This study examined the occurrence and demographic features of multimorbidity (defined as ≥2 chronic conditions) among adults in three low-income nations in sub-Saharan Africa, drawing on secondary data from four population-based cohorts: Malawi (both urban and rural sites), The Gambia (rural), and Uganda (rural). All cohorts provided data on measured hypertension, diabetes, and obesity; two cohorts included measured hypercholesterolaemia, HIV status, and self-reported asthma; and one cohort had data on clinically diagnosed epilepsy. The analysis involved computing age-standardised prevalence rates of multimorbidity and exploring cross-sectional links between multimorbidity and demographic/lifestyle variables through regression models. The median ages of participants were 29 (IQR 22–38) in urban Malawi, 34 (IQR 25–48) in rural Malawi, 32 (IQR 22–53) in The Gambia, and 37 (IQR 26–51) in Uganda. Age-standardised multimorbidity prevalence was highest in urban Malawi (22.5%; 95% CI 21.6–23.4%) and rural Malawi (11.7%; 95% CI 11.1–12.3%), compared to The Gambia (2.9%; 95% CI 2.5–3.4%) and Uganda (8.2%; 95% CI 7.5–9%). In adjusted regression models, women showed higher multimorbidity risk than men in urban Malawi (IRR 1.97, 95% CI 1.79–2.16), rural Malawi (IRR 2.10, 95% CI 1.86–2.37), and Uganda (IRR 1.60, 95% CI 1.32–1.95), but not in The Gambia (IRR 1.16, 95% CI 0.86–1.55). Strong associations were observed between older age and elevated multimorbidity risk across all sites (p < 0.001). Greater educational level was linked to higher multimorbidity risk in urban Malawi (IRR 1.78, 95% CI 1.60–1.98), rural Malawi (IRR 2.37, 95% CI 1.74–3.23), and Uganda (IRR 2.40, 95% CI 1.76–3.26), though not in The Gambia (IRR 1.48, 95% CI 0.56–3.87). Additional studies are required to advance understanding of multimorbidity patterns in sub-Saharan Africa, focusing on comprehensive population-based data gathering for diverse chronic conditions and balanced inclusion of genders and urban/rural settings.
