Abstract
BackgroundSub-Saharan Africa suffers from a dual burden of infectious and non-communicable diseases. There is limited data on causes and trends of admission and death among patients on the medical wards. Understanding the major drivers of morbidity and mortality would help inform health systems improvements. We determined the causes and trends of admission and mortality among patients admitted to Mulago Hospital, Kampala, Uganda.Methods and resultsThe medical record data base of patients admitted to Mulago Hospital adult medical wards from January 2011 to December 2014 were queried. A detailed history, physical examination and investigations were completed to confirm the diagnosis and identify comorbidities. Any histopathologic diagnoses were made by hematoxylin and eosin tissue staining. We identified the 10 commonest causes of hospitalization, and used Poisson regression to generate annual percentage change to describe the trends in causes of hospitalization. Survival was calculated from the date of admission to the date of death or date of discharge. Cox survival analysis was used to identify factors associate with in-hospital mortality. We used a statistical significance level of p<0.05. A total of 50,624 patients were hospitalized with a median age of 38 (range 13–122) years and 51.7% females. Majority of patients (72%) had an NCD condition as the primary reason for admission. Specific leading causes of morbidity were HIV/AIDS in 30% patients, hypertension in 14%, tuberculosis (TB) in 12%), non-TB pneumonia in11%) and heart failure in 9.3%. There was decline in the proportion of hospitalization due to malaria, TB and pneumonia with an annual percentage change (apc) of -20% to -6% (all p<0.03) with an increase in proportions of admissions due to chronic kidney disease, hypertension, stroke and cancer, with apc 13.4% to 24%(p<0.001). Overall, 8,637(17.1%) died during hospitalization with the highest case fatality rates from non-TB pneumonia (28.8%), TB (27.1%), stroke (26.8%), cancer (26.1%) and HIV/AIDS (25%). HIV-status, age above 50yrs and being male were associated with increased risk of death among patients with infections.ConclusionAdmissions and case fatality rates for both infectious and non-infectious diseases were high, with declining trends in infectious diseases and a rising trend in NCDs. Health care systems in sub-Saharan region need to prepare to deal with dual burden of disease.
Highlights
The disease burden in developing countries is continuing to grow faster than the budget allocation for healthcare
We identified the 10 commonest causes of hospitalization, and used Poisson regression to generate annual percentage change to describe the trends in causes of hospitalization
Health care systems in sub-Saharan region need to prepare to deal with dual burden of disease
Summary
The disease burden in developing countries is continuing to grow faster than the budget allocation for healthcare. In low income countries (LIC) medical admissions account for about 40% of total hospital admissions compared to 12–30% in high income countries [1,2] This may be a reflection of disparities in socioeconomic conditions and healthcare systems, or differences in biological and/or environmental factors[3,4,5]. One factor which exacerbated the healthcare crisis in sub-Saharan Africa (SSA) was the advent of the HIV/AIDS epidemic which disproportionately affects the region [2,6,7] Interventions, such as antiretroviral therapy for the treatment of HIV/AIDS, health education, access to clean water, and mass vaccinations, have decreased morbidity and mortality from communicable diseases [8]. We determined the causes and trends of admission and mortality among patients admitted to Mulago Hospital, Kampala, Uganda.
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