The Burden of Inpatient Neurologic Disease in a Tropical African Hospital

Philip-Ephraim, E. E.; Eyong, Komomo; Chinenye, S; William, U. E.; Ephraim, R. P.

doi:10.1017/s0317167100014694

Cited by 16 publications

(22 citation statements)

References 12 publications

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“…The majority of published studies are from African countries; they include all age groups and report more acute NDs, including central nervous system infections [1, 2]. It was not the purpose of this study to define the prevalence of NDs among all inpatients.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that clinical multimorbidity affects 99% of older adult women (≥65 years) and 97% of men [34], and these comorbidities increase the risks for adverse outcomes and the cost of healthcare [14, 35]. The mortality rate for older adult neurological inpatients (18%) was lower than that reported in African neurological inpatients, perhaps because those studies included more participants with severe infections such as HIV and brain tumors [1, 2]. However, compared with neurological inpatients aged 18–59 years, mortality among older adult patients was more frequent and there were differences in mortality and long LOS rates.…”

Section: Discussionmentioning

confidence: 99%

“…Studies on demographics, prevalence, patterns, and prognosis of neurological disorders (NDs) in older adult inpatients would improve estimates of the burden of illness, healthcare costs, and additional neurology resource needs [1–5]. Globally, epidemiological studies in geriatric populations have shifted from communicable to chronic, noncommunicable diseases [6, 7].…”

Section: Introductionmentioning

confidence: 99%

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Frequency, associated features, and burden of neurological disorders in older adult inpatients in Brazil: a retrospective cross-sectional study

Bacellar

Pedreira

Costa

et al. 2017

BMC Health Serv Res

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BackgroundThe burden of neurological disorders (NDs) in older adult inpatients is often underestimated. We studied diagnostic frequency and comorbidity of NDs among inpatients aged ≥60 years. We compared rates of hospital mortality, length of stay (LOS), and readmission with younger patient counterparts (aged 18–59 years) and older adult non-neurological patients.MethodsThis was a retrospective cross-sectional study of inpatients in a tertiary care center in Brazil. We compiled data for all patients admitted between 1 January 2009 and 31 December 2010, and selected those aged ≥18 years for inclusion in the study. We collected data for inpatients under care of a clinical neurologist who were discharged with primary diagnoses of NDs or underlying acute clinical disorders, and data for complications in clinical or surgical inpatients. Patients who remained hospitalized for more than 9 days were categorized as having long LOS.ResultsOlder adult inpatients with NDs (n = 798) represented 56% of all neurological inpatients aged ≥18 years (n = 1430), and 14% of all geriatric inpatients (n = 5587). The mean age of older adult inpatients was 75 ± 9.1 years. Women represented 55% of participants. The most common NDs were cerebrovascular diseases (51%), although multimorbidity was observed. Hospital mortality rate was 18% (95% confidence interval [CI], 15–21) and readmission rate was 31% (95% CI, 28–35), with 40% of patients readmitted 1.8 ± 1.5 times. The long LOS rate was 51% and the median LOS was 9 days (interquartile interval, 1–20 days). In younger inpatients mortality rate was 1.4%, readmission rate was 34%, and long LOS rate was 14%. In older adult non-neurological inpatients, mortality rate was 22%, readmission rate was 49%, and long LOS rate was 30%.ConclusionsOlder adult neurological inpatients had the highest long LOS rate of all patient groups, and a higher mortality rate than neurological patients aged 18–59 years. Readmissions were high in all groups studied, particularly among older adult non-neurological inpatients. Improved structures and concerted efforts are required in hospitals in Brazil to reduce burden of NDs in older adult patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Frequency, associated features, and burden of neurological disorders in older adult inpatients in Brazil: a retrospective cross-sectional study

Bacellar

Pedreira

Costa

et al. 2017

BMC Health Serv Res

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“…While there is a pronounced need to describe the prevalence of neurological illness and identify predictors of mortality associated with these diagnoses in healthcare settings throughout Uganda and other sub-Saharan countries, electronic health record (EHR) systems, and hence, administrative data, are not widely available to aid in such endeavors. Several studies have analyzed inhospital mortality rates and associated factors in various sub-Saharan African countries, with no prior work analyzing in-hospital mortality among patients admitted to a neurology ward particularly within Uganda [9][10][11][12][13][14]. Understanding the prevalence and identifying high-risk causes of mortality is critical for healthcare providers and policy makers to prioritize public health, clinical, and quality improvement interventions.…”

Section: Introductionmentioning

confidence: 99%

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

Diaz

Hu²,

Fenton

et al. 2020

BMC Neurol

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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.

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“…Neurological disorders account for approximately 10% of all admissions in African rural hospitals [10][11][12]. However, the etiological spectrum has been hardly studied so far because of lack of diagnostic facilities [13].…”

Section: Introductionmentioning

confidence: 99%

High frequency of Taenia solium antigen positivity in patients admitted for neurological disorders in the Rural Hospital of Mosango, Democratic Republic of Congo.

Mukendi

Kalo

Lutumba

et al. 2020

Preprint

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Background The epidemiology of human cysticercosis and neurocysticercosis, caused by the larval stage of the pork tapeworm Taenia solium , is not well known in the Democratic Republic of Congo (DRC). As part of an etiological study, we consecutively evaluated from 2012 to 2016 all patients older than 5 years admitted for neurological disorders (neurology cohort) at the rural hospital of Mosango, province of Kwilu, DRC. No neuroimaging was available. A similar study was conducted among patients presenting with persistent fever (> 7 days) during the same period in the same hospital. In both studies, etiological diagnosis relied on a systematic set of reference laboratory assays and on pre-established clinical case definitions. The aim of this post-hoc analysis was to determine the frequency of T. solium infection in these neurology and persistent fever cohorts and to explore its association with specific neurological presentations and final etiological diagnoses. Methods We conducted a descriptive and analytic study between the group of neurological syndrome patients and persistent fever based on the presence or not the cysticercosis IgG using the B158/B60 enzyme-linked immunosorbent assay and of the LDBIO Cysticercosis Western Blot IgG assay, respectively.. Results For the neurology cohort, 340 samples (of 351 enrolled patients) were available for analysis (males: 46.8%; mean age: 38.9 years). T. solium antigen positivity was found in 43 participants (12.6%; 95% confidence interval [CI] 9.3-16.7%), including 9 of 60 (15%) patients with epilepsy. Of the 148 evaluated samples from the persistent fever cohort (males: 39.9%; mean age: 19.9 years), 7 had positive T. solium antigen (4.7%; 95% CI 1.9-9.5%; P=0.009 when compared to the neurology cohort). No significant association was found within the neurology cohort between positivity and clinical presentation or final diagnoses. Of note, the antibody-based assay was found positive in only four (1.3%) of the participants of the neurology cohort and in none of the persistent fever cohort. Conclusions T. solium antigen positivity was frequent in patients admitted with neurological disorders in the Kwilu province, DRC. Further neuroimaging studies should explore whether neurocysticercosis is prevalent in this region.

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The Burden of Inpatient Neurologic Disease in a Tropical African Hospital

Cited by 16 publications

References 12 publications

Frequency, associated features, and burden of neurological disorders in older adult inpatients in Brazil: a retrospective cross-sectional study

Frequency, associated features, and burden of neurological disorders in older adult inpatients in Brazil: a retrospective cross-sectional study

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

High frequency of Taenia solium antigen positivity in patients admitted for neurological disorders in the Rural Hospital of Mosango, Democratic Republic of Congo.

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