title: Age Related Patterns of Disease and Mortality in Hospitalised Adults in Malawi.
abstract: BACKGROUND
  The epidemic of non-communicable diseases (NCDs) in low and middle income countries (LMICs) is widely recognised as the next major challenge to global health. However, in many LMICs, infectious diseases are still prevalent resulting in a "double burden" of disease. With increased life expectancy and longevity with HIV, older adults may particularly be at risk of this double burden. Here we describe the relative contributions of infections and NCDs to hospital admissions and mortality, according to age, in Malawi's largest hospital.
  
  
  METHODS
  Primary diagnosis on discharge/death, mortality rates, and HIV status were recorded prospectively on consecutive adult medical in-patients over 2 years using an electronic medical records system. Diagnoses were classified as infections or NCDs and analysed according to age and gender.
  
  
  RESULTS
  10,191 records were analysed. Overall, infectious diseases, particularly those associated with HIV, were the leading cause of admission. However, in adults ≥55 years, NCDs were the commonest diagnoses. In adults <55 years 71% of deaths were due to infections whereas in adults ≥55 years 56% of deaths were due to NCDs.
  
  
  CONCLUSIONS
  Infectious diseases are still the leading cause of adult admission to a central hospital in Malawi but in adults aged ≥55 years NCDs are the most frequent diagnoses. HIV was an underlying factor in the majority of adults with infections and was also present in 53% of those with NCDs. These findings highlight the need for further health sector shifts to address the double burden of infectious and NCDs, particularly in the ageing population.
authors.affiliation: University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: Theresa J
authors.initials: TJ
authors.lastname: Allain
authors.affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
authors.forename: Stephen
authors.initials: S
authors.lastname: Aston
authors.affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
authors.forename: Gugulethu
authors.initials: G
authors.lastname: Mapurisa
authors.affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
authors.forename: Thokozani N
authors.initials: TN
authors.lastname: Ganiza
authors.affiliation: College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Ndaziona P
authors.initials: NP
authors.lastname: Banda
authors.affiliation: Ministry of Health, Queen Elizabeth Hospital, Blantyre, Malawi.
authors.forename: Servace
authors.initials: S
authors.lastname: Sakala
authors.affiliation: Ministry of Health, Queen Elizabeth Hospital, Blantyre, Malawi.
authors.forename: Andrew
authors.initials: A
authors.lastname: Gonani
authors.affiliation: University College London, London, United Kingdom.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Heyderman
authors.affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Peterson
mesh_terms: D000328:Adult; D000375:Aging; D003141:Communicable Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D057286:Electronic Health Records; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008017:Life Expectancy; D008295:Malawi / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies