|Year : 2018 | Volume
| Issue : 4 | Page : 213-217
Morbidity and mortality profile of patients seen in medical emergency unit of a Teaching Hospital in Nigeria: A 4-year audit
Bello Yusuf Jamoh, Sani Atta Abubakar, Sani Muhammad Isa
Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
|Date of Web Publication||31-Dec-2018|
Dr. Bello Yusuf Jamoh
Department of Medicine, Ahmadu Bello University, Zaria
Background: Ahmadu Bello University Teaching Hospital (ABUTH) Zaria is strategically located to serve as referral center for most stable and emergency cases in the northwestern part of Nigeria. Patients also come on self-referral. Objective: This study aimed to describe the pattern of medical presentation and outcomes at the emergency unit of ABUTH over a 4-year period. Materials and Methods: A review of medical admissions into the Emergency unit of ABUTH, Zaria, between January 2013 and December 2016 was carried out using the case records of patients as well as register of admissions and discharges, information obtained were entered into a predetermined questionnaire. Results: The patients admitted during the period numbered 5193, with age range of 15–92 years. There were 2895 (56.0%) males and 2298 (44.0%), with a male-to-female ratio of 1.3:1. Emergencies attributable to infectious diseases occurred with the highest frequency (20.6%), followed by gastrointestinal (20.5%), renal (14.5%), endocrine (13.8%), respiratory (12.4%), cardiac (9%), neurological (2.8%), and hematological (1.1%). There was a significantly (P < 0.001) higher occurrence of noncommunicable diseases (71.5%) than communicable diseases (28.5%), as well as higher male cases in renal, respiratory, hematological emergencies (P < 0.05). There were more admissions in the wet season, (April to September) while the October to January period consistently recorded the low admission rates. An increasing trend in emergency medical admissions was observed, being highest in the year 2016. The median duration of stay was 4.5 days (range of 0–12 days). The outcomes of admission revealed 470 (9%) deaths, 2012 (37%) direct discharges, and 2801 (54%) transfers to male or female medical wards. Cases of tetanus had the highest case fatality rate (45%) while hypertensive emergencies had the lowest (4%). Conclusion: There is a rising trend of communicable as opposed to non-communicable diseases' emergencies in Zaria. Of the non-communicable diseases, incidence of gastro-intestinal emergencies was the highest while that of haematology was the least. The intra-hospital mortality rate attributable to medical emergencies is relatively lower in Zaria.
Keywords: Admissions, medical emergencies, Nigeria, profile
|How to cite this article:|
Jamoh BY, Abubakar SA, Isa SM. Morbidity and mortality profile of patients seen in medical emergency unit of a Teaching Hospital in Nigeria: A 4-year audit. Sahel Med J 2018;21:213-7
|How to cite this URL:|
Jamoh BY, Abubakar SA, Isa SM. Morbidity and mortality profile of patients seen in medical emergency unit of a Teaching Hospital in Nigeria: A 4-year audit. Sahel Med J [serial online] 2018 [cited 2019 Mar 26];21:213-7. Available from: http://www.smjonline.org/text.asp?2018/21/4/213/249076
| Introduction|| |
The prevailing diseases in the society, no doubt, determine the trend exhibited in hospital admissions, which will also give an overview of the health status of the community., It therefore follows that hospitalization would give an idea of the dynamics in disease pattern in a community although the precise prevalence of such might not be determined. This information would offer insight for planning and formulation of policy necessary for the allocation of resources for health services, research, and training. Unfortunately, data of this sort are often lacking, especially in third-world countries, which would have been helpful in the proper distribution of the meager resources allocated to healthcare in such setting. Emergency services, no doubt, are one of the mainstays in the survival of patients presenting with acute illnesses.
Medical cases have been quoted to constitute 22%–40% of hospital admissions.,, Communicable diseases (CDs), with potentials to degenerating into outbreaks, are the main reasons for hospital admission in the developing counties,, and they account for 51% of years of life lost worldwide while non-CDs (NCDs) account for 34%. Nonetheless, there are large variations across the regions. In high-income countries, CDs account for only 8% of years of life lost, compared with 68% in low-income countries.,, Data on the outcome of hospital admissions are either not readily available or are not complete. Most countries have recorded incomplete data, even when International Classifications of Diseases (ICD)–9 or ICD–10 codes were used.
There is a need to estimate the most prevalent diseases from the pattern of admissions so that appropriate preventive strategies can be designed for the primary intervention. This is the most preferred and cost-effective way of disease control strategy.
Studies on the pattern and outcome of medical admission in Nigerian hospitals,,, have been documented but none, to the best of our knowledge, on emergency cases in Zaria.
