|Year : 2014 | Volume
| Issue : 3 | Page : 102-107
Causes and pattern of death in a tertiary hospital in south eastern Nigeria
CC Nwafor Chukwuemeka Charles1, MA Nnoli Martin Azodo2, C Abali Chuku3
1 Department of Pathology, Federal Medical Centre, Umuahia, Abia State, Nigeria
2 Department of Pathology, University of Calabar, Calabar, Cross River State, Nigeria
3 Department of Ophthalmology, Federal Medical Centre, Umuahia, Abia State, Nigeria
|Date of Web Publication||6-Sep-2014|
C C Nwafor Chukwuemeka Charles
Department of Pathology, Federal Medical Centre, Umuahia, Abia State
Background: Morbidity and mortality pattern is a reflection of disease burden. The aim of this study is to provide a comprehensive report of the causes of death in a tertiary hospital in Nigeria, a developing tropical nation. Methods and Material: We carried out a retrospective descriptive cross-sectional study of all records of deaths from January 2004 to December 2008 in Federal Medical Centre Umuahia, Abia, State in Southeast Nigeria. Results: Of a total of 18,107 patients were admitted during the study period, 2;172 deaths representing 12% mortality rate and comprising 1;230 (56.6%) males and 942 (43.4%) females were recorded. The age of patients ranged from birth to 100 years with a mean of 41.41 ± 26.30 years and 25-44 years age group being the most affected (n = 587, 27.1%). The overall leading cause of death was the infections group, which accounted for 837 (37.6%) deaths. Other major causes were cardiovascular system -related deaths 534 (24.7%), neonatal causes 173 (8.0%), trauma 155 (7.1%), diabetes mellitus complications 144 (6.6%) and neoplasia 76 (3.5%). Conclusion: Majority of the leading causes of mortality in this study are preventable. Our data reflects the effects of double disease burden of infections and non- communicable communicable diseases in a developing nation.
Keywords: Developing nation, mortality, tertiary hospital
|How to cite this article:|
Nwafor Chukwuemeka Charles C C, Nnoli Martin Azodo M A, Chuku C A. Causes and pattern of death in a tertiary hospital in south eastern Nigeria. Sahel Med J 2014;17:102-7
|How to cite this URL:|
Nwafor Chukwuemeka Charles C C, Nnoli Martin Azodo M A, Chuku C A. Causes and pattern of death in a tertiary hospital in south eastern Nigeria. Sahel Med J [serial online] 2014 [cited 2020 Apr 10];17:102-7. Available from: http://www.smjonline.org/text.asp?2014/17/3/102/140292
| Introduction|| |
Data on morbidity and mortality are vital inputs for assessing population health status and disease burden. , While medically certified cause of death data from complete civil registration system is the 'gold standard' for such statistics, these are generally nott available in over two-thirds of all countries.  Reliable information on causes of death is essential to the development of national and international health policies for prevention and control of disease and injury. , Globally there were 52.8 million deaths in 2010.  In a multi--systematic analysis involving 187 countries over a period of 30 years, it was observed that the leading causes of death were ischemic heart disease, stroke, chronic obstructive pulmonary disease, lower respiratory infections, lung lung cancer and HIV/AIDS.  Substantial regional variations in these leading causes were documented with communicable, maternal, neonatal and nutritional causes being responsible for about 76% of premature mortality in sub-Saharan Africa in 2010.  Population-based data disease prevalence, patterns of morbidity and mortality are often lacking in developing countries. ,,,, Hospital-based disease frequency and pattern of death often offer best alternative. ,,,,, Majority of African studies report infectious diseases as the major cause of death. ,,,,, In Ife and Owo (western Nigeria), infections, trauma, neonatal and pregnancy-related deaths were the leading causes of death. , Studies from Kano (northern Nigeria) reported infectious diseases other than HIV/AIDS, cerebrovascular disease and chronic renal failure as leading causes of hospital deaths. , There is paucity of data from south eastern Nigeria on this topic.
The aim of this study is to provide a comprehensive report of the causes of death in a tertiary hospital in south eastern Nigeria.
| Materials and methods|| |
This study was carried out at Federal Medical Center, a 247-bedded tertiary health care facility in Umuahia with a catchment population of 6,772,943 covering Abia and Imo States of Nigeria. 
We carried out a 5 year retrospective descriptive cross-sectional study of deaths in this hospital January 2004 and December 2008. The hospital has a high standard of medical practice as well as both manual and electronic methods of record keeping. Information obtained from the records included, demography, duration of hospital admission, ward of admission, primary diagnosis and cause of death. Cause of death was coded according to the International Classifications of Diseases, (ICD-10). The 10 th version of ICD uses an alphanumeric coding scheme of one letter followed by three numbers at the four character level. 
