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ABSTRACT
Background. An accurate description of the pattern of diseases is important in planning and assessing public health policies. Hence, we aimed to determine the causes of admissions and outcome of patients admitted in the medical ward of a tertiary referral hospital in Cameroon. Methods. This was a retrospective study conducted in the medical ward of the Douala General Hospital. All patients admitted in the ward between January 2015 and December 2017 were included. Medical files were reviewed and data on sociodemographic characteristics, comorbidities, length of stay, outcome and diagnosis at admission were collected. Diagnoses were grouped in communicable diseases or non-communicable diseases (NCDs) and then classified according to the International Classification of Diseases (ICD-10). We defined communicable diseases as diseases presenting with fever and/or abnormal white blood cells count and due to an invasion by a pathogenic microorganism. NCDs were defined as diseases of long duration and not directly associated with the pathogenic effects of a microorganism. A comparison was done according to age. A p-value less than 0.05 was considered statistically significant. Results. A total of 4591 patients were admitted among which 94.0% (4316/4591) were included for analyses. The mean age of participants was 52.9 ± 17.2 years, 51.3% (2212/4316) were young and 55.3% (2288/4316) were male. NCDs constituted two thirds of admissions. According to the ICD-10, infectious diseases were the leading causes of admissions accounting for 20.5% (886/4316) of all admissions, followed by cancer and cardiovascular diseases with 19.9% (862/4316) and 19.0% (820/4316) of admissions respectively. Young patients were more likely to be admitted for infectious diseases (p < 0.001) while elderly patients were more frequently admitted for cardiovascular diseases (p < 0.001). Overall, the median length of stay was 7.0 (4.0-11.0) days and the in-hospital mortality was 17.4%. Conclusion. Infectious, cancer and cardiovascular diseases were the leading causes of medical admissions. The double burden of diseases in developing countries may explain this pattern of admissions.
RÉSUMÉ
Introduction. La description précise du profil des maladies est essentielle pour la planification et l'évaluation des politiques de santé publique. Cette étude vise à déterminer les causes d'admissions et le devenir des patients dans un service de médecine interne. Méthodes. Étude rétrospective au service de médecine interne de l'Hôpital Général de Douala. Inclusion de tous les patients admis entre janvier 2015 et décembre 2017. Collecte des données sociodémographiques, comorbidités, durée d'hospitalisation, diagnostic à l'admission. Classification des diagnostics en maladies transmissibles et maladies non transmissibles (MNT) selon la CIM-10. Les maladies transmissibles sont définies par fièvre et/ou nombre anormal de globules blancs dû à une infection. Les MNT sont des maladies chroniques non causées par un micro-organisme. Comparaison selon l'âge (p < 0,05). Résultats. 4591 patients admis, 94,0% (4316/4591) inclus. Âge moyen : 52,9 ± 17,2 ans, 51,3% jeunes, 55,3% hommes. Les MNT représentaient les deux tiers des admissions. Principales causes d'admissions selon la CIM-10 : maladies infectieuses (20,5%), cancer (19,9%), maladies cardiovasculaires (19,0%). Jeunes patients admis pour maladies infectieuses (p < 0,001), patients âgés pour maladies cardiovasculaires (p < 0,001). Durée médiane de séjour : 7,0 jours, mortalité hospitalière : 17,4%. Conclusion. Les maladies infectieuses, le cancer et les maladies cardiovasculaires étaient les principales causes d'admissions médicales. Ce profil d'admissions peut s'expliquer par le double fardeau des maladies dans les pays en développement.
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References
- Santosa A, Wall S, Fottrell E, Högberg U, Byass P. The development and experience of epidemiological transition theory over four decades: a systematic review. Glob Health Action. 2014;7(1):23574-90.
- United Nations. World population prospects, the 2019 revision - volume I: comprehensive tables. 26th ed. New York: United Nations; 2019. 374 p.
- Foreman KJ, Marquez N, Dolgert A, Fukutaki K, Fullman N, McGaughey M, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet. 2018;392(10159):2052-90.
- World Health Organization. The global burden of disease: 2004 update. Geneva: World Health Organization; 2008. 146 p.
- Dagenais GR, Leong DP, Rangarajan S, Lanas F, Lopez-Jaramillo P, Gupta R, et al. Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study. Lancet. 2020;395(10226):785-94.
