A Study of Morbidity Pattern in Indoor Patients in a Tertiary Care Hospital in Lucknow

ORIGINAL ARTICLE pISSN 0976 3325│eISSN 2229 6816 Open Access Article www.njcmindia.org A Study of Morbidity Pattern in Indoor Patients in a Tertiary Care Hospital in Lucknow Deepak Chopra1, Shilpi Manchanda2, Sakshi Manchanda2, Nidhi Jauhari3 Financial Support: None declared Conflict of Interest: None declared Copy Right: The Journal retains the copyrights of this article. However, reproduction of this article in the part or total in any form is permissible with due acknowledgement of the source. How to cite this article: Chopra D, Manchanda S, Manchanda S, Jauhari N. A Study of Morbidity Pattern in Indoor Patients in a Tertiary Care Hospital in Lucknow. Natl J Community Med 2017; 8(4):169-173. Author’s Affiliation: 1Assistant professor, Department of Community Medicine, IIMSR, Lucknow; 2Department of Medicine, VPIMS, Lucknow; 3Department of Ophthalmology, VPIMS, Lucknow ABSTRACT Introduction-Health statistics decide the foundation and course of health policies and programs. Indicators such as the Birth Rate, Death Rate, Life Expectancy at Birth, Morbidity/Mortality patterns etc. reveal the extent and nature of the health problems in the community and thus assists in establishment of the priorities for policy planning and implementation. The present study is being done to assess the morbidity pattern in indoor patients in a tertiary care hospital. Materials & methods- A cross sectional study done in a tertiary care hospital with sample size of 4511. Results- the study found out that maximum patient (44.4%) were admitted under Chapter I i.e. certain infectious and parasitic diseases and 72% of hospital admissions were accounted for by 12 common causes of morbidity. The results of our study were comparable with other studies, differences being there due to limitation of our study being limited to IPD patients. Correspondence: Dr Deepak Chopra drdeepakchoprakgmu17@gmail.com Conclusion-Leading causes of morbidity in all ages and both sexes which require hospitalization are acute infectious diseases. Date of Submission: 27-03-17 Date of Acceptance: 21-04-17 Date of Publication: 30-04-17 Keywords: Hospitalization, IPD, Morbidity, Mortality. INTRODUCTION Health policies of a country are a key factor in determining the health status of a population and for evidence based formulation of health policies, health statistics is of crucial importance(1). The health indicators and patterns impact the process of policy planning and resource allocation(2).Birth rate, death rate, life expectancy at birth, and morbidity/mortality patterns etc. are vital measures of the population’s health. For indicators to be calculated, it is essential to identify and quantify various diseases that affect the health of the population. Morbidity pattern shows the magnitude of the disease and time trends that highlight demographic differences in disease burden by age, sex, ethnic status etc(3). It shows the extent and nature of the disease load in the community, and thus assists in establishment of the priorities. . It is also needed for monitoring and evaluation of disease control activities. The pattern of mortality and morbidity helps to allocate the resources and monitor the trends for the effect of intervention. The major objective of the present study was to assess the morbidity pattern in indoor patients in a tertiary care hospital in Lucknow and the study was undertaken because no such study has been conducted in a tertiary hospital in northern India. MATERIALS & METHODS It was a cross sectional study conducted in Vivekananda Polyclinic and Institute of Medical Sciences (VPIMS), Lucknow, a tertiary care hospital and the morbidity data was collected from indoor patients admitted from July,2008 to June,2009. All the admitted patients in the study period who consented were included in the study. A total of 4511 patients consented to be the part of the study. National Journal of Community Medicine│Volume 8│Issue 4│Apr 2017 Page 169 Open Acceess Journal │ww ww.njcmindia.orrg Information regarding th he socio-dem mographic ch haracteristics and morbid dity pattern was collectted through a pre-tested, p prre-structured d questionnaaire and includeed age, sex, duration d of stay, diagno osis etc. Internattional classiffication of Diagnosis D (IC CD code)-10 was w assign ned to ev very diagn nosis1.Approprriate statisticcal tests werre applied and a all statisticall calculationss were perfo ormed by usiing statistical so oftware pack kage Stata 11.2. Another set of data to observe o the pattern p of admissions a a and seasonal treends was reetrieved for the period of 2006 to 20099.The inclusiion of only indoor i mediical cause patien nts in a ho ospital settin ng limited the t scope of the study. pISSN 09976 3325│eISSN N 2229 6816 were studied for the t analysis o of morbidity y pattern. Table--1 shows thaat 2004 (44.4%) patients were w admitted d under Chaapter I i.e. ceertain infectious and parasiitic diseases. While the d diseases of th he digestive sy ystem (Chaptter IX) constiituted 12.1% of cases, diseasses of Endoccrine, nutrittional and metabolic m diseasses(chapter IV V) 9.9%, diseases of the genitourinary y system (Ch hapter XIV) 88.1% and diseases of the resspiratory sysstem (Chapteer X) 7.0%. RESULTS A The pattern n of admissiion Pattern of Admissions: was studied d over threee years from m July 2006 to June 2009. The T trend an nalysis (fig. 1) shows th hat admissions varied v from 324 to 596 per p month with w a mean of416+53/month h. The differeence was stattistically insign nificant (p=00.783). Adm missions appeear to increase in i August month m and deecrease in Feebruary month h every year in the graph h but the diffference was no ot statistically y significant..Seasonal treend analysis sho ows an appaarent dip in admissions in winter seaso on(Oct-Jan peeriod) every year and peeak in admission ns in monso oon (July-Sep pt.) every yeear (p=0.505). M IC CD 10 Chapteer wise rankin ngPattern of Morbidity: A total of 4511 4 patientss, admitted to the mediical service of th he VPIMS fro om July 20088 to June 2009, Figure 1: Trend an nalysis of tottal admission ns Table 2 shows thatt acute gastro oenteritis, viral fever, entericc fever, werre the mostt common in nfectious and parasitic diseaases (chapter I) and acutte gastritis, Accid peptic disease d and cchronic liverr disease were three t most common diseeases among diseases of the digestive system (chapteer XI). D Table-1: Chaapter-wise Distribution of Morbiditty Data ICD Chapter I. II. III. Certain infectious and d parasitic diseases Neoplassms Diseasess of the blood and blood forrming organs and certain diso orders involviing the immun ne mechanism m IV. Endocriine,nutritionall and metaboliic diseases V. Mental and a behavioural disorders VI. Diseasess of the nervou us system IX. Diseasess of the circulaatory system X. Diseasess of the respiratory system XI. Diseasess of the digesttive system XII. Diseasess of the skin and subcutaneous tissue XIII. Diseasess of the muscu uloskeletal sysstem and conn nective tissue XIV. Diseasess of the genito ourinary system XVII. Congen nital malformaations, deform mations and chrromosomal ab bnormalities XVIII Symptoms,signs and abnormal clin nical and laborratory findingss XIX. Injury,p poisoning