Non-communicable disease burden among inpatients at a rural district hospital in Malawi  

作　　者：Peter Olds Chiyembekezo Kachimanga George Talama Bright Mailosi Enoch Ndarama Jodie Totten Nicholas Musinguzi Dickson Hangiwa Gene Bukhman Emily B.Wroe 

机构地区：[1]Massachusetts General Hospital,Boston,MA,USA [2]Harvard Medical School,Boston,MA,USA [3]Partners in Health,Neno,Malawi [4]Ministry of Health and Population,Lilongwe,Malawi [5]Department of Emergency Medicine,University of Washington,Seattle,WA,USA [6]Global Health Collaborative,Mbarara University of Science and Technology,Mbarara,Uganda [7]Center for Integration Science,Division of Global Health Equity,Brigham and Women’s Hospital,Boston,MA,USA [8]Program in Global NCDs and Social Change,Deparment of Global Health and Social Medicine,Harvard Medical School,Boston,MA,USA

出　　处：《Global Health Research and Policy》2023年第1期522-531,共10页全球健康研究与政策（英文）

基　　金：supported by the Juvenile Diabetes Research Foundation and Helmsley Charitable Trust.

摘　　要：Background The burden of non-communicable diseases(NCDs)is high in Malawi.However,resources and training for NCD care remain scarce,especially in rural hospitals.Current care for NCDs in the developing world focuses on the WHO’s traditional 4×4 set.However,we do not know the full burden of NCDs outside of that scope,like neurological disease,psychiatric illness,sickle cell disease,and trauma.The goal of this study was to understand the burden of NCDs among inpatients in a rural district hospital in Malawi.We broadened our definition of NCDs beyond the traditional 4×4 set of NCDs,and included neurological disease,psychiatric illness,sickle cell disease,and trauma.Methods We conducted a retrospective chart review of all inpatients who were admitted to the Neno District Hospital between January 2017 and October 2018.We broke patients down by age,date of admission,type,and number of NCD diagnoses,and HIV status,and constructed multivariate regression models for length of stay and in-hospital mortality.Results Of 2239 total visits,27.5%were patients with NCDs.Patients with NCDs were older(37.6 vs 19.7 years,p<0.001)and made up 40.2%of total hospital time.We also found two distinct populations of NCD patients.The first were patients 40 years and older with primary diagnoses of hypertension,heart failure,cancer,and stroke.The second were patients under 40 years old with primary diagnoses of mental health conditions,burns,epilepsy,and asthma.We also found significant trauma burden,accounting for 40%of all NCD visits.In multivariate analysis,carrying a medical NCD diagnosis was associated with longer length of stay(coefficient 5.2,p<0.001)and a higher risk of in-hospital mortality(OR 1.9,p=0.03).Burn patients also had significantly longer length of stay(coefficient 11.6,p<0.001).Conclusions There is a significant burden of NCDs in a rural hospital in Malawi,including those outside of the traditional 4×4 set.We also found high rates of NCDs in the younger population(under 40 years of age).Hospitals must be equipped wi

关 键 词：Malawi Non-communicable disease Burden of disease INPATIENT RURAL HOSPITAL 

分 类 号：R73[医药卫生—肿瘤]