Patients with inadequate clinical information and patients that were brought in dead were excluded from the study. All the data obtained was coded, edited appropriately and re-entered into personal computer.
The data was analyzed using the Statistical Package for Social Sciences version 16 (Chicago, Illinois, USA) and mean ± SD was generated for continuous variables while, Chi-square test was used to test significance of difference between two proportions. P < 0.05 was taken as a measure of statistical significance.
Approval for the study was obtained from the Hospital Ethical Committee. A major limitation of this study was that autopsy was not done on any of the deceased.
| Result|| |
Of the 18,107 patients admitted, 2,172 died giving a 12% mortality rate. The year 2006 had the highest mortality rate (14.2%), followed by the year 2007 (12.8%). Year 2004, recorded the least with a mortality rate of 9.6% as shown in [Figure 1]. [Table 1], shows the monthly pattern of variation in mortality rate. The mortality rate was highest in month of July (13.5%), closely followed by February (13%). The month of August accounted for the least (10.5%).
Of the 7,181 males admitted (39.7% of all admissions), 1,230 died giving a mortality of 17.1%, while of the 10,926 females admitted (60.3% of all admissions), 942 died giving a mortality rate of 8.6% as shown in [Table 2]. Mortality involving males accounted for 1,230 (56.6%) total deaths while females accounted for 942 (43%).The ages of patients were from less than a day old to 100 years with a mean of 41.41 ± 26.30 years. Age group 25-44 years was the most affected (n = 587, 27.1%) closely followed by age groups >65 years and 45-64 years age group accounting for 548 (25.2%) and 495 (22.8%), respectively. The age groups with least mortality were the 1-4 years, 5-9 years and 10-14 years accounting for 4.1%, 1.5% and 1.1%, respectively as shown in [Table 3].
[Table 4], shows the different causes of death. The overall leading cause of death is the infections group, which accounted for 837 (38.6%) deaths. This together with cardiovascular system related deaths 534 (24.7%), constituted over 50% (63.3%) of deaths recorded over the study period. In addition to the above two, other major causes of death were neonatal disease causes 173 (8%), trauma 155 (7.1%), diabetes mellituscomplications 144 (6.6%) and neoplasia 76 (3.5%).
[Table 5]; showed the various causes of death in each of the broad groups. In the infections group, the three leading causes of death were HIV/AIDS 437 (52.2%), malaria 150 (17.9%) and septicaemia 51 (6.1%). In the cardiovascular group, the leading causes of death were cerebrovascular accident 348 (65.1%), congestive cardiac failure 109 (20.4%) and severe/malignant hypertension. Deaths among neonates were primarily caused by severe birth asphyxia 59 (34.1%), prematurity 42 (24.3%) and neonatal sepsis 41 (23.6%) Neoplastic causes of death were mainly due to breast cacinomas 17 (22.5%), primary liver cell carcinoma 16 (21.2%), and prostatic adenocarcinoma 13 (17.2%). Rare causes of death were respiratory diseases like status asthmaticus, chronic bronchitis and central nervous system diseases like hydrocephalus and epilepsy.
[Table 6]; shows the pattern of occurrence of each of the major group of diseases in relation to the age groups. Infections occurred in each of the age groups with most 362 (43.2%) occurring in the 25-44 years age group and the least 10 (1.2%) in neonates. Cardiovascular diseases were seen most in patients older than 65 years, 306 (57.3%).Only a case of cardiovascular disease was seen in childhood. Mortality cases due to trauma were seen in all age groups except in age group 2-11 months. Majority of the trauma related mortality cases were seen in age group 25-44 years. All diabetes mellitus complications related deaths were seen in adults, with 65 cases (45.1%), occurring in those older than 65 years and the least 3 cases (2.1%) seen in cases aged 15-24 years. Neoplasia related deaths involved adults mainly with only a case seen during childhood. Majority of neoplastic deaths, 30 (40.5%) were seen in people aged 45-64 years.
Most patients (46.5%, n = 1010) were on admission for less than a week before they died. Cases that died within 24hours of admission were 658 (30.3%) and 342 (15.7%) patients died within 1 to 2 weeks of admission.
| Discussion|| |
Death statistics are valuable tools for a a comparison of mortality and hospital audit systems. ,
The mortality rate of 12% was observed in this study is higher than 7.8% reported by Iliyasu et al. and 6.3% by Adekunle et al. both in Nigeria and far much higher than 1.6% reported by Salimuddin et al. in Karachi, Pakistan. ,, Similar to observations in previous studies, ,,, males were more involved than females. The relatively lower number of female deaths despite the high number of females admitted into the hospital is in accord with observations in Kano.  Females have generally been shown to have lower mortality and longer life expectancy than males. , The precise explanations for gender difference in life expectancy still elude scientists because of the apparent complex interplay of biological, social and behavioral conditions. 
