearing of the patient’s difficult experience after a fracture resulting in mobility disability. The patient had not been able to move, they had been in a lot of pain, and they did not get access to physiotherapy services after discharge. A key recommendation from this experience and on multimorbidity in general was a need to have integration of health services. It was great to hear from the MoHCC representative that this is something the ministry was keen to commit to implementing.
Disability screening and assistive devices for better quality of life
From a mentimeter feedback question, all stakeholders strongly agreed that older adults should be routinely assessed for disability (e.g. walking, vision, hearing). Another key discussion item concerned assistive technology. Importantly, the MoHCC recently launched the new assistive technology list for Zimbabwe. It was recommended that advocacy and community engagement was needed to raise public awareness about the range of assistive technologies and how best to access them. This led to another key area that needs policy review; the 65-year age threshold for free government benefits (e.g. for assistive technology) meant many who are younger with disability were left out.
Training and upskilling needed for frailty screening
Workshop participants found the concept of frailty to be interesting despite being new in Zimbabwe. Screening older people for frailty can identify the most vulnerable and enable treatment plans and interventions to be personalised. However, health workers will need training to be able to do this screening. In mentimeter feedback, confidence levels in recognising frailty were reported as average. This was further picked up in room discussions where stakeholders recommended upskilling the health workforce in ageing care. An interesting observation by one stakeholder was that declaration of frailty as a public health disaster would catalyse action and policy changes. This has been observed in the past in Africa after the declaration of HIV as health disaster.
Committed to action and way forward
Wrapping up the day, a MoHCC representative concluded that the day was a big success. He promised to work to their level best to ensure that changes are made based on the workshop learning. In conclusion, the trip to Harare and the KM workshop were a great success for sharing knowledge and building connections between researchers and key stakeholders Learning from the workshop will inform ongoing analysis and write up of publications and potentially grant applications. We have already prepared a summary of the findings of this analysis and sent this to the MoHCC. We will continue engaging them on this and other related analysis to inform policy change and improved healthcare for all.
Acknowledgments
We are grateful to all stakeholders who attended the workshop and actively contributed. We are grateful to all THRU-Zim colleagues who helped in organising and contributing to the workshop. Finally, thanks for Fractures E-3 project for suplementing the KM Catalyst Award to make the workshop a success.
Project links:
Visit the Global Healthy Aging page to learn more about this project on The epidemiology of ageing in The Gambia, Zimbabwe & South Africa that aims to provide local and contextual epidemiological evidence to inform healthy ageing interventions, policies, and debates in Africa. An immediate use of the evidence from this project, specifically from Zimbabwe, will be informing intervention development in the KOSHESAI project.
Anthony is a Senior Research Associate (Epidemiologist in Global Health and Ageing) in Bristol Medical School.