- Etyang AO, Munge K, Bunyasi EW, Matata L, Ndila C, Kapesa S, et al. Burden of disease in adults admitted to hospital in a rural region of coastal Kenya: an analysis of data from linked clinical and demographic surveillance systems. Lancet Glob Health. 2014;2(4):e216-24.
- Carneiro I, Howard N. Introduction to epidemiology. 2nd ed. Maidenhead: Open University Press; 2011. 183 p.
- English M, Mwaniki P, Julius T, Chepkirui M, Gathara D, Ouma PO, et al. Hospital mortality - a neglected but rich source of information supporting the transition to higher quality health systems in low and middle income countries. BMC Med. 2018;16(1):32-41.
- Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151-210.
- Direction de la Recherche des Etudes, de l’Evaluation et des Statistiques. Les établissements de santé : édition 2020. Paris: Direction de la Recherche des Etudes, de l’Evaluation et des Statistiques; 2020. 204 p.
- Etyang AO, Gerard Scott JA. Medical causes of admissions to hospital among adults in Africa: a systematic review. Glob Health Action. 2013;6(1):19090-104.
- Okoroiwu HU, Uchendu KI, Essien RA. Causes of morbidity and mortality among patients admitted in a tertiary hospital in southern Nigeria: a 6 year evaluation. PLoS One. 2020;15(8):e0237313-28.
- Adebayo O, Freeman O, Osarenkhoe J, Omoruyi L, Imarhiagbe L. Pattern and outcome of medical admissions in a Nigerian rural teaching hospital (2009-2012). Ann Trop Med Public Health. 2014;7(3):171-6.
- Ali E, Woldie M. Reasons and outcomes of admissions to the medical wards of Jimma University Specialized Hospital, Southwest Ethiopia. Ethiop J Health Sci. 2011;20(2):113-20.
- Noor SK, Elmadhoun WM, Bushara SO, Ahmed MH. The changing pattern of hospital admission to medical wards: burden of non-communicable diseases at a hospital in a developing country. Sultan Qaboos Univ Med J. 2015;15(4):e517-22.
- Ministère de Santé Publique. Profil sanitaire analytique 2016 Cameroun. Yaoundé: Ministère de Santé Publique; 2016. 121 p.
- Nkoke C, Jingi AM, Makoge C, Teuwafeu D, Nkouonlack C, Dzudie A. Epidemiology of cardiovascular diseases related admissions in a referral hospital in the South West region of Cameroon: a cross-sectional study in sub-Saharan Africa. PLoS One. 2019;14(12):e0226644-52.
- Mapoure YN, Kuate C, Tchaleu CB, Mbatchou Ngahane HB, Mounjouopou GN, Ba H, et al. Stroke epidemiology in douala: three years prospective study in a teaching hospital in Cameroon. World J Neurosci. 2014;4(5):406-14.
- Luma HN, Doualla MS, Mbatchou Ngahane HB, Temfack E, Joko HA, Kuaban C. Extrapulmonary tuberculosis and HIV coinfection in patients treated for tuberculosis at the Douala General Hospital in Cameroon. Ann Trop Med Public Health. 2013;6(1):100-4.
- Pancha Mbouemboue O, Ngoufack JO, Koona Koona A, Maha F, Kingue S. Place et profil évolutif des maladies cardiovasculaires en milieu hospitalier nord camerounais : le cas de l’Hôpital Régional de Ngaoundéré. Health Sci Dis. 2015;16(1):1-7.
- World Health Organization. International statistical classification of diseases and related health problems. 10th ed. Geneva: World Health Organization; 2009. 1203 p.
- 3è recensement général de la population et de l’habitat. http://www.bucrep.cm/index.php/fr/ressources-et-documentations/telechargement/category/46-resultats-du-3eme-rgph. Accessed on 28 December 2021.
- Ogunmola OJ, Oladosu OY. Pattern and outcome of admissions in the medical wards of a tertiary health center in a rural community of Ekiti state, Nigeria. Ann Afr Med. 2014;13(4):195-203.
- Olatayo Adeoti A, Adekunle Ajayi E, Oladimeji Ajayi A, Ayokunle Dada S, Olusesan Fadare J, Akolawole M, et al. Pattern and outcome of medical admissions in Ekiti State University Teaching Hospital, Ado-Ekiti- a 5 year review. Am J Med Med Sci. 2015;5(2):92-8.
- Ogunmola OJ, Olamoyegun MA. Patterns and outcomes of medical admissions in the accident and emergency department of a tertiary health center in a rural community of Ekiti, Nigeria. J Emerg Trauma Shock. 2014;7(4):261-7.
