Describe cardio-metabolic diseases and the associated cost in a district hospital in the North West Province

Abstract

BACKGROUND: Gelukspan District Hospital is situated in the Ngaka Modiri Molema District in the North West Province. The majority of patients admitted in the adult medical wards of this Hospital are due to two conditions namely (a) HIV/ AIDS and (b) Cardio-metabolic diseases. The Hospital regularly analyse data related to the HIV/ AIDS patients for HIV/ AIDS conditional grant. The information related to cardio-metabolic diseases are seldom analysed by the Hospital management, although there is a belief within the Hospital that more than one thirds of the patients admitted in these two wards are due to cardio–metabolic diseases. This study was planned against this background to systematically analyse the routinely collected data from the Hospital information system. The results of the study would hopefully provide the estimation of the prevalence of these diseases at a health facility level and the cost for managing these conditions. AIM: To describe the profiles of patients admitted of cardio–metabolic diseases in the Gelukspan District Hospital in the North West Province during one year study period (from 01 April 2010 to 31 March 2011). METHODOLOGY: This was a cross-sectional study based on retrospective review of routinely collected data from the Adult Medical Wards of the Gelukspan District Hospital during the one year study period (1 April 2010 to 31 March 2011). No primary data was collected for this study. The study variables included: the number of subjects with cardio-metabolic diseases among the subjects who were admitted in the Medical wards of the Hospital during one year study period; their profiles and the type and cost of laboratory tests performed for these patients at the time of admission. Permission to conduct the research at the Hospital was obtained from the North West Department of the Health and the University of the Witwatersrand ‘Human Research Ethics Committee (Medical) before commencement of the study. RESULTS: Number of admissions in male and female medical wards for noncommunicable diseases was 558. There were almost same number of female (n= 287) and male (271) admissions. The result showed that both males and females suffer equally from cardio-metabolic diseases. The age – group 8805634J DM Moalosi vi analysis showed almost a third of the subjects were below 50 years age and another third was above 65 years of age. More than 20% of the population were pensioners representing the age distribution of the study cohort. The majority of the subjects were black (97.8%) and unemployed (98%) representing the demographics of the catchment population. The majority of the women were single (55.4%). There was no significant difference between male and female patients in terms of primary clinical diagnoses. Thirty-nine percent of the males (n=108) and 56% (163) females stayed more than 3 days (the norms of average length of stay for District hospitals. The case fatality rate was 19.5% probably high in a district hospital setting, this implies that probably these patients were not managed properly at the PHC level and or at this The laboratory tests done at the time of admission included random and fasting blood glucose, and creatinine. No HbA1C, lipogram and other renal function tests were done at the time of admission contrary to the norms and guidelines for management of cardio-metabolic diseases. The laboratory test result showed the possibility of significant comorbidity among the patients. Fourteen percent of the subject probably had nephropathy. CONCLUSION: This was the first study conducted in this Hospital to systematically evaluate management of a particular group of patients. Hopefully, this study would assist the Hospital management to improve the management of patients admitted in this Hospital.