General patient characteristics upon hospital admission
4317 patients were admitted during our study period. Of those patients, 2616 patients (60.6%) were handled by triage, 1178 patients (27.3%) by the adult emergency room and 523 patients (12.1%) by the paediatric emergency room (Table 1). In total, 67 patients (1.6%) deceased in the emergency room during treatment, of which 56 in the adult emergency room and 11 in the paediatric emergency room. Almost half of all the patients were male (2121/4317; 49.1%), the other half female (2193/4317; 50.8%). The majority of admitted patients (3375/4317; 78.2%) came from urban areas, the rest (795/4317; 18.4%) from rural areas. While patients reported fever as the most frequent primary reason for seeking care at the hospital, none of the 2616 patients handled by triage had a measured axillary body temperature ≥ 38,0°C (febrile). However, with regard to the emergency facilities, 15.4% (182/1178) of adult emergency patients and 43.8% (229/523) of paediatric emergency patients resulted to be febrile, amounting to a total 9.5% (411/4317) of all patients being febrile upon hospital admission. For 274 patients (6.3%) no body temperature was recorded. Of all admitted patient, most febrile patients were within the age group 0–4 years (4.3%; 174/4043; Fig. 1). The three most frequent referral services were internal medicine (35.4%), paediatrics (20.2%) and surgery (14.5%). Deceased patients, surgical patients and patients where body temperature was not recorded were excluded from the following analysis.
Table 1: Patient characteristics upon admission
|
Total
|
Triage
|
Adult emergency room
|
Paediatric emergency room
|
Total Number of Patients N
|
4317
|
2616
|
1178
|
523
|
General Characteristics
|
|
|
|
|
Median Age – years (IQR)
|
27 (11-45)
|
29 (16-45)
|
35 (23-55)
|
1 (1-4)
|
Male Sex – n/N (%)
|
2121/4317 (49.1)
|
1134/2616 (43.3)
|
691/1178 (58.7)
|
296/523 (56.6)
|
Female Sex – n/N (%)
|
2193/4317 (50.8)
|
1482/2616 (56.7)
|
484/1178 (41.1)
|
227/523 (43.4)
|
Sex not registered – n/N (%)
|
3/4317 (0.1)
|
0/2616 (0.0)
|
3/1178 (0.3)
|
0/523 (0.0)
|
Residence in urban area – n/N (%)
|
3375/4317 (78.2)
|
2127/2616 (81.3)
|
863/1178 (73.3)
|
385/523 (73.6)
|
Residence in rural area – n/N (%)
|
795/4317 (18.4)
|
487/2616 (18.6)
|
183/1178 (15.5)
|
125/523 (23.9)
|
Residence not registered – n/N (%)
|
147/4317 (3.4)
|
2/2616 (0.1)
|
132/1178 (11.2)
|
13/523 (2.5)
|
Referred Service
|
|
|
|
|
Internal Medicine – n/N (%)
|
1527/4317 (35.4)
|
840/2616 (32.1)
|
687/1178 (58.3)
|
0/523 (0.0)
|
Paediatrics – n/N (%)
|
872/4317 (20.2)
|
360/2616 (13.8)
|
0/1178 (0.0)
|
512/523 (97.9)
|
Surgery – n/N (%)
|
625/4317 (14.5)
|
190/2616 (7.3)
|
435/1178 (36.9)
|
0/523 (0.0)
|
Ophthalmology – n/N (%)
|
446/4317 (10.3)
|
446/2616 (17.0)
|
0/1178 (0.0)
|
0/523 (0.0)
|
Gynaecology – n/N (%)
|
353/4317 (8.2)
|
353/2616 (13.5)
|
0/1178 (0.0)
|
0/523 (0.0)
|
Dental Clinic – n/N (%)
|
220/4317 (5.1)
|
220/2616 (8.4)
|
0/1178 (0.0)
|
0/523 (0.0)
|
Ear Nose Throat (ENT) Clinic– n/N (%)
|
182/4317 (4.2)
|
182/2616 (7.0)
|
0/1178 (0.0)
|
0/523 (0.0)
|
Not recorded – n/N (%)
|
25/4317 (0.6)
|
