The disease profile of poverty: morbidity and mortality in northern Uganda in the context of war, population displacement and HIV/AIDS

Abstract

The population of Gulu District (northern Uganda) has been severely incapacitated by war, epidemics and social disruption. This study is aimed at describing disease patterns and trends in this area through a retrospective analysis of discharge records for 155205 in-patients of Lacor Hospital in the period 1992-2002. The burden of infectious diseases in childhood is overwhelming, with malaria accounting for the steepest increase in admissions. Admissions for war-related injuries and malnutrition fluctuated with the intensity of the war and the severity of famine. Emerging and re-emerging infections, such as HIV/AIDS, tuberculosis and Ebola, accounted for a heavy disease burden; however, there has been a trend for admissions related to HIV/AIDS and tuberculosis to decrease since the implementation of community-based services. Vulnerable groups (infants, children and women) accounted for 79.8% of admissions. Long-term war, population displacement, the collapse of social structures and the breakdown of the health system place people at a much greater risk of persistent, emerging and re-emerging infectious diseases, malnutrition and war-related injuries, shaping the 'disease profile of poverty'. Most of the disease burden results from infectious diseases of childhood, whose occurrence could be dramatically reduced by low-cost and effective preventive and curative interventions.

Adult and paediatric mortality patterns in a referral hospital in Liberia 1 year after the end of the war

“…31 Infectious diseases, some of them preventable, are still the main cause of morbidity and mortality among African children. 6,29,30,34 The morbidity and mortality patterns were very similar in the other hospitals in Monrovia and in other African hospitals. 15,26,29,30 The proportion of admissions for meningitis was similar in Mamba Point and in a Kenyan hospital: 3% and 2% respectively.…”

“…The high fatality rate observed in this study is probably due to the actual situation in Liberia where the deficient living conditions, the nutritional status after a long-term war and a health system breakdown cause a very high proportion of severely ill patients among those admitted to hospitals. 6 Often, the severe clinical status upon admission is also caused by delays in seeking medical attention, since two-thirds of the Liberians initially seek care from traditional healers, and they use modern medicine only when the traditional treatment has been unsuccessful. 2 In Mamba Point Hospital many patients were severely ill upon arrival.…”

“…Likewise, only limited literature is available about mortality patterns after wars in Africa. [6][7][8][9] The aim of this study was to describe and analyse the causes of death in adult and paediatric patients in a referral hospital in Monrovia 1 year after the end of the war.…”

Structure and management of tuberculosis control programs in fragile states—Afghanistan, DR Congo, Haiti, Somalia

“…Experiences from Afghanistan, Somalia, Uganda, Angola and World War II suggest that TB incidence and mortality increase during conflict [3,13,24,40,41]. Effective TB programs during and after conflict might offset increasing TB incidence [18,19,22,26].…”

Forests and human health: assessing the evidence

“…In their longitudinal study in northern Uganda, from 1992 to , Accorsi et al (2005 find important roles for war, population displacement, social structural loss or disruption, and breakdown of the health system in increasing the risk of infectious disease, malnutrition and war-related injuries. Vulnerable groups (infants, children and women) accounted for 80% of admissions, and malaria in children was "overwhelming" and increasing.…”