Trends of morbidity in general medicine at United Bulawayo Hospitals, Bulawayo, Zimbabwe.

Objective: To determine the trends of the 10 most common diseases in the Medical Department.

Design: Retrospective descriptive study of patients' discharge summaries.

Setting: United Bulawayo Hospital, tertiary level hospital and referral centre for district hospitals.

Subjects: All patients admitted and discharged from the medical wards from 1987 to 1994, excluding all those who died.

Main Outcome Measures: Number of discharges, patients' origin, paying status, diagnoses, staffing levels, reasons for transfer out.

Results: The top 10 diseases encountered in 12,280 patients were: pneumonia, HIV/AIDS, pulmonary tuberculosis, hypertension, Diabetes mellitus, malaria, gastro-enteritis, congestive cardiac failure secondary to cardiomyopathy, congestive cardiac failure secondary to hypertension, and asthma. They respectively accounted for 11% and 49% of all hospital and departmental admissions. Most disease prevalences increased from 1987 to 1994, with HIV/AIDS showing the sharpest rise. Tuberculosis was the most frequent disease and hypertension proved to be the leading non communicable disease. A positive diagnosis was made in 76% of cases. Patients' median age was 37 years and sex ratio M/F was 1.7:1. Staffing levels and bed capacity remained unchanged despite an increasing number of patients. Of these, 22% came from rural areas and 77% with low incomes did not pay for services. Transfers out effected mainly for special diagnostic procedures accounted for 0.2%.

Conclusions: Infections and cardiovascular diseases alone accounted for 50% of the diagnoses made in patients discharged from the Medical Department of United Bulawayo Hospitals from 1987 to 1994. The 10 commonest diseases accounted for 49% of the morbidity and most of them increased in frequencies, while in case of HIV/AIDS, the increase was six fold. Cardiovascular diseases showed unexpectedly high prevalences. Diagnoses were confirmed in 76% of cases. The main problem encountered was multi pathology mainly due to added super infections and inability of 77% of patients to afford adequate health care. They resulted in frequent readmissions, heavy workload and high costs which threatened the quality of care.