25/2616 (1.0)
|
0/1178 (0.0)
|
0/523 (0.0)
|
Deceased during treatment – n/N (%)
|
67/4317 (1.6)
|
0/2616 (0.0)
|
56/1178 (4.8)
|
11/523 (2.1)
|
Body Temperature
|
|
|
|
|
<38°C – n/N (%)
|
3632/4317 (84.1)
|
2585/2616 (98.8)
|
781/1178 (66.3)
|
266/523 (50.9)
|
≥38°C – n/N (%)
|
411/4317 (9.5)
|
0/2616 (0.0)
|
182/1178 (15.4)
|
229/523 (43.8)
|
Not recorded – n/N (%)
|
274/4317 (6.3)
|
31/2616 (1.2)
|
215/1178 (18.2)
|
28/523 (5.4)
|
Most frequent primary reasons for consultation
|
Fever, Musculoskeletal injury,
Eye problems
|
Eye problems, Fever,
Chest pain
|
Musculoskeletal injury,
Abdominal pain, Head injury
|
Fever, Asthenia, Cough
|
Clinical features of medical adult and paediatric emergency patients: febrile vs. non-febrile patients
Of 1119 medical adult and paediatric emergency patients whose body temperatures were recorded, 34.9% (391/1119) were febrile, with the larger proportion of febrile patients being paediatric patients (26.1% adults vs. 46.3% children; Table 2). Overall, asthenia (52.6%; 589/1119), loss of appetite (36.9%; 413/1119), vomiting (30.8%; 345/1119) and cough (30.3%; 339/1119) were the most frequently reported symptoms amongst medical emergency patients. Adult febrile patients were more likely than non-febrile patients to report asthenia (50.0% vs 36.1%, p = 0.002), diarrhoea (17.7% vs 10.1%, p = 0.020) and cough (25.6% vs. 11.0%, p < 0.001). They were also more likely to receive a mRDT upon admission (65.9% vs. 49.2%, p < 0.001). In total, 45 adult patients (7.2%; 45/629) had a positive mRDT result, of which 19 patients were febrile and 26 patients non-febrile (11.6% vs. 5.6%, p = 0.014). For children, none of the reported symptoms were more specific for febrile in comparison to non-febrile patients. MRDTs were performed on all but one paediatric patient with results being almost equally distributed between febrile and non-febrile children: 50.0% of all children (47.1% febrile vs 52.5% non-febrile, p = 0.277) received a negative mRDT result and 49.8% (52.4% febrile vs. 47.5% non-febrile, p = 0.319) a positive result.
Table 2: Clinical features of febrile vs. non-febrile medical adult and paediatric emergency patients
|
Total
|
Adult medical patients
|
Paediatric medical patients
|
|
|
Total
|
Febrile N=164
|
Non-febrile N=465
|
p-value
|
Total
|
Febrile N=227
|
Non-febrile N=263
|
p-value
|
Total Number of Patients N – n/N (%)
|
1119
|
629
|
164/629 (26.1)
|
465/629 (73.9)
|
|
490
|
227/490 (46.3)
|
263/490 (53.7)
|
|
Most frequent symptoms (besides fever)
|
|
|
|
|
|
|
|
|
|
General symptoms
|
|
|
|
|
|
|
|
|
|
Asthenia – n/N (%)
|
589/1119 (52.6)
|
250/629 (39.7)
|
82/164 (50.0)
|
168/465 (36.1)
|
0.002
|
339/490 (69.2)
|
163/227 (71.8)
|
176/263 (66.9)
|
0.281
|
Loss of appetite – n/N (%)
|
413/1119 (36.9)
|
158/629 (25.1)
|
50/164 (30.5)
|
108/465 (23.2)
|
0.075
|
255/490 (52.0)
|
123/227 (54.2)
|
132/263 (50.2)
|
0.415
|
Headache – n/N (%)
|
194/1119 (17.3)
|
171/629 (27.2)
|
46/164 (28.0)
|
125/465 (26.9)
|
0.761
|
23/490 (4.7)
|
12/227 (5.3)
|
11/263 (4.2)
|
1.000
|
Dizziness – n/N (%)
|
113/1119 (10.1)
|
112/629 (17.8)
|
33/164 (20.1)
|
79/465 (17.0)
|
0.406
|
1/490 (0.2)