- Wang T, Zhao Z, Yu X, Zeng T, Xu M, Xu Y, et al. Age-specific modifiable risk factor profiles for cardiovascular disease and all-cause mortality: a nationwide, population-based, prospective cohort study. Lancet Reg Health West Pac. 2021;17:100277-86.
- Kalyesubula R, Mutyaba I, Rabin T, Andia-Biraro I, Alupo P, Kimuli I, et al. Trends of admissions and case fatality rates among medical in-patients at a tertiary hospital in Uganda; A four-year retrospective study. PLoS One. 2019;14(5):e0216060-73.
- Allain TJ, Aston S, Mapurisa G, Ganiza TN, Banda NP, Sakala S, et al. Age related patterns of disease and mortality in hospitalised adults in Malawi. PLoS One. 2017;12(1):e0168368-80.
- Wong EB, Olivier S, Gunda R, Koole O, Surujdeen A, Gareta D, et al. Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study. Lancet Glob Health. 2021;9(7):e967-76.
- Boutayeb A. The double burden of communicable and non-communicable diseases in developing countries. Trans R Soc Trop Med Hyg. 2006;100(3):191-9.
- World Health Organization. Global status report on noncommunicable diseases 2010. World Health Organization. Geneva: World Health Organization; 2011. 162 p.
- Yusuf S, Reddy S, Ôunpuu S, Anand S. Global burden of cardiovascular diseases: Part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104(22):2746-53.
- Sobngwi E, Mbanya JC, Unwin NC, Porcher R, Kengne A-P, Fezeu L, et al. Exposure over the life course to an urban environment and its relation with obesity, diabetes, and hypertension in rural and urban Cameroon. Int J Epidemiol. 2004;33(4):769-76.
- Ezzati M, Riboli E. Behavioral and dietary risk factors for noncommunicable diseases. N Engl J Med. 2013;369(10):954-64.
- Bane A, Bayisa T, Adamu F, Guteta Abdissa S. Medical admissions and outcomes at Saint Paul’s Hospital, Addis Ababa, Ethiopia: a retrospective study. Ethiop J Health Dev. 2016;30(1):50-6.
- Baek H, Cho M, Kim S, Hwang H, Song M, Yoo S. Analysis of length of hospital stay using electronic health records: a statistical and data mining approach. PLoS One. 2018;13(4):e0195901-16.
- McMullan R, Silke B, Bennett K, Callachand S. Resource utilisation, length of hospital stay, and pattern of investigation during acute medical hospital admission. Postgrad Med J. 2004;80(939):23-6.
- Kellett J, Deane B. The diagnoses and co-morbidity encountered in the hospital practice of acute internal medicine. Eur J Intern Med. 2007;18(6):467-3.
- Marco J, Barba R, Plaza S, Losa JE, Canora J, Zapatero A. Analysis of the mortality of patients admitted to internal medicine wards over the weekend. Am J Med Qual. 2010;25(4):312-8.
- Halle MP, Kengne AP, Ashuntantang G. Referral of Patients with kidney impairment for specialist care in a developing country of sub-Saharan Africa. Ren Fail. 2009;31(5):341-8.
- Halle MP, Tsinga L, Fottsoh Fokam A, Kaze Folefack F, Mouelle Sone A, Ashuntantang G. Does timing of nephrology referral influence outcome among patients on maintenance hemodialysis in Cameroon. Health Sci Dis. 2017;18(3):28-34.
- Halle MP, Nyongbella J, Fouda H, Balepna JY, Kaze Folefack F, Ashuntantang Enow G. Factors associated with late presentation of patients with chronic kidney disease in nephrology consultation in Cameroon-a descriptive cross-sectional study. Ren Fail. 2019;41(1):384-92.
- Luma HN, Jua P, Donfack OT, Kamdem F, Ngouadjeu E, Mbatchou HB, et al. Late presentation to HIV/AIDS care at the Douala General Hospital, Cameroon: its associated factors, and consequences. BMC Infect Dis. 2018;18(1):298-306.
References
Santosa A, Wall S, Fottrell E, Högberg U, Byass P. The development and experience of epidemiological transition theory over four decades: a systematic review. Glob Health Action. 2014;7(1):23574-90.
United Nations. World population prospects, the 2019 revision - volume I: comprehensive tables. 26th ed. New York: United Nations; 2019. 374 p.
