Trends of admissions and case fatality rates among medical in-patients at a tertiary hospital in Uganda; A four-year retrospective study.

Authors:
Dr Robert Kalyesubula, MD
Dr Robert Kalyesubula, MD
Makerere University & MRC/UVRI &LSHTM Research Unit
Senior Lecturer/ Senior Scientist
Nephrology
Kampala, Uganda | Uganda

PLoS One 2019 14;14(5):e0216060. Epub 2019 May 14.

Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.

Background: Sub-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 Results: The 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.

Conclusion: Admissions 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.

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216060PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516645PMC
January 2020
15 Reads
3.234 Impact Factor

Publication Analysis

Top Keywords

admission death
8
medical wards
8
mulago hospital
8
trends admission
8
patients admitted
8
admitted mulago
8
hospital kampala
4
percentage change
4
ugandamethods medical
4
data base
4
base patients
4
trends
4
record data
4
mortality patients
4
medical record
4
kampala ugandamethods
4
improvements determined
4
help inform
4
inform health
4
mortality help
4

References

(Supplied by CrossRef)
Reasons and outcomes of admissions to the medical wards of jimma university specialized hospital, southwest ethiopia
E Ali et al.
Ethiopian journal of health sciences 2010
Morbidity profile of admissions to GF Jooste Hospital, Manenberg, Cape Town
J Marszalek et al.
South African Family Practice 2006
Health disparities and health equity: concepts and measurement
P Braveman et al.
Annual review of public health 2006

Similar Publications