|
0/227 (0.0)
|
1/263 (0.4)
|
1.000
|
Digestive symptoms
|
|
|
|
|
|
|
|
|
|
Vomiting – n/N (%)
|
345/1119 (30.8)
|
111/629 (17.6)
|
35/164 (21.3)
|
76/465 (16.3)
|
0.094
|
234/490 (47.8)
|
98/227 (43.2)
|
136/263 (62.0)
|
0.070
|
Diarrhoea – n/N (%)
|
224/1119 (20.0)
|
78/629 (12.4)
|
29/164 (17.7)
|
49/465 (10.5)
|
0.020
|
146/490 (29.8)
|
65/227 (28.6)
|
81/263 (30.8)
|
0.622
|
Abdominal pain – n/N (%)
|
221/1119 (19.7)
|
176/629 (28.0)
|
40/164 (24.4)
|
136/465 (29.2)
|
0.266
|
45/490 (9.2)
|
21/227 (9.3)
|
24/263 (9.1)
|
1.000
|
Respiratory symptoms
|
|
|
|
|
|
|
|
|
|
Cough – n/N (%)
|
339/1119 (30.3)
|
93/629 (14.8)
|
42/164 (25.6)
|
51/465 (11.0)
|
<0.001
|
246/490 (50.2)
|
114/227 (50.2)
|
132/263 (50.2)
|
1.000
|
Dyspnoea – n/N (%)
|
104/1119 (9.3)
|
72/629 (11.4)
|
17/164 (10.4)
|
54/465 (11.6)
|
0.774
|
32/490 (6.5)
|
14/227 (6.2)
|
18/263 (6.8)
|
0.855
|
Malaria rapid diagnostic test (mRDT)
|
|
|
|
|
|
|
|
|
|
Negative – n/N (%)
|
537/1119 (48.0)
|
292/629 (46.4)
|
89/164 (54.3)
|
203/465 (43.7)
|
0.023
|
245/490 (50.0)
|
107/227 (47.1)
|
138/263 (52.5)
|
0.277
|
Positive – n/N (%)
|
289/1119 (25.8)
|
45/629 (7.2)
|
19/164 (11.6)
|
26/465 (5.6)
|
0.014
|
244/490 (49.8)
|
119/227 (52.4)
|
125/263 (47.5)
|
0.319
|
Not performed – n/N (%)
|
293/1119 (26.2)
|
292/629 (46.4)
|
56/164 (34.1)
|
236/465 (50.8)
|
<0.001
|
1/490 (0.2)
|
1/227 (0.4)
|
0/263 (0.0)
|
0.463
|
Most frequent suspected diagnosis
|
|
|
|
|
|
|
|
|
|
Malaria– n/N (%)
|
632/1119 (56.5)
|
163/629 (25.9)
|
57/164 (34.8)
|
106/465 (22.8)
|
0.002
|
469/490 (95.7)
|
221/227 (97.4)
|
248/263 (94.3)
|
0.118
|
Gastroenteritis – n/N (%)
|
376/1119 (33.6)
|
285/629 (45.3)
|
73/164 (44.5)
|
212/465 (45.6)
|
0.855
|
91/490 (18.6)
|
42/227 (18.5)
|
49/263 (18.6)
|
1.000
|
Pneumonia/Respiratory infection – n/N (%)
|
356/1119 (31.8)
|
51/629 (8.1)
|
22/164 (13.4)
|
29/465 (6.2)
|
0.007
|
305/490 (62.2)
|
140/227 (61.7)
|
165/263 (62.7)
|
0.852
|
Gastroduodenal Ulcer – n/N (%)
|
106/1119 (9.5)
|
106/629 (16.9)
|
25/164 (15.2)
|
81/465 (17.4)
|
0.305
|
0/490 (0.0)
|
0/227 (0.0)
|
0/263 (0.0)
|
|
Stroke – n/N (%)
|
54/1119 (4.8)
|
54/629 (8.6)
|
6/164 (3.7)
|
48/465 (10.3)
|
0.009
|
0/490 (0.0)
|
0/227 (0.0)
|
0/263 (0.0)
|
|
Selected emergency medications
|
|
|
|
|
|
|
|
|
|
Antibiotics
|
|
|
|
|
|
|
|
|
|
Ampicillin – n/N (%)
|
650/1119 (58.1)
|
316/629 (50.2)
|
89/164 (54.3)
|
227/465 (48.8)
|
0.239
|
334/490 (68.2)
|
149/227 (65.6)
|
185/263 (70.3)
|
0.285
|
Metronidazole – n/N (%)
|
189/1119 (16.9)
|
69/629 (11.0)
|
18/164 (11.0)
|
51/465 (11.0)
|
1.000
|
120/490 (24.5)
|
54/227 (23.8)
|
66/263 (25.1)
|
0.753
|
Gentamycin – n/N (%)
|
103/1119 (9.2)
|
1/629 (0.2)
|
1/164 (1.0)
|
0/465 (0.0)
|
1.000
|
102/490 (20.8)
|
46/227 (20.3)
|
56/263 (21.3)
|
0.824
|
Ceftriaxone – n/N (%)
|
97/1119 (8.7)
|
47/629 (7.5)
|
13/164 (6.7)
|
34/465 (7.3)
|
0.863
|
50/490 (10.2)
|
23/227 (10.1)
|
27/263 (10.3)
|
1.000
|
Amoxicillin – n/N (%)
|
22/1119 (2.0)
|
6/629 (1.0)
|
1/164 (1.0)
|
5/465 (1.1)
|
1.000
|
16/490 (3.3)
|
4/227 (1.8)
|
12/263 (4.6)
|
0.124
|
Ciprofloxacin – n/N (%)
|
8/1119 (0.7)
|
7/629 (1.1)
|
2/164 (1.2)
|
5/465 (1.1)
|
1.000
|
1/490 (0.2)
