Medical Ward In-Patient Mortality Patterns at a Tertiary Hospital in Urban Zambia: A One Year Review June 2018-June 2019

Abstract

Background: Very little information exists about the causes of death in Zambian Hospitals. Recording of health related vital events in Zambia is often incomplete, and thus government relies on inaccurate verbal autopsies and models to guide policy and monitor increasing amounts of donor aid given towards the eradication of specific diseases. As most developing regions of the world are undergoing gradual epidemiologic transition, inpatient hospital mortality patterns become more important in reflecting this  transition.
Objectives: The purpose of this study was to establish the inpatient mortality patterns among patients admitted to the adult medical wards of Kitwe Teaching Hospital between June 2018 and June 2019.
Methods: The files of patients who had died between June 2018 and June 2019 were reviewed and death information extracted by a combined team of clinicians. This information was then inputted and analysed using SPSS version 16.0 for Statistical Analysis.
Results: It was observed that most (n=145, 56.60%) deaths occurred within 72 hours of admission, 47% of these deaths were of Human Immune-deficiency Virus (HIV) positive patients (p=0.04). 55% of all HIV positive related mortalities occurred within 72
hours of admission. There was a bimodal distribution of causes of death with deaths due to communicable diseases (n=118, 46.09%) occurring in the younger age groups (median age 36, p=0.000) and HIV positive and deaths due to noncommunicable diseases (n=138, 53.9%) occurring in the older age groups (median age 54, p=0.000) and HIV negative. HIV (n=124, 48.44%) and TB (n=54, 21.10%) were the leading communicable causes of death. Stroke (n=37, 14.50%) and heart failure (n=24, 9.40%) were leading non-communicable
causes of death. Hypertension was the most common associated cause of death (n=38, 13.80%). Overall, more men died than women (male to female ratio 1.49:1), men died at a younger age (median age 42, p=0.180) compared to women (median age 46, p=0.180).
Conclusion: Most patients died within 72 hours of admission, with the young dying mainly from communicable diseases associated with HIV and the elderly from non-communicable diseases associated with hypertension.

Key words: Africa, Zambia, inpatient mortality patterns, HIV, TB, HTN, CVA