and certain other consequencess of external caauses Adm missions(n=45511) M F Total (%) 1144 4 860 2004(444.4) 10 15 25 (0.5)) 102 146 248 (5.44) 449 (9.99) 105 (2.33) 45 (0.9)) 312 (6.99) 318 (7.00) 550 (122.1) 3 (0.06)) 33 (0.7)) 264 22 24 185 186 285 3 13 185 83 21 7 132 265 20 158 3 209 367 (8.11) 4 (0.08)) 1 30 14 2 2 National Journaal of Communitty Medicine│Vo olume 8│Issue 4│Apr 4 2017 Age of Patients 15-44 y yrs 45-59 yrs M F M F 685 5001 279 220 5 3 1 5 58 1000 26 28 >60 yrs M F 180 139 7 4 18 18 28 16 16 42 28 141 2 3 188 655 177 244 477 1552 3 102 4 4 48 46 83 1 4 91 17 3 55 46 78 10 134 2 4 95 112 61 6 47 1 1007 1 29 - 46 - 82 56 2 - 44 (0.9)) 11 8 5 4 14 2 4 (0.08)) 2 1 - 1 - 76 1 1 48 39 35 7 - Page 170 Open Access Journal │www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816 Certain diseases of Skin & subcutaneous tissue (chapter XII) like boils (0.02%), diseases of Congenital malformations, deformations and chromosomal abnormalities (chapter XVII) like VSD(0.02) and Diseases of the nervous system (chapter VI) like Meningitis(0.04) were relatively uncommon causes of Morbidity. Table-2: Common Causes Of Morbidity Under Each Chapter ICD Chapter VII. Certain infectious and parasitic diseases VIII. Neoplasms IX. Diseases of the blood and blood forming organs and certain disorders involving the immune mechanism X. Endocrine,nutritional and metabolic diseases XI. Mental and behavioural disorders XII. Diseases of the nervous system IX. Diseases of the circulatory system X. Diseases of the respiratory system XI. XII. Diseases of the digestive system Diseases of the skin and subcutaneous tissue XIII. Diseases of the musculoskeletal system and connective tissue XIV. Diseases of the genitourinary system XVII. Congenital malformations, deformations and chromosomal abnormalities XVIII Symptoms, signs and abnormal clinical and laboratory findings XIX. Injury, poisoning and certain other consequences of external causes *AGE = Acute Gastroenteritis Common causes of Morbidity(%)(N=4511) AGE*(9.9),Viral fever(9.4), Enteric fever(6.0) Carcinoma gall bladder(0.2), AML(0.1), Bronchogenic carcinoma(0.06) Anemia(5.2),Thrombocytopenia(0.1),Vitamin B12 deficiency anemia(0.04) DM type-2(9.7), DM type-1(0.1), Hypoglycemia(0.04) Anxiety Neurosis(1.7),Conversion Reaction(0.3),Depression(0.1) Seizure disorder(0.4), Migraine(0.4), Meningitis(0.04) Hypertension(3.8),CVA(1.7), CAD/IHD(0.3) Chronic obstructive airway disease with acute exacerbation(5.4),LRTI(0.6)Bronchial asthma(0.3) Acute gastritis(4.5),Acid peptic disease(2.1),Chronic liver disease(1.5) Psoriasis(0.04), Boils(0.02) Rheumatoid arthritis(0.3),Cervical spondylosis(0.2),Back pain(0.1) UTI(4.3), CRF(2.8), ARF(0.6) Polycystic kidney disease(0.06),VSD(0.02) Generalised weakness(0.5),Muscular chest pain(0.2),Loss of appetite(0.06) Drug reaction(0.08) Table-3: Most Common Causes of Morbidity Primary Diagnosis ICD-10 Admissions (N=4511) Code M F Total (%) Acute Gastroenteritis DM type-2 Viral fever Enteric fever Chronic obstructive airway disease with acute Exacerbation Anemia Acute Viral Hepatitis Pulmonary Tuberculosis Acute Gastritis UTI Hypertension Malaria A09 E11 B34.9 A01.0 J44.1 193 256 276 158 155 256 183 152 114 89 449(9.9) 439(9.7) 428(9.4) 272(6.0) 244(5.4) Age Distribution (Years) 15-44 45-59 ≥60 M F M F M F 105 138 53 69 35 49 21 17 102 90 133 76 142 57 81 62 53 33 120 78 29 29 9 7 14 18 38 36 103 35 D64.9 B19.9 A16.2 K29.1 N39.0 I10 B54 97 159 144 47 53 106 87 141 71 84 156 142 69 55 238(5.2) 230(5.0) 228(5.0) 203(4.5) 195(4.3) 175(3.8) 142(3.1) 53 111 74 28 33 28 64 Table 3 illustrates acute gastroenteritis (A09) to be the most common cause of morbidity accounting