|
1/227 (0.4)
|
0/263 (0.0)
|
0.463
|
Antipyretic/Analgesic
|
|
|
|
|
|
|
|
|
|
Paracetamol – n/N (%)
|
514/1119 (45.9)
|
350/629 (55.6)
|
119/164 (72.6)
|
231/465 (49.7)
|
<0.001
|
164/490 (33.5)
|
123/227 (54.2)
|
41/263 (15.6)
|
<0.001
|
Diclofenac – n/N (%)
|
26/1119 (2.3)
|
26/629 (4.1)
|
3/164 (1.8)
|
23/465 (4.9)
|
0.109
|
0/490 (0.0)
|
0/227 (0.0)
|
0/263 (0.0)
|
|
Antimalarials
|
|
|
|
|
|
|
|
|
|
Artesunate – n/N (%)
|
231/1119 (20.6)
|
22/629 (3.5)
|
11/164 (6.7)
|
11/465 (2.4)
|
0.014
|
209/490 (42.7)
|
103/227 (45.4)
|
106/263 (38.0)
|
0.273
|
Artemether/Lumefantrine– n/N (%)
|
28/1119 (2.5)
|
14/629 (2.2)
|
3/164 (1.8)
|
11/465 (2.4)
|
1.000
|
14/490 (2.9)
|
8/227 (3.5)
|
6/263 (2.3)
|
0.430
|
Hospitalization status
|
|
|
|
|
|
|
|
|
|
Inpatient – n/N (%)
|
865/1119 (77.3)
|
418/629 (66.5)
|
121/164 (73.8)
|
297/465 (63.9)
|
0.021
|
447/490 (91.2)
|
209/227 (92.1)
|
238/263 (90.5)
|
0.632
|
Outpatient – n/N (%)
|
254/1119 (22.7)
|
211/629 (33.5)
|
43/164 (26.2)
|
168/465 (36.1)
|
0.021
|
43/490 (8.2)
|
18/227 (7.9)
|
25/263 (9.5)
|
0.632
|
The three most frequently suspected diagnoses as per adult medical emergency patient were salmonella gastroenteritis/typhoid (45.3%; 286/629), malaria (25.9%; 163/629) and gastroduodenal ulcer (16.9%; 106/629). Only malaria was significantly more often diagnosed amongst febrile as compared to non-febrile adults (34.8% vs. 22.8%, p = 0.002). With regard to all diagnoses suspected in adult medical emergency patients combined, 58.5 % (594/1016) belonged to the diagnosis group infectious diseases, 16.3% (166/1016) to non-infectious diseases of the gastrointestinal tract and 11.2% (114/1016) to non-infectious cardiovascular diseases (Fig. 2). In children, the three most frequently suspected diagnoses were malaria (95.7%; 469/490), respiratory infection/pneumonia (62.2%; 305/490) and gastroenteritis (18.6%; 91/490). There was no significant difference in the proportion of suspected diagnoses between febrile and non-febrile children. In total, 70.0% (892/1275) of all suspected diagnoses combined amongst children in the emergency room belonged to the diagnosis group infectious diseases, 12.2% (156/1275) to non-infectious diseases of the blood system and 6.4% (82/1275) to non-infectious diseases of the gastrointestinal tract (Fig. 3).
Treatments for medical emergency patients consisted mainly of antibiotic, analgesic/antipyretic and antimalarial treatment. For adult patients, ampicillin (50.2%; 316/629) and paracetamol (55.6%; 350/629) were by far the most commonly used medications. For children, ampicillin was given to 68.2% (334/490) of patients, artesunate to 42.7% (209/490) of patients and paracetamol to 33.5% (164/490) of patients. For both adults and children metronidazole was another frequently prescribed antibiotic (11.0% adults, 24.5% children). Furthermore, gentamycin was often used for paediatric patients (20.8%; 102/490). Altogether, only paracetamol was significantly more often used in the groups of febrile adult patients (72.6% vs. 49.8%, p < 0.001) and febrile paediatric patients (54.2% vs. 15.6%, p < 0.001) in comparison to non-febrile patients.