In this study, infectious diseases were the highest cause of mortality. This is similar to the findings of other studies in developing countries. ,,,,, HIV/AIDS alone caused 52.2% of infectious disease-related deaths in the current study. Africa has 70% of adults and 80% of children living with AIDS in the world and 75% of the 2.1 million people worldwide who have died of AIDS.  Nigeria (the most populous country in Sub-Saharan Africa) has 5.8% of her adult population having HIV infection at the end of 2003.  Antiretroviral drugs were not free in our centerr until 2007. In spite of the current free drugs, late presentation of HIV/AIDS with complications is frequent. Efforts should be made to increase awareness and early diagnosis and treatment of HIV. Twenty six point seven percent of malaria associated deaths were seen in adults. Wrong diagnosis may be responsible for this high number of malaria associated deaths in this semi immune population.
Death from cardiovascular system diseases accounted for 24.7% of all deaths which is higher than rates reported by other Nigerian studies. ,,, The cardiovascular system disease patients died mainly of cerebrovascular accidents (65.1%), congestive cardiac failure (20.4%) and severe/malignant hypertension (13.3%). Cases of myocardial infarction might have been missed because of lack of high index of suspicion, non-routine performance of ECG for suspected cases, non-availability of facilities for determination of cardiac enzymes (serum troponin and MB creatinine kinase). It has been projected that by year 2030, almost 23.6 million people will die from cardiovascular diseases.  In sub-Saharan Africa, the prevalence of cardiovascular diseases has reached near epidemic proportions with systemic hypertension being the main driver of cardiovascular complications.  In the current study, 95% of cardiovascular disease-related mortalitiesies are related to complications of hypertension. Neonatal mortality is a useful index of assessing the socioeconomic development.  Neonatal disease accounted for 8% of deaths and ranked as the third major cause of death in the current study. This is similar to 8% reported in Kano, Nigeria and less than 10.8% and 26.8% reported in Ife, Nigeria, and Karachi, Pakistan. ,, Neonatal deaths have have consistently featured among the five major causes of mortality in most reports from developing nations. ,, The causes of neonatal deaths in our study including severe birth asphyxia, prematurity, neonatal sepsis, jaundice and low birth weight were previous observations. ,,,, Perinatal mortality is at unacceptably high levels in sub-Saharan Africa and South Central Asia.  It is a key indicator of the health status of a community.  Specifically, it reflects the quality of prenatal, delivery and early infant care practices available in any setting. It is also a major contributor to overall causes of mortality in children under the age of 55 years. 
Trauma was the fourth leading cause of death in our study and accounted for 7.1% of all deaths. This may be an underestimate because a lot of road traffic accident victims might have been brought in dead and not included in this study. Road traffic accidents and burns accounted for 67.7% and 14.8% of all trauma-related deaths. Globally 1 in every 10 deaths is due to injuries (trauma).  Trauma mortality is said to be highest in south east Asia, Latin America and the eastern Mediterranean region.  In the current study majority of trauma victims (32.9%) were in the age group 25-44 years and were mainly males. This is similar to findings in a global survey of patterns of mortality in young people.  The high number of burns cases in this study was mainly as a result of petroleum product explosion. Petroleum products are stored in homes and business premises because of inadequate supply of electricity with attendant increase rate of fire outbreak.
Neoplasia accounted for 3.5% of deaths and ranked sevenseventh leading cause of mortality in the current study. These neoplastic deaths were mainly due to breast carcinomas, primary liver cell carcinoma, prostatic adenocarcinoma and uterine cervical carcinoma. The high rate of liver and cervical carcinoma agrees with well-documented findings that most developing countries are disproportionately affected by cancer related to infectious agents. 
| Conclusion|| |
In conclusion, our data illustrate mortality due to double disease burden comprising largely preventable infectious and non-communicable diseases in a typical developing nation. We recommend comprehensive preventive and interventional programs aimed at reducing these trends.
