What are the main ICD-10 coded diagnoses in hospitalized patients in Madagascar? A sentinel surveillance in 18 hospitals from 2014 to 2018
Authors: Randrianasolo Laurence , Dreyfus Anou , Rabehasimbola Tojonirina , Randriamampionona Léa , Randria Mireille , Ramarokoto Toky , Bernardson Barivola , Rakotoarimanana Feno Manitra , Ratsitorahina Maherisoa , Andriamasoandro Roland Razanatsimba , Randrimbitsialonina Hasina Alain , Razafindrazaka Hajalalaina , Rafaliarisoa Jery Soa Bakolitiana , Ramanantoanina Nirinarilala , Randrianary Haja , Rakotonimanana Solofinirina , Ranarijaona Gisèle , Djaosany Giovanie , Rasoamirantsoa Ramananarivo , Rasolofoharizanany Jacqueline , Ravaonandrasana Iharisoa , Radama Andriamanjava Delbert , Fanambinantsoa Liva , Ralijaona Victor , Randrianasolo Prosper , Randrianavelo - , Ralaivao Jaona , Rakotovao Noelson , Amaïde Tsikomia Nyelsen , Randrianantenaina Antoine Olivier , Botoihely Jean Erick , Pierre Stéphan , Zafilahy Totohako Aimé Bruno , Andrianantenaina Claude Marcel , Piola Patrice , Baril Laurence , Randremanana Rindra 
Published: July 2023

Abstract
Background: In Madagascar, a sentinel surveillance was set up in 18 hospitals using a web-based form to collect medical and demographic information from hospitalized patients. This network was managed by the Ministry of Public Health and Institut Pasteur de Madagascar. In order to improve the access to appropriate health care in Madagascar, the main clinical diagnoses in hospitalized patients were analyzed.
Methods: At entry of a patient, each unit involved in the sentinel surveillance recorded the clinical diagnosis and reason for hospitalization, classified according to the International Statistical Classification of Diseases (ICD-10) through an e-health platform. Data from September 2014 to July 2018 were analyzed comparing the proportion of hospitalized patients with communicable and non-communicable diseases, stratified by age categories, gender and bio-climate. Morbidity and annual incidence of diseases according to ICD-10 chapters were reported.
Results: A total of 140,789 records were entered into the web-based database. The median age for hospitalized patients was 28.2 years (IQR: 18.3; 45.3). One fifth of the children <15 years suffered from communicable diseases, whereas individuals aged ≥ 15 years were more affected by non-communicable diseases (< 15 years: 21.6%; > 15 years 7.8%; p<0.01). Malaria was the most frequent diagnosis in hospitalized patients. The hospital morbidity was 4.01% for malaria, 0.84% for tuberculosis, 0.09% for HIV/AIDS and 0.05% for plague taking all hospitalized inpatients into account. The hospital morbidity of non-communicable diseases was higher compared to communicable diseases with 7.8%, 7.1% and 3.1% for ”Diseases of the circulatory system”, "Injury, poisoning and certain other consequences of external causes" and "Mental and behavioural disorders”, respectively. "Pregnancy, childbirth and puerperium" represented 20.5% of the hospitalized patients.
Conclusions: The e-health platform enabled continuous and standardized data collection, giving an overview of prevalent communicable and non-communicable diseases in hospitalized patients. Communicable diseases affect mainly children <15 years. Non-communicable diseases are on the rise and need more attention by national health authorities. A number of hospitalizations could be prevented by a better health care management at the community-based health care level and by implementation of a Universal Health Coverage (UHC) in Madagascar.