Prevalence of and characteristics associated with in-hospital mortality in a Ugandan neurology ward

Monica M Diaz^{1

2

3}, Xin Hu⁴, Brenda T Fenton^{5

6}, Ivan Kimuli⁷, Allison Lee⁶, Hayley Lindsey⁶, Jeffrey K Bigelow⁸, Samuel Maiser^{9

10}, Hamada H Altalib^{6

11

12

13

14}, Jason J Sico^{5

6

11

13

14

15

16}

Affiliations

¹ Department of Neurosciences, University of California San Diego, 220 Dickinson Street, Mail Code 8231, San Diego, CA, 92103, USA. mmdiaz@health.ucsd.edu.
² University of California San Diego Health, 220 Dickinson Street, Mail Code 8231, San Diego, CA, 92103, USA. mmdiaz@health.ucsd.edu.
³ Johnson and Johnson Global Scholars Program, Yale School of Medicine, 20 York Street, New Haven, CT, 06510, USA. mmdiaz@health.ucsd.edu.
⁴ Yale Center for Analytical Science, Yale School of Public Health, New Haven, CT, USA.
⁵ Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
⁶ Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.
⁷ Mulago Hospital and Makerere University, Kampala, Uganda.
⁸ Intermountain Medical Center, Salt Lake City, UT, USA.
⁹ Departments of Neurology and Internal Medicine, University of Minnesota, Minneapolis, MN, USA.
¹⁰ Hennepin Healthcare, Minneapolis, MN, USA.
¹¹ Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
¹² Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
¹³ Center for NeuroEpidemiological and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, USA.
¹⁴ Neurology Service, VA Connecticut Healthcare System, West Haven, CT, USA.
¹⁵ Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
¹⁶ Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, USA.

PMID: 32005185
PMCID: PMC6995141
DOI: 10.1186/s12883-020-1627-5

Prevalence of and characteristics associated with in-hospital mortality in a Ugandan neurology ward

Monica M Diaz et al. BMC Neurol. 2020.

. 2020 Jan 31;20(1):42.

doi: 10.1186/s12883-020-1627-5.

Authors

Affiliations

¹ Department of Neurosciences, University of California San Diego, 220 Dickinson Street, Mail Code 8231, San Diego, CA, 92103, USA. mmdiaz@health.ucsd.edu.
² University of California San Diego Health, 220 Dickinson Street, Mail Code 8231, San Diego, CA, 92103, USA. mmdiaz@health.ucsd.edu.
³ Johnson and Johnson Global Scholars Program, Yale School of Medicine, 20 York Street, New Haven, CT, 06510, USA. mmdiaz@health.ucsd.edu.
⁴ Yale Center for Analytical Science, Yale School of Public Health, New Haven, CT, USA.
⁵ Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
⁶ Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.
⁷ Mulago Hospital and Makerere University, Kampala, Uganda.
⁸ Intermountain Medical Center, Salt Lake City, UT, USA.
⁹ Departments of Neurology and Internal Medicine, University of Minnesota, Minneapolis, MN, USA.
¹⁰ Hennepin Healthcare, Minneapolis, MN, USA.
¹¹ Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
¹² Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
¹³ Center for NeuroEpidemiological and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, USA.
¹⁴ Neurology Service, VA Connecticut Healthcare System, West Haven, CT, USA.
¹⁵ Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
¹⁶ Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, USA.

PMID: 32005185
PMCID: PMC6995141
DOI: 10.1186/s12883-020-1627-5

Abstract

Background: While the burden of neurologic illness in developing countries is increasing, less is known about mortality among patients admitted to sub-Saharan African hospitals with neurologic disease. We sought to characterize the rate and patient-level predictors of in-hospital mortality in a Ugandan Neurology ward.cc.

Methods: Data was prospectively collected on 335 patients admitted to the Neurology ward of Mulago Hospital, Kampala, Uganda. Kaplan-Meier survival curves and multivariate COX proportional hazard modeling were used to assess survival.

Results: Within our sample (n = 307), 35.8% received no diagnosis at time of hospital admission. Stroke (27.3%), head trauma (19.6%), and malaria (16.0%) were the most common diagnoses. Among the 56 (18.5%) patients who died during the index hospitalization, the most common diagnosis at admission and at death was stroke. Adjusted regression analysis showed that patients without a diagnosis at time of death (HR = 7.01 [2.42-20.35], p < .001) and those with diagnoses of infections (HR = 5.21 [2.16-12.58], p = <.001), stroke (HR = 2.69 [1.20-6.04], p = .017), or head trauma (HR = 3.39, [1.27-9.07], p = 0.15) had worse survival.

Conclusions: In-hospital mortality affected nearly 20% of the cohort, with worse survival among those without a diagnosis and with infections, stroke, head trauma. Future work should identify reasons for increased mortality among these high-risk groups and implement targeted interventions.

Keywords: Global neurology; Head trauma; Neurological illness; Neurological infections; Stroke; Uganda.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Kaplan Meier Survival Curves. A. Kaplan Meier Survival Curves by age group (N = 302). B. Kaplan Meier Survival Curves by occupation (N = 223)^a. C. Kaplan Meier Survival Curves by discharge diagnosis of stroke (N = 196)^a. D. Kaplan Meier Survival Curves by discharge diagnosis of infectious disease (N = 196)^a. (B,C,D) legend: ^a Missing groups and patients missing follow-up time were not counted in Kaplan Meier analysis

See this image and copyright information in PMC

References

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1. GBD Neurological disorders collaborator group (2017) global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the global burden of disease study 2015. Lancet Neurol. 2015;16:877–897. - PMC - PubMed
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1. World Health Organization. Noncommunicable diseases country profiles: World Health Organization; 2014. https://apps.who.int/iris/bitstream/handle/10665/128038/9789241507509_en....
1. Bigelow J, Berrett S, Kimuli I, et al. Perceptions of epilepsy among first-year medical students at Mulago Hospital in Kampala, Uganda. Epilepsy Behav. 2015;51:28–32. doi: 10.1016/j.yebeh.2015.06.020. - DOI - PubMed

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Prevalence of and characteristics associated with in-hospital mortality in a Ugandan neurology ward

Affiliations

Prevalence of and characteristics associated with in-hospital mortality in a Ugandan neurology ward

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical