Joseph O. Fadare1 and A.O. Afolabi2
- Department of Medicine, Kogi State Specialist Hospital, Lokoja, Nigeria.
- Department of Surgery, Kogi State Specialist Hospital, Lokoja, Nigeria.
Abstract
Background: Review of causes of morbidity and mortality in health care facilities is an important exercise which gives a picture of the prevailing disease pattern in the particular community and at the same time looks out for any change in the disease pattern over time. This exercise is a necessary component for planning of the health care needs of the community.
Objective: To determine the mortality pattern on the medical wards of the Kogi State Specialist Hospital, a tertiary center located in Lokoja, North-Central Nigeria.
Methods: A retrospective review of medical records of all patients admitted to the medical wards of the hospital over a period of 18 months (December 2008 – May 2010) was carried out. The information recorded from these sources included the age and gender, diagnosis/ cause of death and the duration of admission.
Results: A total of six hundred and eighty-four patients were admitted during the period being studied with a predominance of female patients (Female: Male Ratio = 1.07). There were seventy-six deaths (11.1%) during the period in question with HIV and related complications accounting for most recorded mortality (32.9%) closely followed by non-communicable cardiovascular conditions (hypertension, heart failure and CVD) – 28.9%.
Conclusion: This study clearly shows that HIV infection and its complications remains the leading cause of death despite the advent of HAART. Clearly there is a need to revisit the strategies of HIV prevention and control. Also there is an urgent need to focus on the prevention and treatment of non communicable diseases like hypertension and diabetes.
Keywords: Mortality pattern, causes, medical wards, Nigeria
Correspondence:
Dr. Joseph O. Fadare
Department of Medicine,
Kogi State Specialist Hospital,
Lokoja, Nigeria
Email: jofadare@gmail.com
Introduction
The review of causes of morbidity and mortality in health care facilities is an important exercise with farreaching implications. This form of clinical audit gives a picture of the prevailing disease pattern in the particular community and at the same time looks out for any change in the disease pattern over time. It a well known fact that the lifestyle and habits of most people living in developing countries like Nigeria is being influenced tremendously by the that of the western world1. This obviously has its own effect on the health status of the population of these nations leading to a change in the disease pattern seen in these nations. The information provided by this kind of review plays an important role in future planning and strategizing for better service provision in the health care sector2. It also highlights the particular areas where the government and various non-governmental organizations have to prioritize as regards health care delivery to the community.
Studies carried out in Nigeria in the pre-HIV and early post-discovery era3, 4 revealed non-HIV infections and cardiovascular conditions as the main causes of medical mortality, it is important to investigate the current trend in our environment especially in this era of HIV/AIDS. For the purposes of this study, it will be practical to view the HIV/AIDS period in two phases: the pre-ARV, and the post- ARV. While studies done in the pre-ARV period showed that HIV/AIDS or its related conditions were the main causes of morbidity and mortality in the medical wards5, 6, there is a need to assess the trend especially now ARVs are now more accessible to patients needing them in developing countries at little or no cost.
Global projections of mortality and burden of disease up to 2030 have indicated a significant shift from infectious/communicable to non-communicable diseases worldwide and this transition is expected to affect developing countries like Nigeria7. The objective of this study was to investigate the causes of mortality on the medical wards of a specialist hospital in Lokoja, north-central Nigeria and to observe whether the trends discussed earlier exist in our environment.
METHODS
A retrospective review of medical records of all patients admitted to the medical wards of the Kogi State Specialist Hospital, Lokoja, North-central Nigeria was carried out. Lokoja, located about 200 kilometres from Abuja (the Federal Capital), is a major transit town connecting the Northern and Southern parts of Nigeria. It is also a major inland river port and the meeting point of the rivers Niger and Benue. This centre is one of two medical facilities rendering tertiary level health care services for the people of Lokoja, capital of Kogi State and its environs. The facility is an 80-bed hospital, with the medical wards accounting for thirty-two. It also provides in-patient and outpatient care with about twenty specialists in various fields of medicine: internal medicine, paediatrics, surgery, obstetrics and gynaecology, haematology and histopathology. In addition to providing services in the above mentioned fields, the hospital also has a fully functional HIV/ARV clinic which is supported by the federal government of Nigeria and some foreign developmental partners which has been operational in the last three years. The review included all cases admitted to the medical wards of the hospital from December 2008 till the end of May 2010 and the records used for this study are the admission and discharge register, patients’ case notes and copies of death certificates. The information recorded from these sources included the age and gender, diagnosis/ cause of death and the duration of admission. The data was entered and analyzed using SPSS version 12.