The mortality of acutely ill medical patients for up to 60 days after admission to a resource poor hospital in sub-Saharan Africa compared with patients of similar illness severity admitted to a Danish Regional Teaching Hospital — An exploratory observational study

Abstract

BackgroundThe outcomes of patients with the same severity of illness in the developed and developing countries have not been compared. Illness severity can now be measured anywhere by the National Early Warning Score (NEWS). MethodsAn exploratory observational study that compared the 7, 30 and 60days mortality of 195 Ugandan and 588 Danish acutely ill medical patients that had a NEWS >6 at the time of their admission to the hospital. The association of vital sign changes, alertness and mobility at admission on subsequent outcome was explored. ResultsMore Kitovu (34.4%) than Danish patients (22.1%) died within 60days of admission (OR 1.85, 95% CI 1.27–2.71, p 0.001). However, the survival of non-comatose patients admitted without severely deranged vital signs or who were able to stand without help was identical in both cohorts (Chi square 0.32, p 0.57): these patients made up 50% of all Ugandan and 60% of all Danish patients. In contrast the survival curves of patients admitted in a coma were widely divergent within a week of hospital admission and remained so for a further 60days (Chi square 10.29, p 0.001). ConclusionThis small hypothesis generating observational study with huge selection and treatment bias found no survival difference at 60days after admission to resource rich and resource poor hospitals for patients without severely deranged vital signs or who were able to stand without help.