Original Research

Infectious disease consultations at a South African academic hospital: A 6-month assessment of inpatient consultations

Lauren Richards, David C. Spencer, Jeremy S. Nel, Prudence Ive
Southern African Journal of Infectious Diseases | Vol 35, No 1 | a169 | DOI: https://doi.org/10.4102/sajid.v35i1.169 | © 2020 Lauren Richards, David C. Spencer, Jeremy S. Nel, Prudence Ive | This work is licensed under CC Attribution 4.0
Submitted: 27 June 2019 | Published: 09 September 2020

About the author(s)

Lauren Richards, Division of Infectious Diseases, Department of Medicine, Faculty of Health Sciences, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
David C. Spencer, Division of Infectious Diseases, Department of Medicine, Faculty of Health Sciences, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa; and Clinical HIV Research Unit (CHRU), University of the Witwatersrand, Johannesburg, South Africa
Jeremy S. Nel, Division of Infectious Diseases, Department of Medicine, Faculty of Health Sciences, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
Prudence Ive, Division of Infectious Diseases, Department of Medicine, Faculty of Health Sciences, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa


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Abstract

Background: Infectious diseases (IDs) dominate the disease profile in South Africa (SA) and the ID department is increasingly valuable. There has been little evaluation of the IDs consultation services in SA hospitals.

Methods: A qualitative review of ID inpatient consultations was performed over 6 months at a SA tertiary hospital. Prospectively entered data from each consultation were recorded on a computerised database and retrospectively analysed.

Results: 749 ID consultations were analysed, 4.8% of hospital admissions. Most consultations included initiation of antiretroviral therapy (ART) (27.8%), lipoarabinomannan antigen testing (24.8%) and change of ART (21.6%). Of patients reviewed, 93.3% were human immunodeficiency virus (HIV) positive and the median CD4 count was 52 cells/mm3. The infectious diagnoses (excluding HIV) most frequently encountered were pulmonary and abdominal tuberculosis (TB) and acute gastroenteritis. When all subcategories of TB infection were combined, 42.9% were found to have TB. Patients had predominantly one (45.4%) or two (30.2%) infectious diagnoses in addition to HIV. Some (12%) had three infectious diagnoses during their admission. The number of diagnoses, both infectious (odds ratio [OR] 2.00; 95% confidence interval [CI] 1.11–3.60) and non-infectious (OR 2.27; 95% CI 1.25–4.11), was associated with increased odds of death.

Conclusion: The IDs department sees a high volume of patients compared to most developed countries. HIV, TB and their management dominate the workload. This study shows that HIV patients still have significant morbidity and mortality. The complexity of these patients indicates that specific expertise is required beyond that of the general physician.


Keywords

infectious diseases; inpatient; consultations; South Africa; HIV; TB.

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