This study was aimed at describing the pattern and outcome of medical emergencies seen in tertiary Health Institution in Zaria, Nigeria. It will be valuable in contributing information for planning and budgeting for the policy makers and providing source of data for the future studies as very limited information is available on the pattern and outcome of emergency medical cases admitted to Nigerian hospitals.
| Materials and Methods|| |
This retrospective study was conducted at the Ahmadu Bello University Teaching Hospital (ABUTH), Kaduna State, Nigeria, between January 2013 and December 2016. Ethical approval for the study was obtained on 17th August 2015 from Ahmadu Bello University Teaching Hospital Health and Research Ethical Committee (ABUTH/HREC/R18/2015). Patients usually present to the accident and emergency (A and E) unit as referral from surrounding secondary health-care centers although patients could come on self-referral. For the purpose of this study, all medical emergency cases that presented to the A and E unit during this period were recruited.
Admission and discharge records were retrieved, and recruitment was done using structured questionnaire designed for this study; outcome variables were discharge following improvement, transfer to the medical ward, death, and discharge against medical advice. Medical diagnoses of the admitted patients were categorized using ICD-10 coding system. The data were analyzed with STATA package (STATDISK Inc., Chicago, Version 3.0). Continuous variables were expressed as means ± standard deviation while categorical variables as frequencies and percentages. Comparisons of categorical data were performed using Pearson's Chi-square test, and P < 0.05 was considered statistically significant.
| Results|| |
The total number of cases recorded during the study was 5193 [Table 1]. There were significantly (P = 0.03) more males (2895) than female (2298) patients with male: female ratio of 1.3:1. Emergencies attributable to infectious diseases occurred under the highest frequency (1121), followed by gastrointestinal (GI) (1115), renal (786), endocrine (750), respiratory (674), cardiac (490), neurological (155), and hematological (61) emergencies, in that order. There were statistically higher male cases in renal, respiratory, hematological, and 'other' emergencies.
The distribution of emergency cases with respect to the proportions of age groups revealed that patients within the age group of 40–59 years constitute the largest proportion (39%), followed by 20–29 years (34%), and then >60 years (17%). Those patients aged 20 years or less constitute the smallest proportion (10%).
Distribution of cases by months and years
The temporal presentation of emergency cases, with respect to months, revealed a definite pattern with 2 nadirs at the extremes [Figure 1]. The first was observed from October, declining progressively to April, then it gradually rises to peak in May to June. This observed trend is more marked for 2013 and 2016 admissions. Total admissions in 2016 appear to be more than that in any other year.
Case fatality rates
Among all the emergency cases, the highest case fatality rate was observed with tetanus, having recorded 47% [Figure 2]. It was followed closely by acute hepatitis and snake envenomation, with 47% and 40%, respectively. Hypertensive crises and cerebral malaria had the lowest rate at 5% or less.
Outcome of admissions
The overall outcome of emergency admissions revealed that 2937 (54% of all) cases were transferred to medical wards after stabilization, and 2012 cases (37%) recovered and were directly discharged home (18 against medical advice). Unfortunately, 490 patients (9%) deteriorated and died.
Average duration of stay
The median duration of stay in the A and E unit revealed the order of that cases of upper GI bleeding (8 days; range of 1–11 days), heart failure (7 days; range of 1–12 days) and lung cancer (7 days; range of 3–10 days), prior to discharge, demise, or transfer to male or female medical wards. On the other hand, cases of disseminated intravascular coagulation (2 days; range of 1–2 days) and hepatic encephalopathy (2 days; range of 0–2 days) had shortest duration of stay.
| Discussion|| |
As an objective of the World Health Organization (WHO), constant evaluation of available health services as an integral part of managing health-care delivery is a plausible target, especially when applied to emergency care. In ABUTH Zaria, A and E are a major route of admission, and majority of the cases eventually get transferred to stable wards for onward management.
Findings of this study revealed more male patients admitted throughout the study period. This may be due to the fact that the 2006 population census recorded more males in Zaria. It could also be attributable to the fact that males are more economically empowered are likely to seek medical interventions more readily than females. In addition, their activities also tend to pose more injuries and risks relative to the female counterparts. A similar pattern of male preponderance was reported in tertiary health-care facility in Ekiti state. In Sagamu, a study reported that women usually seek spiritual healers' intervention first, then in hospitals when complications set in.
A temporal distribution of emergency admissions revealed higher rates during April to October interval, in 3 out of the 4 years under study. This period coincides with the rainy season. This is similar to finding by Isezuo in the same geopolitical region where he reported higher admission rates in Harmattan and wet seasons The relatively low admission rate observed from November to January is attributable to harvest activities during that period, given that farming is the predominant occupation in and around Zaria. The period also coincided with religious festivities for Christian and Muslim faithfuls, the major religious communities in and around Zaria. This pattern was also reported in Ekiti and Kano.
In the present study, NCDs were frequently diagnosed compared to CDs. This finding is in contrast to the traditional observation of CD preponderance in developing countries. The increasing adoption of a Westernized lifestyle may have contributed to the finding. Another contributing factor may have been the widespread awareness and administration of vaccines. The change in pattern from CDs to NCDs has been reported for the disease burden in urban A and E admissions in Nigeria. Similar findings were reported from Federal Medical Centres, Asaba, and Ado-Ikiti and in a Primary Health Center in South Africa.