Diagnostics, discharge diagnoses and outcomes of medical adult and paediatric inpatients: febrile vs. non-febrile patients
Of the 1119 medical emergency patients, 418 adults and 447 children were hospitalized. 100 adult patients (23.9%; 100/418) and 55 paediatric patients (12.3%; 55/447) were lost to follow-up, leaving 94 febrile (29.6%; 94/318) and 224 non-febrile (70.4%; 224/318) adult inpatient charts and 178 febrile (45.4%; 178/392) and 214 non-febrile (54.6%; 214/392) paediatric inpatient charts for review (Fig. 4).
On average, adult febrile inpatients were hospitalized for almost one day longer than non-febrile inpatients (5.9 days vs. 5 days; Table 3). Paediatric inpatients stayed hospitalized less days than adults: 3.5 days on average for febrile children and 3.2 days for non-febrile children. Overall, 56.8% (403/710) of all inpatients were discharged with improved health, 24.3% (172/710) either self-discharged against medical advice or without notifying hospital staff and 18.0% (128/710) deceased in inpatient care. The larger proportion of deceased inpatients was amongst adults (26.4% adults vs. 11.2% children). However, febrile children were significantly more likely to die during hospitalization than non-febrile children (18.5% vs. 5.1%, p < 0.001), which only reached a level of a trend for adult inpatients (29.8% vs. 25.0%, p = 0.404).
The most frequent diagnostic tests performed amongst all inpatients were mRDT (78.6%; 558/710), thick blood smear (TBS, 38.3%; 272/710), Widal TO/TH test (23.7%; 168/719) and HIV antibody screening test (8.7%; 62/710), which was mainly used in adult inpatients. Overall, there were no significant differences in the proportion of positive malaria tests between febrile and non-febrile patients. MRDT were positive in 6.3% (20/318) of all adult inpatients (6.6% febrile vs. 8% non-febrile, p = 1.000) and in 48% (188/392) of all paediatric inpatients (50.6% febrile vs. 45.8% non-febrile, p = 0.416). TBS showed presence of P. falciparum in 4.4% (14/318) of adult inpatients (4.3% febrile vs. 4.5% non-febrile, p = 1.000) and in 8.7% (34/392) of paediatric inpatients (9.6% febrile vs. 7.9% non-febrile, p = 0.594).
Table 3: Diagnostics, diagnoses and outcomes of febrile vs. non-febrile medical adult and paediatric inpatients
|
Total
|
Adult medical inpatients
|
Paediatric inpatients
|
Comments
|
|
|
Total
|
Febrile N=94
|
Non-febrile N=224
|
p-value
|
Total
|
Febrile N=178
|
Non-febrile N=214
|
p-value
|
|
Total Number of Patients N – n/N (%)
|
710
|
318
|
94/318 (29.6)
|
224/318 (70.4)
|
|
392
|
178/392 (45.4)
|
214/392 (54.6)
|
|
|
Days hospitalized – Mean in days (SD)
|
4.3 (3.0)
|
5.3 (4.0)
|
5.9 (4.1)
|
5.0 (3.9)
|
|
3.3 (2.0)
|
3.5 (1.8)
|
3.2 (2.1)
|
|
|
Most frequently performed diagnostics
|
|
|
|
|
|
|
|
|
|
|
Malaria rapid diagnostic test (mRDT)
|
|
|
|
|
|
|
|
|
|
Malaria in Guinea is assumed to be caused by P. falciparum only.
|
Positive – n/N (%)
|
208/710 (29.3)
|
20/318 (6.3)
|
6/94 (6.4)
|
14/224 (8.0)
|
1.000
|
188/392 (48.0)
|
90/178 (50.6)
|
98/214 (45.8)
|
0.416
|
|
Negative – n/N (%)
|
350/710 (49.3)
|
148/318 (46.5)
|
59/94 (62.8)
|
89/224 (39.7)
|
<0.001
|
202/392 (51.5)
|
87/178 (48.9)
|
115/214 (53.7)
|
0.361
|
|
Thick blood smear (TBS)
|
|
|
|
|
|
|
|
|
|
Malaria in Guinea is assumed to be caused by P. falciparum only.
