The Burden of Acute Disease in Mahajanga, Madagascar – A 21 Month Study

Abstract

BackgroundEfforts to develop effective and regionally-appropriate emergency care systems in sub-Saharan Africa are hindered by a lack of data on both the burden of disease in the region and on the state of existing care delivery mechanisms. This study describes the burden of acute disease presenting to an emergency unit in Mahajanga, Madagascar.Methods and FindingsHandwritten patient registries on all emergency department patients presenting between 1 January 2011 and 30 September 2012 were reviewed and data entered into a database. Data included age, sex, diagnosis, and disposition. We classified diagnoses into Clinical Classifications Software (CCS) multi-level categories. The population was 53.5% male, with a median age of 31 years. The five most common presenting conditions were 1) Superficial injury; contusion, 2) Open wounds of head; neck; and trunk, 3) Open wounds of extremities, 4) Intracranial injury, and 5) Unspecified injury and poisoning. Trauma accounted for 48%, Infectious Disease for 15%, Mental Health 6.1%, Noncommunicable 29%, and Neoplasms 1.2%. The acuity seen was high, with an admission rate of 43%. Trauma was the most common reason for admission, representing 19% of admitted patients.ConclusionsThis study describes the burden of acute disease at a large referral center in northern Madagascar. The Centre Hôpitalier Universitaire de Mahajanga sees a high volume of acutely ill and injured patients. Similar to other reports from the region, trauma is the most common pathology observed, though infectious disease was responsible for the majority of adult mortality. Typhoid fever other intestinal infections were the most lethal CCS-coded pathologies. By utilizing a widely understood classification system, we are able to highlight contrasts between Mahajanga’s acute and overall disease burden as well as make comparisons between this region and the rest of the globe. We hope this study will serve to guide the development of context-appropriate emergency medicine systems in the region.

Mapping Three Versions of the International Classification of Diseases to Categories of Chronic Conditions

“…Such mapping resources are essential to advance health analytics but have been lacking. Most previous mappings have covered ICD-9 codes only [ 26 , 27 , 46 – 49 ], or focused on a single condition or category of conditions (e.g., respiratory diseases, cancer, and cardiovascular diseases) [ 35 , 36 , 50 – 55 ]. These prior classifications of ICD codes to clinically meaningful categories have highlighted the fact that each crosswalk is curated for a specific context, varying in the objectives, process, and results.…”

“…The CCS provides validated crosswalks for categorizing diagnoses captured in ICD-9-CM and ICD-10-CM into mutually exclusive and broad classes of health conditions, which enables health outcome assessment and disease cohort development. The CCS has previously been used to report interpretable and clinically meaningful information about diseases, including their prevalence and associated medical expenditures [ 26 , 27 ]. Extending such a crosswalk to other versions of the ICD (i.e.…”

Transitions between versions of the International Classification of Diseases and chronic disease prevalence estimates from administrative health data: a population-based study

“…The chronic health conditions were selected from multiple chronic health conditions derived using Clinical Classification Software (CCS) [ 7 ]. The CCS, developed by the Agency for Healthcare Research and Quality in the US, has been adopted in many studies to provide clinically meaningful and interpretable statistics such as disease prevalence, frequencies, and medical expenditures [ 30 , 31 ]. Crosswalks of diagnoses codes to CCS categories are provided by Hamad et al [ 7 ].…”

Detection of Salmonella Typhi nucleic acid by RT-PCR and anti-HlyE, -CdtB, -PilL, and -Vi IgM by ELISA at sites in Ghana, Madagascar and Ethiopia

“…The Malagasy sites were chosen based on their coastal location, a presumed high disease burden, and following discussions with Malagasy country partners. In Mahajanga, previously published information on typhoid fever also existed [ 14 ]. The Ethiopian sites were included in consultation with the Ethiopian Health Management Information System and the Federal Ministry of Health based on contemporary unpublished reports on the prevalence of diarrheal illness.…”