Hospital admissions attributed to adverse drug reactions in tertiary care in Uganda: burden and contributing factors

Abstract

Background: Adverse drug reactions (ADRs) contribute to the burden of disease globally and of particular concern are ADR-related hospital admissions. Objectives: This study sought to determine the burden, characteristics, contributing factors and patient outcomes of ADRs that were the primary diagnosis linked to hospital admission among inpatients in Uganda. Design: We conducted a cross-sectional secondary analysis of data from a prospective cohort study of adult inpatients aged 18 years and older at Uganda’s Mulago National Referral Hospital from November 2013 to April 2014. Methods: We reviewed clinical charts to identify inpatients with an ADR as one of the admitting diagnoses and, if so, whether or not the hospital admission was primarily attributed to the ADR. Logistic regression was used to determine factors associated with hospital admissions primarily attributed to ADRs. Results: Among 762 inpatients, 14% had ADRs at hospital admission and 7% were primarily hospitalized due to ADRs. A total of 235 ADRs occurred among all inpatients and 57% of the ADRs were the primary diagnosis linked to hospital admission. The majority of ADRs occurred in people living with HIV and were attributed to antiretroviral drugs. HIV infection [aOR (adjusted odds ratio) = 2.97, 95% confidence interval (CI): 1.30–6.77], use of antiretroviral therapy (aOR = 5.46, 95% CI: 2.56–11.68), self-medication (aOR = 2.27, 95% CI: 1.14–4.55) and higher number of drugs used (aOR = 1.13, 95% CI: 1.01–1.26) were independently associated with hospital admissions attributed to ADRs. Conclusion: Antiretroviral drugs were often implicated in ADR-related hospital admissions. HIV infection (whether managed by antiretroviral therapy or not), self-medication and high pill burden were associated with hospital admissions attributable to ADRs. The high HIV burden in Sub-Saharan Africa increases the risk of ADR-related hospitalization implying the need for emphasis on early detection, monitoring and appropriate management of ADRs associated with hospital admission in people living with HIV.

Variation of adverse drug events in different settings in Africa: a systematic review

“…Of 78 studies, 27 studies [ 18 – 44 ] were carried out among general patients, while the remaining studies [ 45 – 95 ] were carried out among specific patients. Seventeen studies [ 18 – 22 , 24 , 26 , 31 , 33 – 35 , 38 , 39 , 41 – 43 , 51 ] reported the prevalence of ADEs leading to hospital admissions, while 30 studies [ 18 , 19 , 22 – 33 , 35 , 37 – 41 , 43 , 44 , 65 , 80 , 85 – 88 , 91 , 95 ] reported the prevalence of ADEs during hospitalization. Twelve studies [ 18 , 19 , 22 , 24 , 26 , 31 , 33 , 35 , 38 , 39 , 41 , 43 ] reported ADE occurrence in both settings.…”

“…Seventeen studies [ 18 – 22 , 24 , 26 , 31 , 33 – 35 , 38 , 39 , 41 – 43 , 51 ] reported the prevalence of ADEs leading to hospital admissions, while 30 studies [ 18 , 19 , 22 – 33 , 35 , 37 – 41 , 43 , 44 , 65 , 80 , 85 – 88 , 91 , 95 ] reported the prevalence of ADEs during hospitalization. Twelve studies [ 18 , 19 , 22 , 24 , 26 , 31 , 33 , 35 , 38 , 39 , 41 , 43 ] reported ADE occurrence in both settings. In addition, 38 studies [ 45 – 50 , 52 , 54 – 64 , 66 – 74 , 76 , 78 , 79 , 82 – 84 , 89 , 90 , 92 – 94 ] reported the occurrence of ADEs in the outpatient setting, and four studies [ 53 , 75 , 77 , 81 ] reported ADEs in the community setting.…”

“…In addition, 38 studies [ 45 – 50 , 52 , 54 – 64 , 66 – 74 , 76 , 78 , 79 , 82 – 84 , 89 , 90 , 92 – 94 ] reported the occurrence of ADEs in the outpatient setting, and four studies [ 53 , 75 , 77 , 81 ] reported ADEs in the community setting. Majority of included studies [ 18 – 22 , 27 – 29 , 32 – 34 , 36 , 37 , 40 , 41 , 43 , 45 – 48 , 52 , 54 – 60 , 62 – 65 , 67 , 70 , 72 – 74 , 76 , 79 , 81 , 82 , 89 , 90 , 92 – 94 ] were carried out on adult population (aged ≥ 18 years) ( n = 46), while 18 studies were conducted among all age groups (aged 0–100 years) [ 23 , 24 , 30 , 50 , 51 , 61 , 66 , 68 , 69 , 71 , 75 , 77 , 78 , 84 – 88 ], 12 studies [ 25 ...…”

“…These 27 studies with a focus on general patient groups were carried out in 6 African countries; Nigeria (4), Morocco (3), Uganda (4), South Africa (8), Tunisia (1), and Ethiopia (7). Twenty-two studies [ 18 – 22 , 24 – 33 , 35 , 38 – 42 , 44 ] were carried out at a single center, while five studies [ 23 , 34 , 36 , 37 , 43 ] were conducted at a multi-center. There was a total of 15 studies [ 18 , 21 , 23 , 25 – 29 , 31 , 33 , 38 , 40 – 42 , 44 ] that were conducted prospectively, five studies [ 19 , 24 , 30 , 32 , 37 ] used a retrospective approach; whereas the remaining studies used a cross-sectional study design [ 20 , 22 , 34 – 36 , 43 ].…”

“…Twenty-two studies [ 18 – 22 , 24 – 33 , 35 , 38 – 42 , 44 ] were carried out at a single center, while five studies [ 23 , 34 , 36 , 37 , 43 ] were conducted at a multi-center. There was a total of 15 studies [ 18 , 21 , 23 , 25 – 29 , 31 , 33 , 38 , 40 – 42 , 44 ] that were conducted prospectively, five studies [ 19 , 24 , 30 , 32 , 37 ] used a retrospective approach; whereas the remaining studies used a cross-sectional study design [ 20 , 22 , 34 – 36 , 43 ]. Oshikoya et al’s [ 39 ] study used both retrospective and prospective study designs.…”