for 9.9% of total patients with female preponderance and maximum burden in 15-44 years of age group; while least in age group >60 years. Diabetes Mellitus type II (E11) and its complications were the second most common cause of morbidity (9.7%) with male preponderance and highest in > 60 years age group. Third most common cause was Viral fever (B34.9) being 9.4%, being higher in males and in 15-44 age group. The most common diseases in males were Viral Fever, Diabetes Melli- 95 37 47 105 93 16 42 26 32 37 5 10 25 16 28 17 21 43 31 31 10 18 16 33 14 10 53 7 18 17 16 8 18 22 3 tus type 2, COPD with acute exacerbation, Acute Viral Hepatitis, Pulmonary Tuberculosis while in women most common causes were Acute gastroenteritis (A09) with 256(12.31%), Diabetes mellitus type 2 (E11) (8.80%), Acute gastritis (K29.1) (7.50%), Urinary tract infection (N39.0) (6.83%), Viral fever (B34.9) (7.31%), Anemia (D64.9) (6.78%). The pie chart (figure 2) shows that 72% of hospital admissions were accounted for by 12 common causes of morbidity. The table also illustrates that the acute infectious diseases were the most common causes of morbidity in the younger age group National Journal of Community Medicine│Volume 8│Issue 4│Apr 2017 Page 171 Open Access Journal │www.njcmindia.org 15-44 years (Acute gastroenteritis, Viral fever, Enteric fever, Acute viral hepatitis) while both chronic diseases (e.g.DM type2, COPD, Hypertension, Anemia) and acute infectious diseases (e.g. Viral fever, AGE, Enteric fever, Acute viral hepatitis, Acute gastritis) are common in the age group of 4559 years. Chronic diseases like DM type 2, COPD, CRF, Hypertension, CVA, Anemia are more common than infectious diseases in the age group >60 years. DISCUSSION Our study showed that acute gastroenteritis (9.9%), diabetes mellitus type 2 (9.7%), viral fever (9.4%), enteric fever (6.0%), chronic obstructive pulmonary disease (5.4%), anemia (5.2%), acute viral hepatitis (5.0%), pulmonary tuberculosis (5.0%), acute gastritis (4.5%), urinary tract infection (4.3%), hypertension (3.8%) and malaria (3.1%) were the leading causes of morbidity in our hospital while the Ministry of Health & Family Welfare, Government of India (2005)2 shows that the leading causes of morbidity in India were injuries (16.7%), maternal and perinatal conditions (11.6%),cardiovascular diseases (10.0%), mental illness (8.5%), diarrheal diseases (8.2%), childhood diseases (5.4%), cancers (3.4%), tuberculosis (2.8%), HIV/AIDS (2.1%), malaria and other vector borne diseases (1.6%), COPD and asthma (1.5%), refractive errors (1.4%) and diabetes (0.7%). The WHO report “The Global Burden of Disease: 2004 update3 in 2008 in which revealed the leading causes of morbidity to be lower respiratory tract infections (6.2%), Diarrheal diseases (4.8%), unipolar depressive disorders(4.3%), Ischemic heart disease (4.1%), HIV/AIDS (3.8%), cerebrovascular disease (3.1%), prematurity and low birth weight (2.9%), birth asphyxia and birth trauma (2.7%), road traffic accidents (2.7%), neonatal infections (2.7%), tuberculosis (2.2%), malaria (2.2%), chronic obstructive pulmonary disease (2.0%), refractive errors (1.8%), hearing loss adult onset (1.8%), congenital anomalies(1.7%), alcohol use disorders(1.6), violence(1.4%), diabetes mellitus (1.3%), self-inflicted injuries (1.3%). Most of the findings of our study are in concurrence with the MoHFW report& WHO report, variations may be due to that our study being restricted to indoor medicine department cases only and MoHFW& WHO data also including the morbidity from Obstetrics causes and Infant & Childhood illnesses. The high prevalence of Diabetes Mellitus in our study as comparison