Adult and paediatric mortality patterns in a referral hospital in Liberia 1 year after the end of the war

Huerga, Helena; Vasset, Brigitte; Prados, Elisa

doi:10.1016/j.trstmh.2008.12.004

Cited by 18 publications

(39 citation statements)

References 38 publications

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“…Four studies (13%) provided case definitions for the illnesses that were studied (25, 26, 33, 34). One study conducted in Uganda (30) provided a case definition for only one condition (anemia) but this differed from the standard WHO definition (35).…”

Section: Resultsmentioning

confidence: 99%

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Medical causes of admissions to hospital among adults in Africa: a systematic review

Etyang

Scott

2013

Global Health Action

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BackgroundDespite the publication of several studies on the subject, there is significant uncertainty regarding the burden of disease among adults in sub-Saharan Africa (sSA).ObjectivesTo describe the breadth of available data regarding causes of admission to hospital, to systematically analyze the methodological quality of these studies, and to provide recommendations for future research.DesignWe performed a systematic online and hand-based search for articles describing patterns of medical illnesses in patients admitted to hospitals in sSA between 1950 and 2010. Diseases were grouped into bodily systems using International Classification of Disease (ICD) guidelines. We compared the proportions of admissions and deaths by diagnostic category using χ2.ResultsThirty articles, describing 86,307 admissions and 9,695 deaths, met the inclusion criteria. The leading causes of admission were infectious and parasitic diseases (19.8%, 95% confidence interval [CI] 19.6–20.1), respiratory (16.2%, 95% CI 16.0–16.5) and circulatory (11.3%, 95% CI 11.1–11.5) illnesses. The leading causes of death were infectious and parasitic (17.1%, 95% CI 16.4–17.9), circulatory (16%, 95% CI 15.3–16.8) and digestive (16.2%, 95% CI 15.4–16.9). Circulatory diseases increased from 3.9% of all admissions in 1950–59 to 19.9% in 2000–2010 (RR 5.1, 95% CI 4.5–5.8, test for trend p<0.00005). The most prevalent methodological deficiencies, present in two-thirds of studies, were failures to use standardized case definitions and ICD guidelines for classifying illnesses.ConclusionsCardiovascular and infectious diseases are currently the leading causes of admissions and in-hospital deaths in sSA. Methodological deficiencies have limited the usefulness of previous studies in defining national patterns of disease in adults. As African countries pass through demographic and health transition, they need to significantly invest in clinical research capacity to provide an accurate description of the disease burden among adults for public health policy.

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Section: Resultsmentioning

confidence: 99%

“…Two recent retrospective studies reported case fatality rates and the diagnostic categories with the highest case fatality rates were infectious and parasitic diseases (25%) and circulatory illnesses (21%) (25, 33). …”

Section: Resultsmentioning

confidence: 99%

Medical causes of admissions to hospital among adults in Africa: a systematic review

Etyang

Scott

2013

Global Health Action

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“…Four studies reported on urban, non-displaced populations living in armed conflict areas, of which one covered the acute emergency period (Bissau, Guinea Bissau, 1998-1999) [45] and three the post-emergency or early recovery period (Kabul [46] and Herat [47], Afghanistan, 2002-2003; Monrovia, Liberia, 2005 [48]).…”

Section: Resultsmentioning

confidence: 99%

“…Causes of death more frequent than ARI included malnutrition among Ugandan IDPs [42,43] and Cambodians in Thailand [24]; malaria among Ugandan IDPs [42,43], Burundians in Rwanda [29], and older children in Liberia [48]; diarrhoea among Sudanese in Uganda [41] and Somalis in Ethiopia [25]; measles among Cambodians in Thailand [24]; sepsis or septicaemia among children in Liberia [48] and Afghanistan [46]; heart disease among adult Kosovars in Albania [32]; cancer among earthquake survivors in Japan [49]; and surgical complications, tetanus and trauma among older children in Liberia in a referral hospital [48]. …”

