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

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

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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 tradi- tional 4 × 4 set of NCDs, and included neurological disease, psychiatric illness, sickle cell disease, and trauma. We conducted a retrospective chart review of all inpatients who were admitted to the Neno District Hos- pital 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.

We 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.

There is a significant burden of NCDs in a rural hospital in Malawi, including those outside of the tradi- tional 4 × 4 set. We also found high rates of NCDs in the younger population (under 40 years of age). Hospitals must be equipped with adequate resources and training to meet this burden of disease.