A Study of Lifestyle Factors among Patients with Diagnosis of Multi-Morbidity in a Primary Care Setting in Western Nigeria

Download Article

DOI: 10.21522/TIJMD.2013.05.01.Art001

Authors : Taiwo Sogunle


Multi-morbidity can be defined as the simultaneous occurrence of two or more chronic health conditions in the same person, without defining a primary disease. Most health systems have prominently pure single disease outlook. In these settings, multimorbidity was found to be associated with suboptimal care, increased mortality, poor quality of life and an increased demand on healthcare utilization.


[1]. Autenrieth CS, Kirchberger I, Heier M, Zimmermann AK, Peters A, Doring A, Thorand B. (2013). Physical activity is inversely associated with multimorbidity in elderly men: results from the KORA-Age Augsburg study. Prev Med. 57:17–19.

[2]. Agborsangaya CB, Lau D, Lahtinen M, Cooke T, Johnson JA. (2012). Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey. BMC Public Health. 12:201.

[3]. Anderson, N.B. (1998). “Levels of Analysis in Health Science: A Framework for Integrating Sociobehavioral and Biomedical Research,” Annals of the New York Academy of Sciences. 8. Vol. 840, pp. 563-576.

[4]. Aarts S, den Akker M, Bosma H, Tan F, Verhey F, Metsemakers J, van Boxtel M. (2012). The effect of multimorbidity on health related functioning: temporary or persistent? Results from a longitudinal cohort study. J Psychosom Res. 73(3):211–217.

[5]. Akesson A, Weismayer C, Newby PK, Wolk A. (2007). Combined effect of low-risk dietary and lifestyle behaviors in primary prevention of myocardial infarction in women. Arch Intern Med., 167:2122–2127.

[6]. Alaba O, and Chola L. (2013). ; The social determinants of multimorbidity in South Africa. International Journal for Equity in Health. 12:63 

http://www.equityhealthj.com/content/12/1/63. Viewed August 5, 2014.

[7]. Adedoyin RA, Adesoye A. (2005). Incidence and pattern of cardiovascular disease in a Nigerian Teaching Hospital. Trop Doct. 35104-6

[8]. Booth HP, Prevost AT, Gulliford MC. (2014). Impact of body mass index on prevalence of multimorbidity in primary care: cohort study. Fam Pract. 31(1):38–43.

[9]. Baum, A. (1990). “Stress, Intrusive Imagery, and Chronic Distress,” Health Psychology, Vol. 6, pp. 653-675.

[10]. Buddy T, Five - Shot Questionnaire Alcohol Screening Test – About.com Guide. Updated May 01, 2010. Alcohol Concern. “Primary Care Alcohol Information Service - Screening tools for healthcare settings.” Viewed August 15, 2014.

[11]. Britt HC, Harrison CM, Miller GC, Knox SA. (2008). Prevalence and patterns of multimorbidity in Australia. Med J Aust. 189(2):72–77.

[12]. Booth BP, Prevost AT, Gulliford MC. (2014). Impact of body mass index on the prevalence of multimorbidity in primary care: cohort study. Family Practice. Vol. 31 No. 1, 38-43

[13]. Banjare P, Pradhan J Socio-Economic Inequalities in the Prevalence of Multi-Morbidity among the Rural Elderly in Bargarh District of Odisha (India). PLoS ONE 2014 9(6): e97832. doi:10.1371/journal.pone.0097832

[14]. Britt HC, Harrison CM, Miller GC, Knox SA. (2008). Prevalence and patterns of multimorbidity in Australia. Med J Aust. 189:72–77.

[15]. Carguilo T (2007). Understanding the health impact of alcohol dependence. Am J Health Syst Pharm 64 (5 suppl 3) : s5-11]

[16]. Chiuve SE, McCullough ML, Sacks FM, Rimm EB. (2006): Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications. Circulation. 114:160–167.

[17]. Cohen S, Janicki-Deverts D, Miller GE (2007). “Psychological stress and disease”. JAMA 298 (14): 1685–1687. doi:10.1001/jama.298.14.1685. PMID 17925521.