Foreman KJ, Marquez N, Dolgert A, Fukutaki K, Fullman N, McGaughey M, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet. 2018;392(10159):2052-90.
World Health Organization. The global burden of disease: 2004 update. Geneva: World Health Organization; 2008. 146 p.
Dagenais GR, Leong DP, Rangarajan S, Lanas F, Lopez-Jaramillo P, Gupta R, et al. Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study. Lancet. 2020;395(10226):785-94.
Etyang AO, Munge K, Bunyasi EW, Matata L, Ndila C, Kapesa S, et al. Burden of disease in adults admitted to hospital in a rural region of coastal Kenya: an analysis of data from linked clinical and demographic surveillance systems. Lancet Glob Health. 2014;2(4):e216-24.
Carneiro I, Howard N. Introduction to epidemiology. 2nd ed. Maidenhead: Open University Press; 2011. 183 p.
English M, Mwaniki P, Julius T, Chepkirui M, Gathara D, Ouma PO, et al. Hospital mortality - a neglected but rich source of information supporting the transition to higher quality health systems in low and middle income countries. BMC Med. 2018;16(1):32-41.
Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151-210.
Direction de la Recherche des Etudes, de l’Evaluation et des Statistiques. Les établissements de santé : édition 2020. Paris: Direction de la Recherche des Etudes, de l’Evaluation et des Statistiques; 2020. 204 p.
Etyang AO, Gerard Scott JA. Medical causes of admissions to hospital among adults in Africa: a systematic review. Glob Health Action. 2013;6(1):19090-104.
Okoroiwu HU, Uchendu KI, Essien RA. Causes of morbidity and mortality among patients admitted in a tertiary hospital in southern Nigeria: a 6 year evaluation. PLoS One. 2020;15(8):e0237313-28.
Adebayo O, Freeman O, Osarenkhoe J, Omoruyi L, Imarhiagbe L. Pattern and outcome of medical admissions in a Nigerian rural teaching hospital (2009-2012). Ann Trop Med Public Health. 2014;7(3):171-6.
Ali E, Woldie M. Reasons and outcomes of admissions to the medical wards of Jimma University Specialized Hospital, Southwest Ethiopia. Ethiop J Health Sci. 2011;20(2):113-20.
Noor SK, Elmadhoun WM, Bushara SO, Ahmed MH. The changing pattern of hospital admission to medical wards: burden of non-communicable diseases at a hospital in a developing country. Sultan Qaboos Univ Med J. 2015;15(4):e517-22.
Ministère de Santé Publique. Profil sanitaire analytique 2016 Cameroun. Yaoundé: Ministère de Santé Publique; 2016. 121 p.
Nkoke C, Jingi AM, Makoge C, Teuwafeu D, Nkouonlack C, Dzudie A. Epidemiology of cardiovascular diseases related admissions in a referral hospital in the South West region of Cameroon: a cross-sectional study in sub-Saharan Africa. PLoS One. 2019;14(12):e0226644-52.
Mapoure YN, Kuate C, Tchaleu CB, Mbatchou Ngahane HB, Mounjouopou GN, Ba H, et al. Stroke epidemiology in douala: three years prospective study in a teaching hospital in Cameroon. World J Neurosci. 2014;4(5):406-14.
Luma HN, Doualla MS, Mbatchou Ngahane HB, Temfack E, Joko HA, Kuaban C. Extrapulmonary tuberculosis and HIV coinfection in patients treated for tuberculosis at the Douala General Hospital in Cameroon. Ann Trop Med Public Health. 2013;6(1):100-4.
Pancha Mbouemboue O, Ngoufack JO, Koona Koona A, Maha F, Kingue S. Place et profil évolutif des maladies cardiovasculaires en milieu hospitalier nord camerounais : le cas de l’Hôpital Régional de Ngaoundéré. Health Sci Dis. 2015;16(1):1-7.
World Health Organization. International statistical classification of diseases and related health problems. 10th ed. Geneva: World Health Organization; 2009. 1203 p.
3è recensement général de la population et de l’habitat. http://www.bucrep.cm/index.php/fr/ressources-et-documentations/telechargement/category/46-resultats-du-3eme-rgph. Accessed on 28 December 2021.
Ogunmola OJ, Oladosu OY. Pattern and outcome of admissions in the medical wards of a tertiary health center in a rural community of Ekiti state, Nigeria. Ann Afr Med. 2014;13(4):195-203.
