3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Trends in adult medial admissions at Tambo Memorial Hospital, Gauteng, between 2005 and 2007(2010-09-23) Naidoo, AroomuganIntroduction: The study analysed the admission trends at six adult medical wards in a regional hospital in Gauteng over 2005 and 2007. Methods: This was a retrospective analysis of data from admission ward registers and patient case notes. Information obtained included age, gender, duration of stay, clinical outcomes and disease profile. The study population comprised of all patients admitted to the adult medical wards at Tambo Memorial Hospital for the period 1 January 2005 to 31 December 2005 and 1 January 2007 to 31 December 2007. Results: The number of medical admissions increased by 2.07% during the years of study. The male admissions were slightly higher than the female admissions. The mean age of male patients decreased from 42.30 years to 40.41 years. In contrast the mean age for female patients increased from 38.00 years to 40.50 years. The average length of stay decreased from 6.16 days to 5.33 days. The younger age groups (15-34 years of age) accounted for the majority of admissions. Based on the ICD 10 coding, infectious and parasitic diseases accounted for the majority of the admissions followed by respiratory disorders. Tuberculosis became the most frequent diagnosis and was prevalent in the younger age groups followed by pneumonia. Hypertension was a common diagnosis in the older age groups (55 years and older). As was expected the majority of patients (86-95% in 2005 and 80.24% in 2007) were discharged home but a considerable number of patients were transferred to other institutions. Importantly, a decrease in the mortality rate from 4.02% to 0.03% was also demonstrated. Conclusions: An increase in the number of patient’s admissions, a decrease in the average length of stay and a decrease in mortality rate were noted during the study period. Changing trends with regards to gender, age and disease profile were also observed. The challenges and recommendations identified by the study will provide valid information that would be meaningful to hospital management as well as potential users such as budget planners, resource allocators and efficient referral pathways designers.Item Causes of and trends in childhood mortality in a rural South African sub-district(2006-10-31T13:53:45Z) Ansong, DanielBackground: Studies into childhood mortality present the opportunity to identify the leading and common causes of childhood mortality in different populations. Objectives: To study the trends in all-cause mortality, and patterns of cause-specific mortality, in children 0-14 years living in the Agincourt sub-district of South Africa over the period 1992-2000. Methods: Secondary data analysis based on the longitudinal database from the Agincourt Demographic and Health Surveillance System was used to study trends in childhood mortality between 1992 and 2000, and a comparison was made between the earlier period (1992-96) and the later period (1997-2000). Results: Seven hundred and twenty four deaths occurred over the 9 year period, 1992 to 2000, in children aged 0-14 years in the Agincourt sub-district of South Africa. Over 80% of the deaths occurred in children under-five years of age. Death rates in children under one year in the periods 1992-1996 and 1997-2000 were 8.9/1000 live births and 18.0/1000 live births respectively. Children under five years between 1992-1996 and 1997-2000 had death rates of 18.0/1000 live births and 35.0/1000 live births respectively. There was a statistically significant difference in death rate in infants, and in children less than five years, in those who died over the period 1992-1996 and those who died during the later period 1997-2000, with mortality showing an increasing trend (p-values <0.0001 for infants and for children under five years). Overall mortality rates in all children under 14 years between 1992-1996 and 1997-2000 were 26.4/10000 person-years and 37.7/10000 person-years respectively. There was no significant statistical difference in the overall mortality trend among children aged 0-14 years between the two periods of time (p-value 0.614). Infectious and communicable diseases were the leading causes of death with diarrhoeal deaths accounting for 15.2%, HIV/AIDS 9.7% and malnutrition 7.6%. Deaths from diarrhoeal disease between 1992-1996 and 1997-2000 were 481/million and 449/million person-years respectively. Deaths from HIV/AIDS within the same time periods were 107/million and 607/million person-years respectively. HIV/AIDS showed a statistically significant difference over the two periods with an increased risk ratio of 5.59 (95% confidence interval of 4.6 to 70). Conclusion: This analysis reinforced previous findings pointing to the fact that infectious and communicable diseases are the leading causes of childhood mortality in South Africa and other developing countries. HIV/AIDS and diarrhoeal diseases have emerged as major causes of mortality in this analysis. Efforts to control the HIV epidemic and prevent the spread of HIV/AIDS must be accelerated in the Agincourt sub-district.