Trends, causes and predictors of mortality amongst hospitalized hiv/aids patients at the Douala general hospital

CaHReF 20116, Yaoundé Conges hall, 23 – 26 August 2016 , PL086

The advent of Highly Active Anti-Retroviral Therapy (HAART) has greatly reduced mortality amongst people living with HIV/AIDS. There have also been a change in the causes of death from HIV-related conditions to non-HIV-related conditions. However, this disease still remains a major public health problem and in sub-Saharan Africa mortality is still largely due to HIV-related conditions. In an era of free HAART in our country, there still remains a gap in knowledge of in-hospital mortality trends amongst these patients.

This study was aimed at determining the trends, causes and predictors of mortality amongst hospitalized HIV/AIDS patients, at the Douala General Hospital (DGH).

This was a 9 year (2007 to 2015) cross-sectional study conducted over a period of 4 months. We reviewed a total of 874 eligible medical records of HIV/AIDS patients hospitalized in the medical wards of the DGH. Data were collected using a data collection form. Four cause-of-death categories were defined: ‘communicable conditions and AIDS-defining malignancies’, ‘chronic non-communicable conditions’, ‘other non-communicable conditions’ and ‘unknown’. Data were entered and analysed using SPSS version 20 statistical software.Trends in mortality and in the causes of death categories over time were analysed using thechi square test for trends with year of death as an independent continuous variable. Logistic regression was used to determine independent predictors of mortality.

An overall mortality rate of 23.6% was recorded. Generally mortality rates decreased over time (from 35% in 2007 to 19.7% in 2015) but there was no statistical significance in this trend (p=0.305). Communicable diseases and AIDS defining malignancies were responsible for 80.1% of deaths and increased over time (from 77.2% in 2007 to 77.8% in 2015). Tuberculosis was the most common cause of death (24.3%). Length of hospital stay <7days(p<0.001, OR=3.31, CI: 2.28-4.60) and late WHO clinical stages (3and 4)(p=0.033, OR=2.24, CI:1.07-4.71) were independent predictors of mortality.

Although there was a downward trend, mortality is still largely due to HIV-related conditions. Monitoring of causes of death is highly needed and strategies to decrease mortality from TB and other common opportunistic infections are essential.

HIV/AIDS, in-hospital mortality, trends, causes of death, predictors, HAART