Comprehension, viewpoint and precautionary measures against covid-19 among pregnant women attending ante-natal care at a tertiary health facility in Abuja, Nigeria.

Multiple long-term conditions (MLTCs), defined as the coexistence of two or more chronic illnesses, are a growing international health challenge, driven by population ageing and a rising prevalence of chronic disease [–]. People living with MLTC commonly experience frailty, functional decline, polypharmacy, and frequent acute care use, which often become more problematic as conditions progress []. Recent work has introduced the term , conceptualising it as deteriorating health and the point when individuals may be approaching end of life and/or could benefit from a palliative care approach alongside ongoing disease management []. In this context, trajectories in MLTC are often uncertain, with alternating periods of relative stability and episodes of sudden deterioration, creating distinctive challenges for timely care planning and decision-making [, ]. Health and care systems have largely evolved around single-disease specialties and condition-specific pathways, with care organised through episodic contacts, referrals, and transitions between settings [, ]. Care often begins in generalist settings (such as primary care) before people are referred into specialist services structured around single conditions; later, when holistic, integrated support is needed, systems can struggle to bring fragmented pathways back together [, ]. For people living with MLTC, this can create ambiguous responsibility, such that no single clinician or team consistently holds longitudinal oversight for initiating and revisiting forward-looking discussions. In practice, changes in health status may be missed because cues are distributed across settings and accumulate over time, including escalating frailty, recurrent unplanned admissions or “near-miss” crises, increasing symptom burden, accumulating polypharmacy and treatment burden, and growing caregiver strain. When these cues are not routinely identified, shared, and acted upon across services, planning is more likely to be reactive than anticipatory [, ]. Advance care planning (ACP) provides a framework for addressing these challenges by enabling individuals to define goals and preferences for future treatment and care, discuss these with family and healthcare professionals, and record and review preferences if appropriate. ACP is conceptualised internationally as an ongoing, iterative process involving individuals, those important to them, and healthcare professionals, rather than a single event or document [–]. In conditions characterised by uncertain and fluctuating illness trajectories, such as MLTC, ACP can be initiated in response to emerging patterns of decline and evolving need, rather than relying on prognostic timing [].