Menu
Menu
Menu
Menu
Background: Ethiopia is encountering a growing burden of non-communicable diseases along with infectious diseases, perinatal and nutritional problems that have long been considered major problems of public health importance. This retrospective analysis was carried out to examine the mortality patterns from communicable diseases and non communicable diseases in public and private hospitals of Addis Ababa. Methods. Approximately 47,153 deaths were captured over eight years (2002-2010) in forty three public and private hospitals of Addis Ababa, Ethiopia. Data collectors (43 hospital clerks) and coordinators (3 nurses) had been extensively trained on how to review hospital death records. Information obtained included: dates of admission and death, age, sex, address, and principal cause of death. Only the diseases responsible for deaths are taken as the cause of death. Cause of death was coded using International Classification of Diseases (ICD-10) and data were double entered. Diseases were classified into: Group I (communicable diseases, maternal conditions and nutritional deficiencies); Group II (non-communicable causes); and Group III (injuries). Percentages, proportional mortality ratios, 95% confidence intervals (CI) and Adjusted odd ratios (OR) were calculated. Results: Overall, 59% of the deaths were attributed to Group I diseases, and 31% to Group II diseases and 12% to injuries. Nearly 56% of the males and 68% of the females deaths were due to five leading causes (conditions arising during perinatal period, HIV/AIDS, tuberculosis, cardiovascular diseases and respiratory infections). Significantly larger proportions of females died from Group I (67%) and Group II diseases (32%) compared with males (where the respective proportions were 52% and 30%). Significantly higher proportion of males (17%) than females (6%) were dying from Group III diseases. Deaths due to Group I diseases decreased while those due to Group II diseases increased with age. Overall Group I diseases and HIV/AIDS, tuberculosis and still birth mortality in particular have showed decreasing trend while Group II and III increasing over time. Double burden in mortality was highly observed in the age groups of 15-64 years. Those aged >45 years were dying more likely with non-communicable diseases compared with children. Children aged below 15 years were 16 times more likely to die from communicable, perinatal and nutritional conditions compared with elders. Mortality variation with age has been identified between public and private hospitals. Conclusions: The results of the present study shows that, in addition to the common Group I causes of death, emerging group II diseases are contributing to high proportions of mortality in the public and private hospitals of Addis Ababa, Ethiopia. Thus, priority should be given to the prevention and management of conditions arising during perinatal period such as low birth weight and still birth, HIV/AIDS; tuberculosis, respiratory infections, cardiovascular diseases, malignant neoplasm, chronic respiratory diseases and road traffic accident. The planning of health resources and activities should take into account the double burden in mortality due to Group I and Group II diseases. This calls for strengthening approaches towards the control and prevention of non-communicable diseases such as cardiovascular and malignant neoplasm. © 2012 Misganaw et al.; licensee BioMed Central Ltd.
This study was part of Addis Ababa Mortality Surveillance Program (AAMSP) the then project and in place since 2001 in Addis Ababa, Ethiopia. In Addis Ababa, totally there are 43 (21% of the total hospitals in the country) hospitals of which 12 are registered public and 31 are registered private hospitals. In addition, there are 41 health centers (24 governmental and 7 private) with 141 beds and 551 private clinics (109 special, 169 higher, 146 medium and 127 lower). Nearly 43% of the total medical doctors in the country are serving in these health facilities. The hospitals provide health care services not only for Addis Ababa residents but also serve as referral facilities for the nation [11,12]. According to the 2007 national census, the total population of Addis Ababa, the capital of Ethiopia was above 2.7 million, of which 47.6% were males and 52% were females. The total fertility rate of the city is below replacement level (1.5) and crude death rate is 9/1000. Infant mortality rate is 40/1000 [13] live births and maternal mortality rate is 0.001 [14]. This retrospective study was carried out to examine the causes of all deaths in private and public hospitals in Addis Ababa over eight years period (2002–2010). There were 43 data collectors assigned within each hospital and three research coordinators. The data collectors and coordinators had prior relevant experience and extensive training on how to review hospital death records and registration books. To capture deaths in all hospitals, medical records and death registry books for the study period were reviewed. Information obtained includes: date of admission and date of death, name, age, sex, address, principal cause of death. Only the disease/s responsible for death is/are taken as the cause of death. Cause of death was coded according to the International Classification of Diseases, tenth revision (ICD-10) [15]. Approximately, 47,153 deaths were captured in public and private hospitals in Addis Ababa during the study period. Data were double entered to Access Microsoft Office spreadsheet and cleaned using STATA .do files. The 2006 Global Burden of Diseases classification was adapted to classify cause of deaths in our study. This classification categorized diseases into: Group I (communicable diseases, maternal conditions and nutritional deficiencies); Group II (non-communicable causes); and Group III (injuries) [16]. Percentages and proportional mortality ratios were calculated using STATA software. Binary logistic regression model was used to assess associations and significant differences, with adjusted odds ratio (OR) and 95% confidence intervals (CI). The program protocol was approved by Institutional Review Board (IRB) of the College of Health Sciences, Addis Ababa University, and the National Ethics Review of Committee of the Ethiopian Ministry of Science and Technology. Permission for the study had been also obtained from local authorities. In the office, individual information was accessible only to the research team and is kept confidential.
N/A
