Prevalence of and characteristics associated with in-hospital mortality in a Ugandan neurology ward

Abstract

Background: While the burden of neurologic illness in developing countries is increasing, less is known about mortality among patients admitted to sub-Saharan African hospitals with neurologic disease. We sought to characterize the rate and patient-level predictors of in-hospital mortality in a Ugandan Neurology ward.cc. Methods: Data was prospectively collected on 335 patients admitted to the Neurology ward of Mulago Hospital, Kampala, Uganda. Kaplan-Meier survival curves and multivariate COX proportional hazard modeling were used to assess survival. Results: Within our sample (n = 307), 35.8% received no diagnosis at time of hospital admission. Stroke (27.3%), head trauma (19.6%), and malaria (16.0%) were the most common diagnoses. Among the 56 (18.5%) patients who died during the index hospitalization, the most common diagnosis at admission and at death was stroke. Adjusted regression analysis showed that patients without a diagnosis at time of death (HR = 7.01 [2.42-20.35], p < .001) and those with diagnoses of infections (HR = 5.21 [2.16-12.58], p = <.001), stroke (HR = 2.69 [1.20-6.04], p = .017), or head trauma (HR = 3.39, [1.27-9.07], p = 0.15) had worse survival. Conclusions: In-hospital mortality affected nearly 20% of the cohort, with worse survival among those without a diagnosis and with infections, stroke, head trauma. Future work should identify reasons for increased mortality among these high-risk groups and implement targeted interventions.

Neurological disorders in Northern Tanzania: A 6-year prospective hospital-based case series

“…Cerebrovascular disease was the most common ND in the series with stroke accounting for 14%. Stroke is the second leading cause of death globally 1 , 12 and the leading neurological cause of hospital admissions and neurological cause of death in adults in SSA 5 , 7 . In the series cerebrovascular disease was significantly associated with HIV, OR 5.…”

“…The pattern of NDs in SSA differs from that reported in high income countries, with infections, in particular human immunodeficiency virus (HIV) being more prevalent and neurodegenerative diseases less common 3 – 6 . In SSA NDs typically account for 18–25% of adult medical hospital admissions, the majority of whom either die in hospital or are discharged with disability 3 , 5 , 7 . The most common causes of neurological admissions in adults are stroke, infections, paraplegia, neuropathies, coma and seizures 3 – 5 , 7 .…”

“…In SSA NDs typically account for 18–25% of adult medical hospital admissions, the majority of whom either die in hospital or are discharged with disability 3 , 5 , 7 . The most common causes of neurological admissions in adults are stroke, infections, paraplegia, neuropathies, coma and seizures 3 – 5 , 7 . The most common NDs reported in outpatients are seizures/epilepsy, headache, stroke sequelae, neuropathies, movement disorders and neurodegenerative disorders 8 – 11 .…”