HIV, tuberculosis, diabetes mellitus and hypertension admissions and premature mortality among adults in Uganda from 2011 to 2019: is the tide turning?

Andrew Kazibwe; Kuteesa Ronald Bisaso; Andrew Peter Kyazze; Sandra Ninsiima; Phillip Ssekamatte; Felix Bongomin; Joseph Baruch Baluku; Davis Kibirige; George Patrick Akabwai; Moses R Kamya; Harriet Mayanja-Kizza; Pauline Byakika-Kibwika; Magid Kagimu; Robert Kalyesubula; Irene Andia-Biraro

doi:10.1186/s41182-022-00447-y

HIV, tuberculosis, diabetes mellitus and hypertension admissions and premature mortality among adults in Uganda from 2011 to 2019: is the tide turning?

Trop Med Health. 2022 Aug 10;50(1):54. doi: 10.1186/s41182-022-00447-y.

Authors

Andrew Kazibwe^{1

2}, Kuteesa Ronald Bisaso³, Andrew Peter Kyazze⁴, Sandra Ninsiima⁴, Phillip Ssekamatte^{4

5}, Felix Bongomin⁶, Joseph Baruch Baluku^{7

8}, Davis Kibirige⁹, George Patrick Akabwai¹⁰, Moses R Kamya¹¹, Harriet Mayanja-Kizza¹¹, Pauline Byakika-Kibwika¹¹, Magid Kagimu¹¹, Robert Kalyesubula¹², Irene Andia-Biraro^{11

13}

Affiliations

¹ Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda. kazibweandy@gmail.com.
² Directorate of Programs, The AIDS Support Organisation, P. O. Box 10443, Kampala, Uganda. kazibweandy@gmail.com.
³ Breakthrough Analytics, Kampala, Uganda.
⁴ Tuberculosis and Co-Morbidities (TAC) Research Group, Makerere University, Kampala, Uganda.
⁵ Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda.
⁶ Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, P. O. Box 166, Gulu, Uganda.
⁷ Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda.
⁸ Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda.
⁹ Uganda Martyrs Hospital, Lubaga, P. O. Box 14130, Kampala, Uganda.
¹⁰ Baylor College of Medicine, Children's Foundation, Kampala, Uganda.
¹¹ Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda.
¹² Department of Physiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda.
¹³ Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.

Abstract

Background: The growing burden of diabetes mellitus (DM) and hypertension (HTN) on the background of endemic Human Immuno-deficiency Virus (HIV) and tuberculosis (TB) is a concern in low- and middle-income countries. We aimed to describe annual trends in admissions, mortality rates and premature mortality (years of potential life lost-YPLLs) due to HIV, tuberculosis (TB), diabetes mellitus (DM) and hypertension (HTN) in Uganda.

Methods: We conducted a retrospective cohort study, retrieving electronic records of adults admitted to Mulago and Kiruddu national referral hospitals medical wards between 1st January 2011 and 31st December 2019. We used STATA BE 17.0 and GraphPad Prism 8.0.2 to compute total admissions, inpatient crude mortality rates, and YPLLs; and demonstrate trends using Mann-Kendall test.

Results: Of 108,357 admissions, 55,620 (51.3%) were female, 15,300 (14.1%) were recorded in 2012, and 22,997 (21.2%) were aged 21-30 years. HIV, TB, DM and HTN accounted for 26,021 (24.0%); 9537 (8.8%); 13,708 (12.7) and 13,252 (12.2%) of all admissions, respectively. Overall inpatient mortality was 16.7% (18,099/108,357), 53.5% (9674/18,099) were male, 21.5% (3898) were aged 31-40 years and 2597 (14.4%) were registered in 2013. HIV, TB, DM and HTN accounted for 35.6% (6444), 14.6% (2646), 9.1% (1648) and 11.8% (2142) of all deaths, respectively. Total admissions (Kendall's tau-B = - 0.833, p < 0.001) and deaths declined (Kendall's tau-B = - 0.611, p = 0.029). A total of 355,514 (mean = 20.8 years, SD 30.0) YPLLs were recorded, of which 54.6% (191,869) were in males; 36.2% (128,755) were among those aged 21-30 years and were recorded in 2012 (54,717; 15.4%). HIV, TB, DM and HTN accounted for 46.5% (165,352); 19.5% (69,347); 4.8% (16,991) and 4.5% (16,167) of YPLLs, respectively. Proportionate contribution of HIV to deaths and YPLLs declined, remained stagnant for TB; and increased for both DM and HTN.

Conclusion: TB and HIV account for higher though declining, while DM and HTN account for lower albeit rising morbidity and premature mortality among adult medical patients in Uganda. TB prevention and treatment; and DM/HTN service integration in HIV care should be optimized and scaled up.

Keywords: Diabetes mellitus; HIV; Hypertension; Inpatient; Premature mortality; Trend; Tuberculosis; Uganda.