[18]. Chukwuonye CI, Chuku A, Okpechi IG, Ugochukwu Uchenna Onyeonoro. (2013). UU, Madukwe OO, Okafor GOC, Ogah OS, Socioeconomic status and obesity in Abia State, South East Nigeria. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 6 371–378

[19]. Darren E.R. Warburton, Crystal Whitney HYPERLINK 


[20]. Nicol, and Shannon S.D. HYPERLINK


Bredin. (2006). Health benefits of physical activity: the evidence CMAJ. 174(6): 801–809. doi: 10.1503/cmaj.051351 PMCID: PMC1402378

[21]. de S Santos Machado V, Valadares AL, Costa-Paiva LH, Osis MJ, Sousa MH, Pinto-Neto AM. (2013). Aging, obesity, and multimorbidity in women 50 years or older: a population-based study. Menopause 20(8):818–824.


http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf” Your HYPERLINK


Guide To Lowering Your Blood Pressure With DASH (PDF). US Department of Health and Human Services. April 2006.

[23]. De Souza Santos Machado V, Valadares AL, Da Costa-Paiva LS, Moraes SS, Pinto-Neto AM. (2012). Multimorbidity and associated factors in Brazilian women aged 40 to 65 years: a population-based study. Menopause. 19(5):569–575.

[24]. Ford ES, Bergmann MM, Kroger J, Schienkiewitz A, Weikert C, Boeing H. (2009). Healthy living is the best revenge: findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam study. Arch Intern Med. 169:1355–1362.

[25]. Forman JP, Stampfer MJ, Curhan GC. (2009). Diet and lifestyle risk factors associated with incident hypertension in women. JAMA. 302:401–411.

[26]. Fortin M, Bravo G, Hudon C, Lapointe L, Almirall J, Dubois MF, Vanasse A. (2006). Relationship between multimorbidity and health-related quality of life of patients in primary care. Qual Life Res. 15:83–91.

[27]. Fortin M, Dubois MF, Hudon C, Soubhi H, Almirall J. (2007). Multimorbidity and quality of life: a closer look. Health Qual Life Outcomes. 5:52.

[28]. Fortin M, Haggerty J, Almirall J, Bouhali T, Sasseville M and Lemieux M. (2014). Lifestyle Factors and multimorbidity: a cross sectional study. BMC Public Health 14:686

http://www.biomedcentral.com/1471-2458/14/686. Viewed August 6, 2014.

[29]. Glynn LG, Valderas JM, Healy P, Burke E, Newell J, Gillespie P, Murphy AW. (2011). The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract. 28(5):516–523.

[30]. Guenther PM, Krebs-Smith SM, Reedy J, Reeve BB, Basiotis PP. (2007). Development and evaluation of healthy eating index. USDA Center for Nutrition Policy and Promotion and National Cancer Institute.

[31]. Househam KC. (2010).Africa’s Burden of disease: the university of cape town Sub-saharan africa centre for chronic disease. South Afr Med J. 100(2):94–95.

[32]. Heiner Boeing, Angela Bechthold, Achim Bub, Sabine Ellinger, Dirk Haller, Anja Kroke, Eva Leschik-Bonnet, Manfred J. Muller, Helmut Oberritter, Matthias Schulze, Peter Stehle, Bernhard Watzl. (2012).Critical review: vegetables and fruit in the prevention of chronic Diseases. Eur J Nutr 51:637–663 DOI 10.1007/s00394-012-0380-y

[33]. Hall JN, Moore S, Harper SB, Lynch JW (2009) Global variability in fruit and vegetable consumption. Am J Prev Med 36:402–409

[34]. Interagency Workshop Report WFP – FAO. Measures of Food Consumption - Harmonizing Methodologies Rome, 9 - 10 April 2008.

[35]. Kent JA, Patel V, and Varela NA. (2012). Gender disparities in health care. Mount Sinai Journal of Medicine. 79 (5): 555–559.


[36]. Khanam MA, Streatfield PK, Kabir ZN, Qiu C, Cornelius C, Wahlin A. (2011). Prevalence and patterns of multimorbidity among elderly people in rural Bangladesh: a cross-sectional study. J Heal Popul Nutr. 29(4):406–414.

[37]. McCormick WC, Boling PA. (2005). Multimorbidity and a Comprehensive Medicare Care-Coordination Benefit. J Am Geriatr Soc. 53(12):2227–2228.

[38]. Maiyaki MB, Garbati MH. (2014).The burden of non – communicable disease in Nigeria in the context of globalization. Ann. Afr. Med. 131-10

[39]. Myint PK, Luben RN, Wareham NJ, Bingham SA, Khaw KT. (2009). Combined effect of health behaviours and risk of first ever stroke in 20,040 men and women over 11 years’ follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study. BMJ 338:b349.

[40]. Muller D, Koch RD, von Specht H, Volker W, Munch EM. (1985).Neurophysiologic findings in chronic alcohol abuse. Psychiatr Neurol Med Psychol 1985. 37(3):129-32.