|
Positive – n/N (%)
|
48/710 (6.8)
|
14/318 (4.4)
|
4/94 (4.3)
|
10/224 (4.5)
|
1.000
|
34/392 (8.7)
|
17/178 (9.6)
|
17/214 (7.9)
|
0.594
|
|
Negative – n/N (%)
|
224/710 (31.5)
|
85/318 (26.7)
|
38/94 (40.4)
|
47/224 (21.0)
|
0.001
|
139/392 (35.5)
|
59/178 (33.1)
|
80/214 (37.4)
|
0.397
|
|
Widal TO/TH
|
|
|
|
|
|
|
|
|
|
Widal test plays a crucial role in diagnosing typhoid fever (which is recorded as a salmonella gastroenteritis).
|
Positive – n/N (%)
|
129/710 (18.2)
|
53/318 (16.7)
|
20/94 (21.3)
|
33/224 (14.7)
|
0.187
|
76/392 (19.4)
|
37/178 (20.8)
|
39/214 (18.2)
|
0.608
|
|
Negative – n/N (%)
|
39/710 (5.5)
|
11/318 (3.5)
|
4/94 (4.3)
|
7/224 (3.1)
|
0.737
|
28/392 (7.1)
|
13/178 (7.3)
|
15/214 (6.5)
|
1.000
|
|
Cerebrospinal fluid
|
|
|
|
|
|
|
|
|
|
Cerebrospinal fluid is used to diagnose bacterial meningitis only.
|
Pathological (indicating bacterial infection) – n/N (%)
|
11/710 (1.5)
|
2/318 (0.6)
|
2/94 (2.1)
|
0/224 (0.0)
|
0.087
|
9/392 (2.3)
|
5/178 (2.8)
|
4/214 (1.9)
|
0.737
|
|
Normal – n/N (%)
|
3/710 (0.4)
|
0/318 (0.0)
|
0/94 (0.0)
|
0/224 (0.0)
|
|
3/392 (0.8)
|
1/178 (0.6)
|
2/214 (0.9)
|
1.000
|
|
Stool microscopy parasites
|
|
|
|
|
|
|
|
|
|
There are no other diagnostic tests available for recognizing common parasitic infection .
|
Positive – n/N (%)
|
3/710 (0.4)
|
2/318 (0.6)
|
1/94 (1.1)
|
1/224 (0.4)
|
0.504
|
1/392 (0.3)
|
0/178 (0.0)
|
1/214 (0.5)
|
1.000
|
|
Negative – n/N (%)
|
18/710 (2.5)
|
10/318 (3.1)
|
2/94 (2.1)
|
8/224 (3.6)
|
0.729
|
8/392 (2.0)
|
4/178 (2.2)
|
4/214 (1.9)
|
1.000
|
|
HIV antibody test
|
|
|
|
|
|
|
|
|
|
HIV Antigen tests are used to diagnose HIV. If positive, patients are referred to the HIV clinic for further PCR testing.
|
Positive – n/N (%)
|
20/710 (2.8)
|
20/318 (6.3)
|
11/94 (11.7)
|
9/224 (4.0)
|
0.020
|
0/392 (0.0)
|
0/178 (0.0)
|
0/214 (0.0)
|
|
|
Negative – n/N (%)
|
42/710 (5.9)
|
41/318 (12.9)
|
16/94 (17.0)
|
25/224 (11.2)
|
0.198
|
1/392 (0.3)
|
1/178 (0.6)
|
0/214 (0.0)
|
0.455
|
|
Syphilis TPHA
|
|
|
|
|
|
|
|
|
|
Only TPHA screening test is used, confirmation test was unavailable during time of study.
|
Positive – n/N (%)
|
8/710 (1.1)
|
8/318 (2.5)
|
2/94 (2.1)
|
6/224 (2.7)
|
1.000
|
0/392 (0.0)
|
0/178 (0.0)
|
0/214 (0.0)
|
|
|
Negative – n/N (%)
|
26/710 (4.1)
|
25/318 (7.9)
|
9/94 (9.6)
|
16/224 (7.1)
|
0.496
|
1/392 (0.3)
|
1/178 (0.6)
|
0/214 (0.0)
|
0.455
|
|
Toxoplasmosis IgG/IgM
|
|
|
|
|
|
|
|
|
|
|
Positive – n/N (%)
|
5/710 (0.7)
|
5/318 (1.6)
|
2/94 (2.1)
|
3/224 (1.3)
|
0.634
|
0/392 (0.0)
|
0/178 (0.0)
|
0/214 (0.0)
|
|
|
Negative – n/N (%)
|
4/710 (0.6)
|
4/318 (1.3)
|
0/94 (0.0)
|
4/224 (1.8)
|
0.323
|
0/392 (0.0)
|
0/178 (0.0)
|
0/214 (0.0)
|
|
|
Sputum Tuberculosis
|
|
|
|
|
|
|
|
|
|
Pulmonary tuberculosis is usually diagnosed and treated by the external tuberculosis clinic. Suspect cases are referred.