Section: Resultsmentioning

confidence: 99%

The burden of acute respiratory infections in crisis-affected populations: a systematic review

et al. 2010

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Crises due to armed conflict, forced displacement and natural disasters result in excess morbidity and mortality due to infectious diseases. Historically, acute respiratory infections (ARIs) have received relatively little attention in the humanitarian sector. We performed a systematic review to generate evidence on the burden of ARI in crises, and inform prioritisation of relief interventions. We identified 36 studies published since 1980 reporting data on the burden (incidence, prevalence, proportional morbidity or mortality, case-fatality, attributable mortality rate) of ARI, as defined by the International Classification of Diseases, version 10 and as diagnosed by a clinician, in populations who at the time of the study were affected by natural disasters, armed conflict, forced displacement, and nutritional emergencies. We described studies and stratified data by age group, but did not do pooled analyses due to heterogeneity in case definitions. The published evidence, mainly from refugee camps and surveillance or patient record review studies, suggests very high excess morbidity and mortality (20-35% proportional mortality) and case-fatality (up to 30-35%) due to ARI. However, ARI disease burden comparisons with non-crisis settings are difficult because of non-comparability of data. Better epidemiological studies with clearer case definitions are needed to provide the evidence base for priority setting and programme impact assessments. Humanitarian agencies should include ARI prevention and control among infants, children and adults as priority activities in crises. Improved data collection, case management and vaccine strategies will help to reduce disease burden.

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“…Both the relatively low rate of HIV infection [20] and the comparatively short duration between symptom onset and presentation to a healthcare facility may have further contributed to the low fatality rate. These observations may reflect the effectiveness of the Rwandese healthcare system and may explain why studies from other sub-Saharan African countries reported higher death rates in patients with acute infection and sepsis [20][21][22]. Our trial was therefore underpowered to detect a difference in hospital mortality.…”

Section: Discussionmentioning

confidence: 94%

Increasing evidence-based interventions in patients with acute infections in a resource-limited setting: a before-and-after feasibility trial in Gitwe, Rwanda

et al. 2018

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Objective: To evaluate whether a focused education program and implementation of a treatment bundle increases the rate of early evidence-based interventions in patients with acute infections.Design: Single-center, prospective, before-and-after feasibility trial.Setting: Emergency department of a sub-Saharan African district hospital. Patients:Patients > 28 days of life admitted to the study hospital for an acute infection. Interventions:The trial had three phases (each of 4 months). Interventions took place during the second (educational program followed by implementation of the treatment bundle) and third (provision of resources to implement treatment bundle) phases. Measurements and main results:Demographic, clinical, and laboratory data were collected at study enrollment; 24, 48, and 72 h after hospital admission; and at discharge. A total of 1594 patients were enrolled (pre-intervention, n = 661; intervention I, n = 531; intervention II, n = 402). The rate of early evidence-based interventions per patient during Intervention Phase I was greater than during the pre-intervention phase (74 ± 17 vs. 79 ± 15%, p < 0.001).No difference was detected when data were compared between Intervention Phases I and II (79 ± 15 vs. 80 ± 15%, p = 0.58). No differences in the incidence of blood transfusion (pre-intervention, 6%; intervention I, 7%; intervention II, 7%) or severe adverse events in the first 24 h (allergic reactions: pre-intervention, 0.2%; intervention I, 0%; intervention II, 0%; respiratory failure: pre-intervention, 2%; intervention I, 2%; intervention II, 2%; acute renal failure: pre-intervention, 2%; intervention I, 2%; intervention II, 1%) were observed.

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Adult and paediatric mortality patterns in a referral hospital in Liberia 1 year after the end of the war

Cited by 18 publications

References 38 publications

Medical causes of admissions to hospital among adults in Africa: a systematic review

Medical causes of admissions to hospital among adults in Africa: a systematic review

The burden of acute respiratory infections in crisis-affected populations: a systematic review

Increasing evidence-based interventions in patients with acute infections in a resource-limited setting: a before-and-after feasibility trial in Gitwe, Rwanda

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