[41]. Marengoni A, Winblad B, Karp A, Fratiglioni L. (2008). Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden. Am J Public Health. 98:1198–1200.

[42]. Marengoni A, Rizzuto D, Wang HX, Winblad B, Fratiglioni L (2009). Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc. 57:225–230.

[43]. Nimako BA, Baiden F, Sackey SO, Binka F l. (2013). Multimorbidity of chronic diseases among adult patients presenting to an inner-city clinic in Ghana. Globalization and Health. 9:61

[44]. Nugent R, Ann. N.Y. Acad. Sci. 1136: 70–79 (2008). C _ 2008 New York Academy of Sciences. doi: 10.1196/annals.1425.027

[45]. http://www.globalizationandhealth.com/content/9/1/61. Viewed August 5 2014.

[46]. Policy and action for cancer prevention. Food, nutrition, and physical activity: a global perspective. 


[47]. Reis JP, Loria CM, Sorlie PD, Park Y, Hollenbeck A, Schatzkin A. (2011). Lifestyle factors and risk for new-onset diabetes: a population-based cohort study. Ann Intern Med. 155:292–299.

[48]. Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. (2011). Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ. 342:d671. Doi10.1136/bmj.d671

[49]. Steyn K, Damasceno A. (2006). Lifestyle and Related Risk Factors for Chronic Diseases .In 2nd edition Edited by Jamison DT, Feachem RG, Makgoba MW, Bos ER, Baingana FK, Hofman KJ, Monica Smoking Questionnaire. MONICA Manual, Part III, Section 1.

www.ktl.fi/publications/monica/manual/part3/smquest3.htm Viewed August 15, 2014

[50]. Self-Scoring Stress Questionnaire.


Accessed August 14 2014.

[51]. Schafer I, Hansen H, Schon G, Hofels S, Altiner A, Dahlhaus A, Gensichen J,Riedel-Heller S, Weyerer S, Blank WA. (2012). The influence of age, gender and socio-economic status on multi morbidity patterns in primary care. First results from the multicare cohort study. BMC Health Serv Res., 12(89): doi:10.1186/1472-6963-12-89.

[52]. Starfield B, Lemke KW, Bernhardt T, Foldes SS, Forrest CB, Weiner JP. (2003). Comorbidity: implications for the importance of primary care in ‘Case’ management. Ann Fam Med. 1(1):8–14.

[53]. Sasazuki S, Inoue M, Iwasaki M, Sawada N, Shimazu T, Yamaji T, Tsugane S.(2012). Combined impact of five lifestyle factors and subsequent risk of cancer: the Japan Public Health Center Study. Prev Med. 54:112–116.

[54]. Thompson, J. K. & Pasman, L. The Obligatory Exercise Questionnaire. 

http://jkthompson.myweb.usf.edu/oeqweb.htm. Accessed August 18, 2014

[55]. Tolsrup J, Jensen MK, Tjonneland A, Overvad K, Mukamal KJ, Gronbaek M. (2006).Prospective study of alcohol drinking patterns and coronary artery disease in women and men. BMJ; 332(7552):1244 -8.E pub 2006 May3.

[56]. Taylor B, Rehm J, Gmel G, (2005).Moderate alcohol consumption and the gastrointestinal tract. Dig. Dis. 23(3-4); 170-6].

[57]. Tucker-Seeley R, Li Y, Sorensen G, Subramanian S: Lifecourse socioeconomic circumstances and multimorbidity among older adults. BMC Publ Health 2011, 11:313.

[58]. Uijen AA, van de Lisdonk EH. (2008). Multimorbidity in primary care: prevalence and trend over the last 20 years. Eur J Gen Pract. 14 (Suppl 1):28–32.

[59]. U.S. Department of Health and Human Services: Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.

[60]. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. (2009). Defining comorbidity: implications for understanding health and health services. Ann Fam. 7:357–363.

[61]. World Health Report 2002: reducing risks, promoting healthy life.


Viewed August 7, 2014.

[62]. WHO (2008) WHO report on the Global Tobacco Epidemic. Retrieved 19 – 09 - 2014.

[63]. WHO Report on the Global Tobacco Epidemic? World Health Organization. (2008). Retrieved 19 – 9 – 2014.

[64]. Winkleby MA, Jatulis DE, Frank E, Fortmann SP: (1992). Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health. 82:816–820.

[65]. Zeba AN, Delisle HF, Genevieve R, Boubacar S, Banza B. (2012). The double burden of malnutrition and cardiometabolic risk widens the gender and socioeconomic health gap: a study among adults in Burkina Faso (West Africa). Public Health Nutr. 15(12):2210–2219.