Admission trends in a rural south African hospital during the early years of the HIV epidemic
Admission trends in a rural south African hospital during the early years of the HIV epidemic
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DOI：
10.1001/jama.282.11.1087
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发表时间：
1999-09-15
影响因子：
120.7
通讯作者：
Gilks, CF
中科院分区：
文献类型：
--
作者：
Floyd, K;Reid, RA;Gilks, CF
背景很少有研究试图量化人类免疫机能丧失病毒(艾滋病毒)/获得性免疫机能丧失综合症(艾滋病)流行病对发展中国家保健需求的影响。需要更多的数据来加深对其影响的了解，并指导制定适当的应对策略。目的评估艾滋病毒/艾滋病疫情对南非农村地区住院护理需求的影响。对综合医院和个人病房入院登记簿、结核病项目数据库和患者病历的数据进行回顾性分析。1991年至1998年期间收治的患者被安置在一家拥有450张床位的医院，该医院为南非HLabisa区(人口约20万)提供服务，那里产前门诊就诊者的艾滋病毒血清阳性率从1992年的4%上升到1998年的29%，主要结果是入院人数增加到9个医院病房，结果住院总人数由1991年的6562例增加到1998年的11872例，增加了360%，从303例增加到1393例，结核病患者分别占成年男性和女性住院人数的47%和30%，占总住院人数的11%。非结核病临床艾滋病病例增加了43倍，占成人就诊人数的比例由1991年的0.2%上升到1997年的4%。在研究期间，结核病和非结核病临床艾滋病病例是唯一呈现明显和持续上升趋势的入院类型。其他类型的住院模式变化较大，变化较小。结论HIV/AIDS流行对南非某农村地区医院成人结核病和一般医疗服务的需求产生了重要影响。如果这种影响被证明延伸到南非的其他农村地区，就迫切需要应对战略。
Context Few studies have attempted to quantify the effect of the epidemic of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) on demand for health care in developing countries. More data are required to improve understanding of its impact and to guide development of appropriate response strategies.Objective To assess the HIV/AIDS epidemic's impact on demand for inpatient hospital care in a rural area of South Africa.Design Retrospective analysis of data from general hospital and individual ward admission registers, a tuberculosis program database, and patient case notes.Setting and Patients Patients admitted between 1991 and 1998 to a 450-bed hospital that serves Hlabisa District, South Africa (population approximate to 200 000), where HIV seroprevalence among antenatal clinic attendees increased from 4% in 1992 to 29% in 1998,Main Outcome Measures Number of admissions to 9 hospital wards, number of clinical AIDS and general medical admissions (both excluding tuberculosis), and number of tuberculosis admissions to adult medical wards during the study period.Results Total hospital admissions increased by 81%, from 6562 in 1991 to 11 872 in 1998, Adult tuberculosis ward admissions increased by 360%, from 303 to 1393, In 1998, tuberculosis patients accounted for 47% and 30% of adult male and female medical ward admissions, respectively, and for 11% of total hospital admissions. Nontuberculosis clinical AIDS cases increased 43-fold, accounting for 4% of adult medical admissions in 1997 vs 0.2% in 1991. Tuberculosis and nontuberculosis clinical AIDS cases were the only types of admission to show a clear and consistent upward trend over the period studied. Patterns in other types of admissions varied more and changes were smaller.Conclusions The HIV/AIDS epidemic has had an important impact on demand for adult tuberculosis and general medical care in a rural South African district hospital. If this impact is shown to extend to other rural South African areas, response strategies are urgently needed.