Epidemiological study on community acquired pneumonia among hospital treated adults in Tigray, Ethiopia.
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Date
2017-12
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Abstract
Background: - Lower respiratory tract infections are a leading cause of mortality worldwide,
causing 1.6 million deaths annually in adults. Excluding tuberculosis they are the third most
common cause of death worldwide and the most common cause of death in low-income
countries. Community acquired pneumonia is responsible for a large proportion of these deaths.
Globally, it is the leading cause of death from an infectious disease and the sixth leading cause of
death overall. Studies in different settings of the world, attest to the fact that community acquired
pneumonia has a substantial clinical and economic burden. Despite its high morbidity and
mortality globally and specifically in Ethiopia, community acquired pneumonia is not adequately
researched.
Objective:-The aim of this study was to assess the epidemiology of community acquired
pneumonia among hospital treated adults in Tigray, Ethiopia.
Methods:-The study was conducted in Tigray Region, north Ethiopia. A retrospective patient
record review and case control study designs were used. The source population for the case
control study design were both men and women aged 18 years and above who have been
attending their treatment in all zonal hospitals and Ayder Tertiary Hospital. Charts of all types of
pneumonia patients treated from July, 2013 to July, 2015 in all zonal hospitals of Tigray and
Ayder Tertiary Hospital were the source population for the retrospective record review. In this
study cases were patients of community acquired pneumonia who had been on treatment and
fulfilled the definition for community acquired pneumonia, while controls were clients who
came for some other purposes to the hospitals but without community acquired pneumonia. To
assess the magnitude of community acquired pneumonia all medical records from the selected
hospitals of the period 2013 to 2015 were retrieved and the cost estimation was made from the
records of the period 2014 to 2015.The sample size for the case control study was calculated
using two proportion formula with a case to control ration of 1 to 2.To collect the data semistructured
interviewer-administrated questionnaire and check list were adapted from different
literatures .Once the data were collected, it was entered into Epi info 2002 and exported to SPSS
Version 20 statistical program for analysis. Ethical clearance was obtained from Institutional
Review Board of the Addis Ababa University College of Health Sciences. Letter of agreement
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was secured from the Regional Health Bureau. Individual written informed consent was solicited
from the respondents at the time of data collection and examination.
Finally measures of central tendency & proportion were calculated. The association between the
exposure and outcome variables were also determined using bivariate and multivariable analysis.
Data for cost was analyzed using descriptive statistics, numerical summary measures, and simple
linear regression analysis. The method of cost estimation employed, included a bottom-up
approach in order to estimate direct patient side medical cost, whereas the indirect cost was
calculated using a human capital approach.
Results: During the study period, there were 36,005 patients of all types of pneumonia with
5877 cases of community acquired pneumonia, making the magnitude of community acquired
pneumonia to be 16%, with proportions for males (16%) and females (17%). The proportion of
admitted patients due to community acquired pneumonia was 9.8%, with a mean admission
length of 6 (+5.59) days.
History of contact with pets, working in dusty environment, history of pulmonary tuberculosis,
history of pneumonia, having contact with people who had respiratory infection, history of
respiratory infection, history of tonsillectomy, history of upper airway problem, age and
educational status had significant association with community acquired pneumonia in the
bivariate logistic regression analysis, while working in dusty environment [OR (95%
CI);2(1.1,4.1)], history of respiratory infection [OR (95% CI); 2.3(1.5,5.7) ], contact with people
who had respiratory infection [OR (95% CI);2.5(1.2,5.3)] and previous history of pneumonia
confirmed by radiograph [OR (95% CI); 39(19.4,78,6)] were significantly associated in the
multivariate analysis.
The total amount of money incurred over the study year was 319,056.52 Ethiopian Birr
($15,193.2). The direct medical expenditure was 242889.60 Eth.B ($11,566.20) and the cost of
lost working days by the patients due to community acquired pneumonia was 76166.92
Ethiopian Birr ($3627). From the cost of direct medical expense, 47.6 % was used for
medication, 18% for imaging (X-ray), 15% for laboratory, 16% for bed and 3% for registration.
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Conclusion: The study revealed that the magnitude of community acquired pneumonia in the
study area was 16% and most prevalent among younger population. Working in dusty
environment, having history of pneumonia, history of respiratory infection and having contact
with people who had respiratory infections are the risk factors of community acquired
pneumonia confirmed in this study.
The cost of illness among adult patients of community acquired pneumonia in the study area was
substantially high. Of the total cost incurred, 76 % was due to direct medical expense and 24 %
for the lost working days.
Hence, appropriate prevention strategies should be designed and implemented so that the
magnitude of community acquired pneumonia would be minimized and terminally the treatment
cost incur by the community acquired pneumonia will be reduced. Besides, Treatment guideline
has to be developed and proper management should be offered to prevent the re-occurrences of
previous pneumonia and other respiratory infections as a result the development of community
acquired pneumonia would be minimized. Moreover, safety measures like personal protective
equipments should be used when there is contact with patients having respiratory tract infections.
More so, further prospective studies should be conducted to estimate the magnitude and
comprehensive costs of community acquired pneumonia. Larger studies are also needed to assess
the effect of some risk factors in the general population.
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Keywords
Community acquired Pneumonia, Magnitude, Risk factors, Cost, Adults, Ethiopia