Causative Factors of Medical In-patient Mortality at a District Hospital in South Africa: A Retrospective Study

In-patient mortality remains low when compared to general mortality rates; nonetheless, medical in-patient death rates are increasing. Few studies have been undertaken in South Africa to investigate the reasons for in-patient mortality, primarily at tertiary institutions and excluding rural settings. Such data are critical for informing health-system strengthening and planning policies and interventions.

This study aimed to examine the factors that contribute to hospital in-patient death in a district hospital in South Africa.

A cross-sectional analytic study design was undertaken. Data pertaining to patients aged 15 years or older were obtained from in-patient record reviews ranging the period from January 2015 to December 2016. Socio-demographic factors, clinical factors, hospital length of stay, and death outcomes were extracted. Logistic regression was used to determine factors associated with in-patient mortality and Adjusted Odds Ratios (AORs) and 95% Confidence Interval (CI) were reported.

Employed patients were more likely to die than unemployed patients (AOR = 8.315; 95% CI: 1.709 - 18.443), while remaining in the hospital for three days was not protective against death compared to staying less than 24 hours (AOR = 0.139; 95% CI: 0.027-0.714). HIV-infected individuals in WHO clinical stages III/IV (AOR = 10.13; 95% CI: 8.74–12.28) and I/II (AOR = 5.309; 95% CI: 0.315–89.53) were more likely to die. Patients with cancer conditions had a 10.164 times higher mortality rate (95% CI: 1.912 to 18.62).

Our findings demonstrated the key modifiable predictors of in-patient mortality to include TB infection, advanced HIV stage, and prolonged hospital stay, highlighting the need for targeted interventions to address these factors in order to reduce in-patient mortality.