Gender differences in response to living with multimorbidity in Malawi

Background Multimorbidity is an urgent public health challenge in sub-Saharan Africa (SSA). Gender, defined as the socially constructed roles, behaviours, activities, and attributes that societies deem appropriate for males and females, significantly influences healthcare access and health-seeking behaviours. The aim of this study was to examine gendered experiences of living with multimorbidity (PLWMM) in Malawi. Methods This qualitative study is nested within a broader program of multimorbidity research conducted within two hospitals in Malawi. We recruited patients with ≥ 2 combinations of diabetes, HIV, hypertension and chronic kidney disease, the most common chronic conditions in the Malawi setting. We conducted 32 in-depth-interviews (IDI) and 8 focus group discussions (FGDs) with people living with multimorbidity (PLWMM) and their carers. Baseline data were supplemented with follow-up interviews at 90 days post-admission. Data were thematically analysed using the critical gender theory. Results Three key themes emerged: gendered perceptions of chronic conditions; gendered roles and care-seeking; and decision-making behaviours. Wider structural gender norms informed experiences of living with multimorbidity. Men frequently expressed reluctance to seek care due to societal norms around masculinity and stigma associated with vulnerability, whilst women encountered barriers due to required caregiver roles and limited agency to make health decisions. Limited access to essential resources and reduced physical functionality were common features across both genders. We observed increased propensity toward medical pluralism among females, influenced by their roles as carers and economic factors while males predominantly sought to manage side-effects of treatment. Conclusions Gender shapes the experiences of multimorbidity, with male reluctance to seek care driven by masculinity norms, and females engagement with illness constrained by caregiving responsibilities and limited agency. We recommend health education and peer-to-peer initiatives to reframe gendered healthcare interactions and address perceptions of vulnerability and stigma. Among females, strengthened female agency; increased financial independence; and social support may reduce caregiver burdens and promote shared health responsibility