One of the worst and most devastating outcomes of any treatment is death. Although death is inevitable, a lot can be learned from looking at the causes and trends of diseases in different places around the world.
Though when most people die it is obvious, the causes of death are not often well established. This leaves a big gap in the way health policymakers make decisions for resource allocation in the health sector. Much is known about infectious diseases like malaria, HIV-AIDS, and tuberculosis as the leading killers in sub-Saharan Africa. However, little is known about other causes of death.
Doctors from Yale University, USA, and, Makerere University, Uganda, undertook a four-year study to look at the leading causes of admissions and death in medical wards in Mulago National Referral Hospital, the biggest hospital in Uganda. They recruited a total of 50,624 patients admitted to the medical wards between January 2011 and December 2014. They noted that the majority of patients admitted were quite young, with an average age of 38 years, and were more likely to be females.
On further analysis, they found that up to 72% of the patients had a non-communicable disease (NCD) as the main reason for visiting the hospital. NCDs are diseases that are not directly transmissible but largely arise out of people growing older but more importantly from their lifestyle. It is well established that people who smoke, drink excessive amounts of alcohol, or eat unhealthy foods (low in fruits, vegetables but high in fat), are more likely to suffer from these diseases. The same goes for people who are inactive or do little physical exercise. We have been aware that NCDs present a big problem in limited resource settings like Uganda. Patients often present late for medical care, yet the availability of advanced therapy is limited. This prompted doctors to look into this issue.
In this study, doctors noted that although infectious diseases still played a major part in bringing patients to hospitals, there was a general trend of an increase in admission due to diseases like high blood pressure, kidney disease, stroke, and cancer. Out of the 8,637 (17.1%) who died during hospitalization, the leading causes of death were non-tuberculosis pneumonia (28.8%), tuberculosis (26.8%), stroke (26.8%), and cancer (26.1%). Please note that some patients had more than one disease condition. People diagnosed with HIV-AIDS, those above 50 years of age, and those who were male had an increased risk of dying while in hospital.
Our study demonstrated an increasing trend of NCDs as a major cause of admissions over the 4-year period in the midst of an on-going problem of infectious diseases. Healthcare systems in sub-Saharan Africa need to be prepared for the dual burden of disease in order to avoid catastrophic mortalities.
At the individual level, people should not wait until they fall ill to seek medical advice. We recommend getting appropriate checkups for adults. It is recommended that, whenever possible, people should engage in regular physical exercise, which is required at least 4 times a week. They should consume food low in sugar and unsaturated fats. Take less salt in food and avoid the harmful use of alcohol and smoking. Making such practices routine in one’s life will help us to delay or even reverse the NCD epidemic which is now the leading cause of deaths around the world.
These findings are described in the article entitled Trends of admissions and case fatality rates among medical in-patients at a tertiary hospital in Uganda; A four-year retrospective study, recently published in the journal PLOS One.