Detailed standardized annual reports are analysed for 17 rural hospitals in four African countries, with admission figures of 1.2 million patients (excluding deliveries) and more than 67,000 deaths over a period of 16 years. The countries involved are Zambia, Tanzania, Kenya and Ghana. Figures on admission, causes of death and clinical case fatality rates are presented per country and per 4-year calendar period for the most important infectious diseases. The number of admissions increased substantially in 3 of the 4 countries (50-77%) between 1976 and 1990, but admission rates (per 1,000 population per year) by much less (6-25%), indicating that a large part of the increase in the volume of services was due to population growth. The number of infectious disease admissions in Ghana, however, decreased by 12% and even more in terms of admission rates (by 42%). About 75% of all admissions in children below 15 years of age were due to infections and infection related diseases; for adults this figure was 31%. Malaria is the single most important infectious disease both in terms of admissions and as a cause of death; it has increased substantially in three of the four countries. Bacterial infections, in particular pneumonia, gastroenteritis, meningitis and tuberculosis, are also important diseases in terms of admissions and deaths. On the whole they have remained at more or less the same level in 1975-1990 in terms of both admissions and deaths. Immunizable diseases and measles, once important as causes of admissions and deaths, have declined in all countries. Case fatality rates vary substantially by type of disease. They are very high for tetanus (36.7-68.8%) and meningitis (14.7-43%), and low for malaria (0.6-4.6%). However, they vary considerably in the four countries included in the study and are usually lower in children than in adults. A need for detailed studies with good "standardized" hospital records is emphasized. Representative data are needed from all hospitals in a given catchment area, with defined diagnoses for diseases and details regarding age and sex. This kind of information is highly desirable for planning and operation of curative and preventive medical care in developing countries.
PIP: Two Dutch researchers analyzed detailed standardized annual reports from 17 mission hospitals in Ghana, Kenya, Tanzania, and Zambia to determine what can be learned from hospital records on the volume of medical services provided as well as on the incidence and seriousness of major diseases and their patterns of change during 1975-90. These hospitals had more than 1.2 million patients (excluding deliveries, neonates, and premature births) and 67,534 deaths. The number of hospital admissions increased considerably (50-77%) in all countries except Ghana. Yet admission rates (per 1000 population/year) rose at a much lower rate (6-25%) in the three countries, suggesting that population growth accounted for a large part of the increase. During 1975-90, in Ghana, the admission rates decreased by 42% and the number of infectious disease admissions fell by 12%. More than 50% of all admissions were for infectious diseases in Kenya and Tanzania compared to 33% for Zambia and 35% for Ghana. Children aged under 15 years were more likely to be admitted for an infection or infection-related disease than adults (75% vs. 31%). The most common infectious disease responsible for admissions and a cause of death was malaria, probably due to a slowly rising resistance in the malaria parasite, resistance to insecticides in the mosquito, and the decreased immunity of the population due to uncontrolled use of antimalarials. In three countries (except Zambia for admissions and Ghana for causes of death), malaria has risen considerably (p 0.001). The case fatality rate for meningitis had also increased significantly during 1975-90 (p 0.001). Other significant causes of admissions and deaths included pneumonia, gastroenteritis, and tuberculosis. In all four countries, immunizable diseases and measles have declined greatly (p 0.001). Case fatality rates (CFRs) were highest for tetanus (36.7-68.8%) and meningitis (14.7-43%) and lowest for malaria (0.6-4.6%). CFRs for malaria, gastroenteritis, and pneumonia were much higher in adults than in children. These type of data are needed for planning and the operation of curative and preventive care.