Morbidity and mortality in a diarrhoeal diseases hospital in Bangladesh

Abstract

Records of all patients who were admitted to or who died in Dhaka hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) between July 1980 and 30th June 1981 were reviewed to identify epidemiological characters associated with in-hospital diarrhoeal diseases-related deaths. Information on aetiological agents, age, sex, major complications, nutritional status and level of dehydration were analysed. Over the one-year period, 3251 patients were admitted to the medical wards and 400 died. Children under five made up 72% of patients admitted and 77% of those who died. All patients were cultured for enteric vibrios, Salmonella and Shigella; 25% of the patients had at least one of these organisms. Shigella was most common and was isolated from 13% of the patients and 19% of those who died. Case-fatality rates in patients with Shigella and Vibrio cholerae non-OI (NAG) were significantly higher than other enteric pathogens (V. cholerae OI, Salmonella typhi and mixed). Case fatality for Vibrio cholerae non-OI was higher than Shigella (25.8% and 17.2%) but the difference was not statistically significant. Among those who died 21% were severely dehydrated and 50% had various complications. Patients with V. cholerae OI were significantly more dehydrated than other groups (P less than 0.05 by chi 2 test). The patients who died with Shigella were significantly more malnourished and had more frequent associated complications than other non-Shigella diarrhoea patients (P less than 0.01 by chi 2 test). Overall our observations indicate that Shigella and Vibrio cholerae non-OI are associated with unusually high case fatality