|
Positive – n/N (%)
|
1/710 (0.1)
|
1/318 (0.3)
|
0/94 (0.0)
|
1/224 (0.4)
|
1.000
|
0/392 (0.0)
|
0/178 (0.0)
|
0/214 (0.0)
|
|
|
Negative – n/N (%)
|
3/710 (0.4)
|
3/318 (0.9)
|
1/94 (1.1)
|
2/224 (0.9)
|
1.000
|
0/392 (0.0)
|
0/178 (0.0)
|
0/214 (0.0)
|
|
|
Anti-streptolysin O
|
|
|
|
|
|
|
|
|
|
|
Positive – n/N (%)
|
17/710 (2.4)
|
12/318 (3.8)
|
4/94 (4.3)
|
8/224 (3.6)
|
0.754
|
5/392 (1.3)
|
3/178 (1.7)
|
2/214 (0.1)
|
0.663
|
|
Negative – n/N (%)
|
10/710 (1.4)
|
9/318 2.8)
|
3/94 (3.2)
|
6/224 (2.7)
|
0.727
|
1/392 (0.3)
|
1/178 (0.6)
|
0/214 (0.0)
|
0.455
|
|
Hbs Antigen
|
|
|
|
|
|
|
|
|
|
Hepatitis B surface antigen is used to diagnose active Hepatitis B. Other diagnostic tests are not available.
|
Positive – n/N (%)
|
7/710 (1.0)
|
7/318 (2.2)
|
1/94 (1.1)
|
6/224 (2.7)
|
0.678
|
0/392 (0.0)
|
0/178 (0.0)
|
0/214 (0.0)
|
|
|
Negative – n/N (%)
|
19/710 (2.7)
|
19/318 (6.0)
|
6/94 (6.4)
|
13/224 (5.8)
|
0.801
|
0/392 (0.0)
|
0/178 (0.0)
|
0/214 (0.0)
|
|
|
Most frequent discharge diagnoses
|
|
|
|
|
|
|
|
|
|
|
Malaria – n/N (%)
|
222/710 (31.3)
|
24/318 (7.5)
|
9/94 (9.6)
|
15/224 (6.7)
|
0.362
|
198/392 (50.5)
|
101/178 (56.7)
|
97/214 (45.3)
|
0.025
|
Diagnosis based on positive rapid test result and/or positive thick blood smear, or clinical presentation only.
|
Respiratory infection – n/N (%)
|
83/710 (11.7)
|
10/318 (3.1)
|
5/94 (5.3)
|
5/224 (2.2)
|
0.168
|
73/392 (18.6)
|
33/178 (18.5)
|
40/214 (18.7)
|
1.000
|
Diagnosis based on clinical presentation and occasionally on radiological results; includes all respiratory infections other than tuberculosis.
|
Gastroenteritis – n/N (%)
|
69/710 (9.7)
|
40/318 (12.6)
|
10/94 (10.6)
|
30/224 (13.4)
|
0.581
|
29/392 (7.4)
|
14/178 (7.8)
|
15/214 (7.0)
|
0.847
|
Diagnosis based on clinical presentation and/or on Widal test results.
|
Liver Disease (e.g. Hepatitis B) – n/N (%)
|
21/710 (3.0)
|
19/318 6.0)
|
6/94 (6.4)
|
13/224 (5.8)
|
0.801
|
2/392 (0.5)
|
2/178 (1.1)
|
0/214 (0.0)
|
0.207
|
Diagnosis based on clinical presentation and/or positive Anti Hbs results.
|
Meningitis – n/N (%)
|
4/710 (0.6)
|
2/318 (0.6)
|
2/94 (2.1)
|
0/224 (0.0)
|
0.087
|
2/392 (0.5)
|
2/178 (1.1)
|
0/214 (0.0)
|
0.207
|
Diagnosis based on clinical presentation and/or cerebrospinal fluid results.
