Abstract:
South Africa is one of the countries in sub-Saharan Africa that are severely
affected by the HIV/AIDS pandemic. This epidemic has led to high mortality
rates, decreased life expectancies, increasing poverty, and overburdened
health systems.
Objective: To quantify the disease burden related to HIV/AIDS in Leratong
Hospital, a level 2 public sector hospital in Gauteng Province of South Africa.
In the context of the recent introduction of anti-retroviral therapy programme in
the hospital, it is hoped that this study will assist in defining a baseline to
which future evaluation of the programme will be compared.
Methods: This was a retrospective descriptive study on routinely collected
hospital data. The records of all patients admitted into the four medical wards
of the hospital in 2001 and 2004 (n=21,029) were analyzed. Data on their
socio-demographic characteristics, discharge diagnoses, HIV status, clinical
outcome and length of stay in the hospital were extracted and analyzed.
Results: More than half (52%) of the patients were aged between 21 and 40
years. Between the two years, the annual total number of admissions to the
medical wards decreased by 6.6%, and this was more pronounced in the
female wards where the decline was more than 10%. HIV-related diseases
accounted for four out of the top five diseases in all patients. The proportion of
chronic diseases, such as hypertension, diabetes, congestive cardiac failure
and cerebrovascular diseases, decreased from 15.3% in 2001 to 14.3% in 2004. The average length of stay (ALOS) increased from 3.7 days in 2001 to
4.1 days in 2004.
Only 14% of all patients consented to HIV testing in the review period. Of
these more than 90% were reactive to HIV. Although the proportion who had
HIV tests decreased significantly from 16.9% in 2001 to 11% in 2004
(p<0.001), the HIV positive rate increased significantly from 89.1% in 2001 to
92.4% in 2004 (p<0.001). The proportion of patients admitted due to HIVrelated
diseases increased significantly from 52% in 2001 to 58% in 2004
(p<0.001).
The crude mortality rate for all patients during the two years studied was
13.6%. This increased significantly from 12% in 2001 to 15% in 2004
(p<0.001). Mortality was significantly higher in those patients with documented
HIV results and those admitted with HIV-related diseases irrespective of their
HIV status. While cause-specific mortality rate due to HIV-associated
diseases either increased or remained very high, that due to diabetes mellitus
decreased significantly between the two years studied (p=0.02). Patients’
length of stay in the hospital and mortality were both found to be associated
with their age group, HIV status, diagnosis and year of admission.
The study has demonstrated some changes in the clinical profile of the
patients towards a preponderance of HIV-related diseases and crowding out
of other chronic non-infectious diseases. Based on these results, it is
therefore recommended that all patients should have access to voluntary counseling and testing (VCT) and emphasis should be placed on those
diseases with high admission and mortality rates to improve patient care and
outcome. Measures should be developed to ensure that patients with chronic
noninfectious diseases are not crowded out.
