Hospitalization among adultd resident in the Africa centre demographic surveillance area in Rural KwaZulu Natal: South Africa

Abstract

South Africa bears a quadruple disease burden: communicable and non-communicable diseases, as well as perinatal and maternal and injury related disorders. Serious morbidity resulting in hospitalizations are costly to the individual, to the health sector and society. Adults constitute more than half of the population in SSA and survival of children depends to a large extent on the health of the adults. In this analysis, hospital and population based data was used to describe the causes of and factors associated with hospitalization among adults 15 years and older resident in the Africa Centre Demographic Surveillance area. Methods All resident adults of Africa Centre Demographic Information System (ACDIS) as at 1st January, 2011 and followed till 31st December, 2013 were eligible for inclusion in the study. Cause of hospitalization was based on discharge diagnosis based on ICD10 coding. Factors associated with hospitalization were assessed using Cox proportional hazard regression model. Results The cohort consisted of a total of 41,477 individuals with 24,068 (58.03%) females and a median age of 29 years (Inter quartile range 20-45). 1,172 (2.83%) individuals contributed to 1,375 episodes of hospitalization. The top five causes of hospitalization for the period were maternal conditions 335(24.96%), tuberculosis 248(18.48%), injuries 126(9.39%), infectious and parasitic diseases 104(7.75%) and cardiovascular diseases 88(6.56%) with variations in causes of hospitalization by gender. The risk of hospitalization for males increased with age with the exception of the 20-24 year age group. The risk of hospitalization for males increased by 72% among participants on disability

iv (aHR 1.72 95%CI: 1.15-2.56) ) compared to those who did not receive grants whilst married males had a 48% reduction in the risk of hospitalization compared to unmarried males (aHR 0.52 95%CI: 0.38-0.73). Females on disability grant had a 55% (aHR 1.55 95%CI: 1.13-2.12) increase in the risk of hospitalization whilst those on old age pension had a 65% (aHR 1.65 95%CI: 1.15-2.37) increased risk of hospitalization compared to those whose did not receive grants. There was a protective effect in the risk of hospitalization among married (aHR 0.57 95%CI: 0.44-0.73) and widowed (aHR 0.68 95%CI: 0.52-0.90) compared to unmarried females whilst females in the poor (aHR 1.37 95%CI: 1.07-1.76) wealth index had increased risk of hospitalization in comparison to those in the poorest wealth index. Exclusion of maternal causes slightly altered the risk of hospitalization estimates for the above factors in addition to which there were varied increases in the risk for age with the exception of the 20-24 year age group Conclusion The analysis suggest that maternal conditions, tuberculosis, injuries and infectious and parasitic as well as cardiovascular disease were the main causes of hospitalization during the study period. Age, grants and marriage was associated with the risk of hospitalization among males whilst grants, marriage and wealth index was associated with the risk of hospitalization among females. Exclusion of maternal causes slightly altered the risk of hospitalization estimates in addition to which age was associated with increased risk of hospitalization. These should be considered for efficient planning and implementation of health programs to reduce morbidity.