Olatayo Adeoti A, Adekunle Ajayi E, Oladimeji Ajayi A, Ayokunle Dada S, Olusesan Fadare J, Akolawole M, et al. Pattern and outcome of medical admissions in Ekiti State University Teaching Hospital, Ado-Ekiti- a 5 year review. Am J Med Med Sci. 2015;5(2):92-8.
Ogunmola OJ, Olamoyegun MA. Patterns and outcomes of medical admissions in the accident and emergency department of a tertiary health center in a rural community of Ekiti, Nigeria. J Emerg Trauma Shock. 2014;7(4):261-7.
Wang T, Zhao Z, Yu X, Zeng T, Xu M, Xu Y, et al. Age-specific modifiable risk factor profiles for cardiovascular disease and all-cause mortality: a nationwide, population-based, prospective cohort study. Lancet Reg Health West Pac. 2021;17:100277-86.
Kalyesubula R, Mutyaba I, Rabin T, Andia-Biraro I, Alupo P, Kimuli I, et al. Trends of admissions and case fatality rates among medical in-patients at a tertiary hospital in Uganda; A four-year retrospective study. PLoS One. 2019;14(5):e0216060-73.
Allain TJ, Aston S, Mapurisa G, Ganiza TN, Banda NP, Sakala S, et al. Age related patterns of disease and mortality in hospitalised adults in Malawi. PLoS One. 2017;12(1):e0168368-80.
Wong EB, Olivier S, Gunda R, Koole O, Surujdeen A, Gareta D, et al. Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study. Lancet Glob Health. 2021;9(7):e967-76.
Boutayeb A. The double burden of communicable and non-communicable diseases in developing countries. Trans R Soc Trop Med Hyg. 2006;100(3):191-9.
World Health Organization. Global status report on noncommunicable diseases 2010. World Health Organization. Geneva: World Health Organization; 2011. 162 p.
Yusuf S, Reddy S, Ôunpuu S, Anand S. Global burden of cardiovascular diseases: Part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104(22):2746-53.
Sobngwi E, Mbanya JC, Unwin NC, Porcher R, Kengne A-P, Fezeu L, et al. Exposure over the life course to an urban environment and its relation with obesity, diabetes, and hypertension in rural and urban Cameroon. Int J Epidemiol. 2004;33(4):769-76.
Ezzati M, Riboli E. Behavioral and dietary risk factors for noncommunicable diseases. N Engl J Med. 2013;369(10):954-64.
Bane A, Bayisa T, Adamu F, Guteta Abdissa S. Medical admissions and outcomes at Saint Paul’s Hospital, Addis Ababa, Ethiopia: a retrospective study. Ethiop J Health Dev. 2016;30(1):50-6.
Baek H, Cho M, Kim S, Hwang H, Song M, Yoo S. Analysis of length of hospital stay using electronic health records: a statistical and data mining approach. PLoS One. 2018;13(4):e0195901-16.
McMullan R, Silke B, Bennett K, Callachand S. Resource utilisation, length of hospital stay, and pattern of investigation during acute medical hospital admission. Postgrad Med J. 2004;80(939):23-6.
Kellett J, Deane B. The diagnoses and co-morbidity encountered in the hospital practice of acute internal medicine. Eur J Intern Med. 2007;18(6):467-3.
Marco J, Barba R, Plaza S, Losa JE, Canora J, Zapatero A. Analysis of the mortality of patients admitted to internal medicine wards over the weekend. Am J Med Qual. 2010;25(4):312-8.
Halle MP, Kengne AP, Ashuntantang G. Referral of Patients with kidney impairment for specialist care in a developing country of sub-Saharan Africa. Ren Fail. 2009;31(5):341-8.
Halle MP, Tsinga L, Fottsoh Fokam A, Kaze Folefack F, Mouelle Sone A, Ashuntantang G. Does timing of nephrology referral influence outcome among patients on maintenance hemodialysis in Cameroon. Health Sci Dis. 2017;18(3):28-34.
Halle MP, Nyongbella J, Fouda H, Balepna JY, Kaze Folefack F, Ashuntantang Enow G. Factors associated with late presentation of patients with chronic kidney disease in nephrology consultation in Cameroon-a descriptive cross-sectional study. Ren Fail. 2019;41(1):384-92.
Luma HN, Jua P, Donfack OT, Kamdem F, Ngouadjeu E, Mbatchou HB, et al. Late presentation to HIV/AIDS care at the Douala General Hospital, Cameroon: its associated factors, and consequences. BMC Infect Dis. 2018;18(1):298-306.