Insights into the Morbidities and Short-term outcomes of Hospitalised Male and Female Medical Patients in Nigeria: the MOHOPA study.
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Keywords
Morbidities, Mortality, Hospitalisation, MOHOPA, Gender, Nigeria
Abstract
Background: In the MOHOPA (Pattern of Morbidities, Mortality and Healthcare Financing of Hospitalised Medical Patients) study, we aimed to determine the pattern of morbidities, short-term clinical outcomes, and determinants of all-cause mortality of male and female patients admitted to the medical wards of Nigerian tertiary-level hospitals.
Methodology: Patients admitted to the medical and emergency wards of seven tertiary-level hospitals, spread across the 6 geopolitical zones of Nigeria and the Federal Capital Territory, were consecutively recruited after obtaining written informed consent. The Research Ethics Committees of the study centres approved the study protocol, with the following reference numbers: Aminu Kano Teaching Hospital, Kano: NHREC/06/12/19/26, dated 21 October 2020; Delta State University Teaching Hospital, Oghara: HREC/PAN/2023/006/0537, dated 19 April 2023;University of Nigeria Teaching Hospital, Enugu: NHREC/05/01/2008B-FWA00002458-1RB00002323, dated 26 May 2023;University of Maiduguri Teaching Hospital, Maiduguri: IRB-FWA 00013572 UMTH/REC/23/1158, dated 9 August 2023;Federal Teaching Hospital, Lokoja: FTHL/HREC/Vol.I/2023/180, dated 6 July 2023;University of Abuja Teaching Hospital, Gwagwalada, Abuja: UATH/HREC/PR/266, dated 20 July 2023;University of Ibadan & University College Hospital, Ibadan: UI/EC/23/0331, dated 30 June2023.Discharged patients were followed up at four-weekly intervals for 12 weeks by telephone calls or until demise, to determine the study outcomes (all-cause mortality (in-hospital and at 12 weeks post-discharge) and rehospitalisation rate).
Results: 705 patients were recruited over ten months, comprising at least 100 patients from each site, and followed up for a median of 97 days. Their mean age was 51.3±18.3years, and 44.7% were females. Cardiovascular disease (CVD) was the most common primary cause of admission (22.1%) and also the most common co-morbidity (21.3%), without significant gender differences. All-cause mortality rate was higher in males than females (33.3% versus 24.8%; p=0.013), while rehospitalisation rate was higher in females than males (19.0% versus 26.4%; p=0.025), respectively. The risk for all-cause mortality was significantly increased by CVD (hazard ratio: 1.55; 95% confidence intervals: 1.03-2.33) and increased age(hazard ratio: 1.03;95% confidence intervals: 1.02-1.03).
Conclusion: CVD was the most common indication for admission in Nigeria’s referral hospitals. CVD was also the major co-morbidity and determinant of all-cause mortality.
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