to MoHFW/WHO report may be due to the conduction of our study in hospital setting involving indoor cases only. A retrospective hospital record based study of a teaching hospital in western Nepal by Lamichhaneet al4in 2006 demonstrated the morbidity pattern pISSN 0976 3325│eISSN 2229 6816 in OPD in which he found that Upper respiratory tract infections and acid peptic disease were the most common diagnosis, similarly in our study the acute gastritis was among the ten most important causes of morbidity.Adebusoye et al5in 2009 in their study amongst elderly patients presenting at a primary care clinic in Nigeria found the most prevalent morbidities to be hypertension (40.0%), cataracts (39.4%) and osteoarthritis (26.8%). The prevalence of anemia in that study was 8.0% (females = 11.2%; males = 2.6%), and it was significantly associated with gender (p = 0.001).In a study done by Prakash R et al6in Udaipur in elderly(60years and above) in 2004, it was found that 70% elderly were suffering from one or other ophthalmic problems followed by 48% with hypertension, 42% had psycho-social problems, 36% were suffering from respiratory disease and the others were living with musculoskeletal (14.6%), nervous system (8.67%), ENT (8%) and GIT (4.7%) diseases. Our study revealed the prevalence of anemia to be 5.2 % & hypertension to be 3.8%. Such high prevalence of NCD like hypertension in other studies may be due to that the studies being done in elderly subjects. Another study by Sabdeet al7in 2008 studied the morbidity pattern in street sweepers in Nagpur and found that the important morbidities detected were anemia (20.5%), hypertension (9.5%), upper respiratory tract infections (7.3%), chronic bronchitis (5.9%), refractive error (3.7%), pterygium (2.9%), acute atopic conjunctivitis (2.6%) and bronchial asthma (1.8%). A rapid appraisal of morbidity pattern of four villages in Dehradun by Bansal R8 et al in 2000 revealed that COPD/Asthma and ARI were ranked as first and second health problems in males. CONCLUSION Our study found that the Acute infectious diseases were the leading causes of hospitalization in all the ages and both sexes. But the spectrum of diseases differ in males and females like some diseases were more common in males viz, Diabetes mellitus type 2, Viral fever, COPD with acute exacerbation, while others like Acute gastroenteritis, Anemia, Acute gastritis and Urinary tract infection were more common in females. REFERENCES 1. 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Adebusoye LA, Ladipo MM, Owoaje ET, et al. Morbidity pattern amongst elderly patients presenting at a primary care clinic in Nigeria.Afr J Prm Health Care Fam Med. 2009; 3. [cited 2009 Aug 23]; Available from: URL:www.phcfm.org/index.php/phcfm/article/view/211. pISSN 0976 3325│eISSN 2229 6816 6. Prakash R, Choudhary SK, Singh US. A Study of Morbidity Pattern among Geriatric Population in an Urban Area of Udaipur Rajasthan. Indian J Community Med 2004; 29: 1-3. 7. Sabde YD, Zodpey SP. A Study of Morbidity Pattern in Street Sweepers: A Cross Sectional Study. Indian J Community Med 2008; 33: 224-228. 8. Bansal R, Goel NK, Luthra SC, et al. Rapid appraisal of morbidity pattern in a community with the help of local health functionaries. Health Administrator 2000; 9&10: 5760. Available from: URL: http://medind.nic.in. 9. Lagdir Gaikwad, Santosh Haralkar.Morbidity Profile and Seasonal Variations of Communicable Diseases among Hospitalized Patient in a Teaching Hospital Solapur (Maharashtra), India. SSRG International Journal of Medical Science (SSRG-IJMS) – volume 2 Issue 6 June 2015. National Journal of Community Medicine│Volume 8│Issue 4│Apr 2017 Page 173