Trends of admissions and case fatality rates among medical in-patients at a tertiary hospital in Uganda; A four-year retrospective study
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
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.
Description
Keywords
Admissions, Fatality rates, Medical in-patients, Tertiary hospital, Uganda
Citation
Kalyesubula R, Mutyaba I, Rabin T, Andia- Biraro I, Alupo P, Kimuli I, et al. (2019) Trends of admissions and case fatality rates among medical in-patients at a tertiary hospital in Uganda; A fouryear retrospective study. PLoS ONE 14(5): e0216060. https://doi.org/10.1371/journal. pone.0216060