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. 2019 May 14;14(5):e0216060.
doi: 10.1371/journal.pone.0216060. eCollection 2019.

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

Robert Kalyesubula  1 , Innocent Mutyaba  2 , Tracy Rabin  3 , Irene Andia-Biraro  1 , Patricia Alupo  4 , Ivan Kimuli  1 , Stella Nabirye  5 , Magid Kagimu  1 , Harriet Mayanja-Kizza  1 , Asghar Rastegar  3 , Moses R Kamya  1
Affiliations

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

Robert Kalyesubula et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Distribution of diagnoses by district of residence among patients admitted to Mulago Hospital.
Abbreviations: CDs-Communicable disease; NCDs-Non-communicable disease.
Fig 2
Fig 2. Trends in major causes of morbidity by age group and calendar year at Mulago Hospital, 2011–2014.
Panel A shows trends of communicable and non-communicable diseases through the four years of study. Panel B shows the major causes of death by age group through the four years of study. Abbreviations: CDs-Communicable disease; NCDs-Non-communicable disease.
Fig 3
Fig 3. Distribution of discharge diagnoses by gender and HIV status among patients in Mulago Hospital.
Abbreviations: CCF: Congestive cardiac failure; CKD-chronic kidney disease; TB-tuberculosis.
Fig 4
Fig 4. Distribution by HIV Serostatus of discharge diagnoses among patients who died during hospitalization.
Abbreviations: CCF-Congestive cardiac failure; CKD-chronic kidney disease; CVA-cardiovascular accident; HTN-Hypertension; TB-tuberculosis.
See this image and copyright information in PMC

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