| References|| |
|1.||Mathers CD, Fat DM, Inoue M, Rao C, Lopez AD.Counting the dead and whatthey died of: An assessment of the global status of cause of death data. Bull World Health Organ 2005;83:171-7. |
|2.||Sani MU, Mohammed AZ, Bapp A, Borodo MM. A three year review of mortality patterns in the medical wards of Aminu Kano Teaching hospital, Kano, Nigeria. Niger Postgrad Med J 2007;14:347-51. |
|3.||Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global burden of disease study. Lancet 1997;349:1269-76. |
|4.||Seval A, Chalapati R, Nazan Y, Berrak BB, Ozlem A et al. Estimating mortality and causesof death in Turkey: Methods, results and policy implications. Eur J Public Health 2007;17:593-599. |
|5.||Adeolu AA1, Arowolo OA, Alatise OI, Osasan SA, Bisiriyu LA, Omoniyi EO, et al. Pattern of death in a Nigeria teaching hospital; 3 decade analysis. Afr Health Sci 2010;10:266-72. |
|6.||Iliyasu Z, Abubaka IS, Gajida AU.Magnitude and leading causesof in-hospital mortality at Aminu Kano Teaching Hospital Kano, northern Nigeria. A 4-year prospective analysis. Niger JMed 2010;19:400-6. |
|7.||Adekunle O, Olatunde 1O, Abdullateef RM. Causes and pattern of death in a tertiary health institution in South Western Nigeria. NigerPostgrad Med J 2008;15:247-50. |
|8.||Einterz EM, Bates M. Causes and circumstances of death in a district hospital in northern Cameroon, 1993-2009. Rural Remote Health 2011;1:1623. |
|9.||Misganaw A, Mariam DH, Araya T, Ayele K. Patterns of mortality in public and private hospitals of Addis Ababa, Ethiopia. BMC Public Health 2012;12:1007-19. |
|10.||Federal Republic of Nigeria. Table DS 1 on distribution of population by state and sex. National Population Commission, April 2010. Abuja, Nigeria. p. 22. |
|11.||WHO. International statistical classification of diseases and related health problems. Tenth revision. Geneva: World Health Organization; 1994. |
|12.||Erbaydar NP, Cilingiroglu N, Piskin TM. Analysis of three-year death records of Hacettepe University Adult Hospital. Acta Medica 2013;2:8-15. |
|13.||Hannan EL, Racz M, Walford G. Out of Hospital deaths within 30 days following hospitalization where percutaneous coronary intervention was performed. Am J Cardiol 2012;109:47-52. |
|14.||Salimuddin A, Areeba E, Syed EA. Mortality pattern in a trust hospital: A hospital based study in Karachi. J Pak Med Assoc 2013;63:1031-5. |
|15.||Kinsella K, Gist YJ. Bureau of the Census, 1998, International Brief, gender and ageing: mortality and health, international programs centre, Washington. DC. Available from: http://www.census.gov/ipc/prod/ib98-2.pdf [Last accessed date 2013 Oct 05]. |
|16.||Macantyre S, Hunt K, Sweeting H. Gender differences in health: Are things really as simple as they seem? Soc Sci Med 1996;42:617-24. |
|17.||Kolo PM, Chijioke A. Gender disparities in mortality among medical admissions of a tertiary health facility in Ilorin Nigeria. Internet JTrop Med2009; 6 Number I. Dol: 10.5580/15f9. |
|18.||UNAIDS. AIDS epidemic update. Joint United Nations Programme on HIV/AIDS. December, 2000. |
|19.||UNAIDS report on the Global HIV/ADS epidemic. Joint United Nations Programme on HIV/AIDS. July, 2004. |
|20.||World Health Organization (WHO) Non-communicable disease country profiles 20011. WHO Global Report, Geneva, Switzerland, September 2011. Available from: http://whqlibdoc.who.int/publications/2011/9789241502283eng.pdf. [Last accessed on 2013 Oct 10]. |
|21.||Kadiri S. Tackling cardiovascular disease in Africa. BMJ2005;331:711-2. |
|22.||Ekure EN, Ezeaka VC, Iroha EO, Egri-Okwaji MT. Neonatal mortality of inborns in the neonatal unit of a tertiary centre in Lagos, Nigeria. Nig Quart JHosp Med 2005;15: 55-8. |
|23.||Bassani DG, Kumar R, Awasthi S, Morris SK, Paul VK, et al. Causes of neonatal and child mortality in India: A nationally representative mortality Survey. Lancet 2010;376:1853-60. |
|24.||WHO. The World health report 2005: Make every mother and child count. Geneva: World Health Organization; 2005. |
|25.||Mathers CD, Boerma T, Ma Fat D. Global and regional causes of death.Br Med Bull 2009;92:7-32. |
|26.||Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, et al. Global patterns of mortality in young people: A systematic analysis of population health data.Lancet 2009;374:881-92. |
|27.||Jemal A, Center MM, DeSantis C, Ward EM. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 2010;191893-907. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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