Epidemiological study on community acquired pneumonia among hospital treated adults in Tigray, Ethiopia.
Creators: name: Berhe, Haftu
Publisher: name: National Academic Digital Repository of Ethiopia
Year: 2017

description: 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 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 &amp; 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. XV 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.