Medical causes of admissions to hospital among adults in Africa: a systematic review

Abstract

BackgroundDespite the publication of several studies on the subject, there is significant uncertainty regarding the burden of disease among adults in sub-Saharan Africa (sSA).ObjectivesTo describe the breadth of available data regarding causes of admission to hospital, to systematically analyze the methodological quality of these studies, and to provide recommendations for future research.DesignWe performed a systematic online and hand-based search for articles describing patterns of medical illnesses in patients admitted to hospitals in sSA between 1950 and 2010. Diseases were grouped into bodily systems using International Classification of Disease (ICD) guidelines. We compared the proportions of admissions and deaths by diagnostic category using χ2.ResultsThirty articles, describing 86,307 admissions and 9,695 deaths, met the inclusion criteria. The leading causes of admission were infectious and parasitic diseases (19.8%, 95% confidence interval [CI] 19.6–20.1), respiratory (16.2%, 95% CI 16.0–16.5) and circulatory (11.3%, 95% CI 11.1–11.5) illnesses. The leading causes of death were infectious and parasitic (17.1%, 95% CI 16.4–17.9), circulatory (16%, 95% CI 15.3–16.8) and digestive (16.2%, 95% CI 15.4–16.9). Circulatory diseases increased from 3.9% of all admissions in 1950–59 to 19.9% in 2000–2010 (RR 5.1, 95% CI 4.5–5.8, test for trend p<0.00005). The most prevalent methodological deficiencies, present in two-thirds of studies, were failures to use standardized case definitions and ICD guidelines for classifying illnesses.ConclusionsCardiovascular and infectious diseases are currently the leading causes of admissions and in-hospital deaths in sSA. Methodological deficiencies have limited the usefulness of previous studies in defining national patterns of disease in adults. As African countries pass through demographic and health transition, they need to significantly invest in clinical research capacity to provide an accurate description of the disease burden among adults for public health policy.

The Changing Pattern of Hospital Admission to Medical Wards: Burden of non-communicable diseases at a hospital in a developing country

“…The rate of improved and discharged patients (78.0%) was similar to the rate reported in a tertiary health centre in Nigeria, but lower than rates reported from hospitals in Ethiopia and Sudan. 1,6,18 In most cases, the average duration of hospital stay in the current study was one week or less (86.3%), which is consistent with similar studies carried out in Khartoum and Pakistan. 6,15 This could be explained by the fact that most acute communicable diseases, as well as uncomplicated NCDs, are treatable within this short timeframe.…”

“…[12][13][14] However, findings from studies carried out in Ethiopia, Sudan and Pakistan indicated that communicable diseases were more prevalent. 1,6,15 The change from communicable diseases to NCDs in the hospital admission patterns observed in the current study could be explained by the fact that more than half of the admitted patients were from urban areas. Increasing urbanisation can result in reduced physical activity, dietary changes and a rise in the rate of obesity.…”

“…5 In Sudan, as in many other African countries, epidemiological information on disease profiles is very limited; until 2013, there were no data available on the pattern of medical admissions. 6 Recently, a study by El Bingawi et al determined that communicable diseases were the predominant cause of admission in Sudan. 7 In Sudan, the River Nile State lies to the north of the capital of Khartoum and extends to the border of Egypt, covering an area of 124,000 m 2 with a total estimated population of 1,309,129 in 2013.…”

An online formative assessment tool to prepare students for summative assessment in physiology

“…These include a changing school education system where disparate pedagogical approaches have been implemented over the last decade; [2] a changing patient population, with the emergence of previously neglected or unknown diseases; [3] and a lack of available resources, making clinical insight even more important as the primary tool available to healthcare workers. Consequently, long-established didactic approaches to the teaching of physiology may no longer fully meet the needs of current students or fulfil the demands for effective training of healthcare professionals.…”

Feasibility of a cardiovascular cohort in a Sub-Saharan Africa community: preliminary report of the pilot project TAHES (Tanvè Health Study) in Benin

“…Stroke is the main cause of CVD deaths [4]. CVD has progressed in SSA [5,6]; coronary heart diseases are not infrequent [7–9]; stroke incidence varies from 35 to 108/100,000 person-years [10–12]. Asymptomatic PAD prevalence was estimated at around 10% [13–15].…”