Age Related Patterns of Disease and Mortality in Hospitalised Adults in Malawi

Abstract

BackgroundThe epidemic of non-communicable diseases (NCDs) in low and middle income countries (LMICs) is widely recognised as the next major challenge to global health. However, in many LMICs, infectious diseases are still prevalent resulting in a “double burden” of disease. With increased life expectancy and longevity with HIV, older adults may particularly be at risk of this double burden. Here we describe the relative contributions of infections and NCDs to hospital admissions and mortality, according to age, in Malawi’s largest hospital.MethodsPrimary diagnosis on discharge/death, mortality rates, and HIV status were recorded prospectively on consecutive adult medical in-patients over 2 years using an electronic medical records system. Diagnoses were classified as infections or NCDs and analysed according to age and gender.Findings10,191 records were analysed. Overall, infectious diseases, particularly those associated with HIV, were the leading cause of admission. However, in adults ≥55 years, NCDs were the commonest diagnoses. In adults <55 years 71% of deaths were due to infections whereas in adults ≥55 years 56% of deaths were due to NCDs.InterpretationInfectious diseases are still the leading cause of adult admission to a central hospital in Malawi but in adults aged ≥55 years NCDs are the most frequent diagnoses. HIV was an underlying factor in the majority of adults with infections and was also present in 53% of those with NCDs. These findings highlight the need for further health sector shifts to address the double burden of infectious and NCDs, particularly in the ageing population.

HIV‐associated morbidity and mortality in a setting of high ART coverage: prospective surveillance results from a district hospital in Botswana

“…Tuberculosis continues to be the leading presumed cause of morbidity and mortality among HIV‐positive patients. Our results are consistent with findings from other settings in sub‐Saharan Africa demonstrating ongoing high rates of HIV‐positive admissions and associated mortality (especially from tuberculosis) despite increased availability of ART , and contrast with experience from Europe and North America where HIV has become a condition largely managed in the outpatient setting . These differences are likely explained by health system resources, differences in tuberculosis prevalence, different spectrum of opportunistic infections and socio‐economic factors which disadvantage patients in developing‐country settings.…”

“…Few ART‐era studies from the African region have previously reported on rates of ART‐coverage and mortality among HIV‐positive adult medical admissions. The HIV‐related medical inpatient mortality rate of 22% on our wards was similar to that from hospital settings in Malawi (24%, 25%) where a comparable ART‐coverage rate (72%) was reported and lower compared to a multi‐centre study from West Africa which reported 38% mortality in the setting of lower (48%) ART‐coverage . Widely divergent HIV‐related inpatient mortality rates of 17% and 30% have been reported from settings in Kenya and DRC respectively, where a relatively high proportion of patients were on ART at the time of admission .…”

“…The introduction and scale‐up of antiretroviral therapy (ART) over the past decade has led to significant improvements in quality of life, life expectancy and mortality in sub‐Saharan Africa, but the impact of expanded ART availability on the burden of HIV‐related mortality in the hospital setting remains unknown . Recent studies from countries in sub‐Saharan Africa report high inpatient mortality rates despite increased access to free ART . In‐hospital mortality among HIV‐positive patients may be influenced by factors such as rate and timing of ART uptake, toxicity of available ART regimens, co‐morbidities and facility level and health system resources in different settings.…”

Novel approaches to screening for noncommunicable diseases: Lessons from Neno, Malawi

“… 5 NCDs are considered among the leading causes of death, second only to HIV/AIDS, 6 and a recent study on inpatients in Malawi found that, while infections remain the leading cause of adult admission, NCDs were the most frequent causes of death in adults over 55 years old. 7 The high burden of NCDs in Africa presents challenges to providing NCD care, as these countries also have a huge burden of communicable diseases, notably HIV/AIDS and its complications.…”

Conceptualising metabolic disorder in Southern Africa: Biology, history and global health

“…Already in Malawi new studies are emerging that should give us a better picture (though by no means a comprehensive one) of the actual incidence of noncommunicable disease, beyond but including those framed within the terms of 'metabolic disorders' (Price et al in preparation). These studies will also be able to link non-communicable disease to infectious disease, particularly HIV/AIDS and its chemotherapy, as well as to economic status, education and levels of urbanisation, a range of environmental effects and ageing (for example, Allain et al 2017;Moses et al 2017). Moving away from 'transition' to a more complex conceptualisation of the temporalities of epidemiological change also has the potential to give us a somewhat different understanding of what may indeed a creeping 'epidemic' of type 2 diabetes and other conditions.…”