title: Medical causes of admissions to hospital among adults in Africa: a systematic review.
abstract: BACKGROUND
  Despite the publication of several studies on the subject, there is significant uncertainty regarding the burden of disease among adults in sub-Saharan Africa (sSA).
  
  
  OBJECTIVE
  To describe the breadth of available data regarding causes of admission to hospital, to systematically analyze the methodological quality of these studies, and to provide recommendations for future research.
  
  
  METHODS
  We performed a systematic online and hand-based search for articles describing patterns of medical illnesses in patients admitted to hospitals in sSA between 1950 and 2010. Diseases were grouped into bodily systems using International Classification of Disease (ICD) guidelines. We compared the proportions of admissions and deaths by diagnostic category using χ2.
  
  
  RESULTS
  Thirty articles, describing 86,307 admissions and 9,695 deaths, met the inclusion criteria. The leading causes of admission were infectious and parasitic diseases (19.8%, 95% confidence interval [CI] 19.6-20.1), respiratory (16.2%, 95% CI 16.0-16.5) and circulatory (11.3%, 95% CI 11.1-11.5) illnesses. The leading causes of death were infectious and parasitic (17.1%, 95% CI 16.4-17.9), circulatory (16%, 95% CI 15.3-16.8) and digestive (16.2%, 95% CI 15.4-16.9). Circulatory diseases increased from 3.9% of all admissions in 1950-59 to 19.9% in 2000-2010 (RR 5.1, 95% CI 4.5-5.8, test for trend p<0.00005). The most prevalent methodological deficiencies, present in two-thirds of studies, were failures to use standardized case definitions and ICD guidelines for classifying illnesses.
  
  
  CONCLUSIONS
  Cardiovascular and infectious diseases are currently the leading causes of admissions and in-hospital deaths in sSA. Methodological deficiencies have limited the usefulness of previous studies in defining national patterns of disease in adults. As African countries pass through demographic and health transition, they need to significantly invest in clinical research capacity to provide an accurate description of the disease burden among adults for public health policy.
authors: Department of Epidemiology and Demography, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya. Aetyang@kemri-wellcome.org
authors: Anthony O
authors: AO
authors: Etyang
authors: John Anthony Gerard
authors: JA
authors: Scott
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D002423:Cause of Death; D003141:Communicable Diseases / Q000453:epidemiology; D006739:Hospital Administration / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D010557:Personnel Administration, Hospital
keywords: Africa; ICD; adults; cause of death; health; medical admissions; transition