The most common NCD was cardiac emergency; heart failure accounting for the most cases. This is similar to reports from Ekiti, Kano, and Enugu. The high prevalence of cardiovascular risk factors and poor access to healthcare may be responsible for this observation. Garko et al. reported poor compliance to medical instructions and adherence to medications among cardiac patients in Kaduna. The WHO has described cardiovascular disease as a leading contributor to the global disease burden.
Sepsis, gastroenteritis, and HIV/AIDS were the leading infectious diseases in medical emergency admissions. The lack of potable water and safe refuse-disposal methods being experienced in Zaria might increase the frequency of gastroenteritis. The pattern of CD observed in this study is similar to those reported across Nigeria.,,,, Among CDs observed in this study, sepsis was the leading cause of mortality. This finding differs from that in a study conducted in the Port Harcourt Teaching Hospital, where HIV/AIDS was the most common cause of death. Self-medication, the use of substandard medicine and delay in presentation for infections may account for this finding.
The outcome of admissions appears to be good with respect to the number of patients that were successfully treated and discharged. The mortality rate of 9% observed in this study is lower than the 12.9% recorded in a 2-year study at Federal Medical Centre Asaba and 25% in a 3-year study at Ogun State University Teaching Hospital, Sagamu. However, there is a need to further reduce the mortality rate to barest minimum, by making the right diagnoses promptly and instituting appropriate line of management. Equipping the A and E with functional instruments and consumables as well as building the capacity of staff and regular update of management protocols for common illnesses is priceless step to achieving this goal.
| Conclusion|| |
There is a rising trend of communicable as opposed to non-communicable diseases' emergencies in Zaria. Of all the non-communicable diseases, incidence of gastro-intestinal emergencies was the highest while that of haematology was the least. The intra-hospital mortality rate attributable to medical emergencies is relatively lower in Zaria. Prompt diagnosis of cases and immediate institution of treatment is recommended in order to improve the outcome of medical emergencies in our hospitals.
The limitations of the present study include underreporting of cases, missing data, and deficient medical record keeping, which is not unexpected in retrospective studies, thus a longitudinal, prospective study is recommended.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ogun SA, Adelowo OO, Familoni OB, Jaiyesimi AE, Fakoya EA. Pattern and outcome of medical admissions at the Ogun State University Teaching Hospital, Sagamu-A three year review. West Afr J Med 2000;19:304-8.
Odenigbo CU, Oguejiofor OC. Pattern of medical admissions at the Federal Medical Centre, Asaba - A two year review. Niger J Clin Pract 2009;12:395-7.
Okunola OO, Akintunde AA, Akinwusi PO. Some emerging issues in medical admission pattern in the tropics. Niger J Clin Pract 2012;15:51-4. [Full text]
Myint PK, MacLullich AM, Witham MD. The role of research training during higher medical education in the promotion of academic medicine in the UK. Postgrad Med J 2006;82:767-70.
Gagliardi AR, Dobrow MJ. Paucity of qualitative research in general medical and health services and policy research journals: Analysis of publication rates. BMC Health Serv Res 2011;11:268.
WHO. Cause-Specific Mortality and Morbidity. World Health Statistics. Nigeria: WHO; 2009. p. 47-57.
Garko SB, Ekweani CN, Anyiam CA. Duration of hospital stay and mortality in the medical wards of Ahmadu Bello University Teaching Hospital, Kaduna. Ann Afr Med 2004;2:68-71.
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;7:261-7.
] [Full text]
Isezuo SA. Seasonal variation in hospitalisation for hypertension-related morbidities in Sokoto, North-Western Nigeria. Int J Circumpolar Health 2003;62:397-409.
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.
Ogah OS, Akinyemi RO, Adesemowo A, Ogbodo EI. A two-year review of medical admissions at the Emergency Unit of Nigerian tertiary health facility. Afr J Biomed Res 2012;15:59-63.
Tollman SM, Kahn K, Sartorius B, Collinson MA, Clark SJ, Garenne ML. Implications of mortality transition for primary health care in Rural South Africa: A population-based surveillance study. Lancet 2008;372:893-901.
Ike SO. The pattern of admissions into the medical wards of the University of Nigeria Teaching Hospital, Enugu (2). Niger J Clin Pract 2008;11:185-92.
] [Full text]
Ogunmola JO, Oladosu YT. Pattern of medical causes of deaths in accident and Emergency Department of a tertiary health centre situated in Rural Area of developing country. J Med Med Sci 2013;4:112-6.
Onwuchekwa AC, Asekomeh EG, Iyagba AM, Onung SI. Medical mortality in the accident and Emergency Unit of the University of Port Harcourt teaching hospital. Niger J Med 2008;17:182-5.
[Figure 1], [Figure 2]