|
HIV – n/N (%)
|
21/710 (3.0)
|
21/318 (6.6)
|
10/94 (10.6)
|
11/224 (4.9)
|
0.081
|
0/392 (0.0)
|
0/178 (0.0)
|
0/214 (0.0)
|
|
Diagnosis based on positive HIV Antigen test result, later confirmed through PCR at external HIV clinic.
|
Pulmonary Tuberculosis – n/N (%)
|
9/710 (1.7)
|
9/318 (2.8)
|
2/94 (2.1)
|
7/224 (3.1)
|
1.000
|
0/392 (0.0)
|
0/178 (0.0)
|
0/214 (0.0)
|
|
Diagnosis based on clinical presentation and/or radiological findings and/or sputum analysis.
|
Gastroduodenal Ulcer – n/N (%)
|
14/710 (2.0)
|
14/318 (4.4)
|
1/94 (1.2)
|
13/224 (5.8)
|
0.073
|
0/392 (0.0)
|
0/178 (0.0)
|
0/214 (0.0)
|
|
Diagnosis based on clinical presentation only.
|
Anaemia not specified – n/N (%)
|
22/710 (3.1)
|
21/318 (6.6)
|
2/94 (2.1)
|
19/224 (8.5)
|
0.046
|
1/392 (0.3)
|
0/178 (0.0)
|
1/214 (0.5)
|
1.000
|
Diagnosis based on Haemoglobin level without evidence of known cause.
|
Stroke – n/N (%)
|
43/710 (6.1)
|
43/318 (13.5)
|
14/94 (14.9)
|
29/224 (12.9)
|
0.720
|
0/392 (0.0)
|
0/178 (0.0)
|
0/214 (0.0)
|
|
Diagnosis based on clinical presentation only.
|
Hypertension not specified
|
10/710 (1.4)
|
10/318 (3.1)
|
0/94 (0.0)
|
10/224 (4.5)
|
0.037
|
0/392 (0.0)
|
0/178 (0.0)
|
0/214 (0.0)
|
|
Diagnosis based on clinical presentation only.
|
Diabetes – n/N (%)
|
16/710 (2.3)
|
16/318 (5.0)
|
4/94 (4.3)
|
12/224 (5.4)
|
0.786
|
0/392 (0.0)
|
0/178 (0.0)
|
0/214 (0.0)
|
|
Diagnosis based on fasting blood sugar level.
|
Outcomes
|
|
|
|
|
|
|
|
|
|
|
Improvement of health – n/N (%)
|
403/710 (56.8)
|
140/318 (44.0)
|
43/94 (45.7)
|
97/224 (43.3)
|
0.712
|
263/392 (67.1)
|
115/178 (64.6)
|
148/214 (69.2)
|
0.207
|
|
Transferred – n/N (%)
|
7/710 (1.0)
|
6/318 (1.9)
|
1/94 (1.1)
|
5/224 (2.2)
|
0.674
|
1/392 (0.3)
|
0/178 (0.0)
|
1/214 (0.5)
|
1.000
|
|
Deceased – n/N (%)
|
128/710 (18.0)
|
84/318 (26.4)
|
28/94 (29.8)
|
56/224 (25.0)
|
0.404
|
44/392 (11.2)
|
33/178 (18.5)
|
11/214 (5.1)
|
<0.001
|
|
Self-discharge against medical advice – n/N (%)
|
85/710 (12.0)
|
64/318 (20.1)
|
17/94 (18.1)
|
47/224 (21.0)
|
0.646
|
21/392 (5.3)
|
10/178 (5.6)
|
11/214 (5.1)
|
1.000
|
|
Self-discharge without notice – n/N (%)
|
87/710 (12.3)
|
24/318 (7.5)
|
5/94 (5.3)
|
19/224 (8.5)
|
0.484
|
63/392 (16.1)
|
20/178 (11.2)
|
43/214 (20.1)
|
0.019
|
|
Of all inpatients who were tested for malaria by means of mRDT, 67 adult inpatients and 172 paediatric inpatients were also tested for malaria through TBS (Table 4). For adult inpatients, a positive TBS was significantly more likely when the mRDT had been positive: 27.3% (3/11) of adult inpatients with a positive TBS were also tested positive by means of mRDT whereas only 3.6% (2/56) with a negative TBS were tested positive by means of mRDT (2/56, p = 0.006). In other words, 72.7% (8/11) of adult inpatients with a positive TBS received a negative mRDT while 96.4% (54/56) of adult inpatients with a negative TBS also received a negative mRDT result. For children, 5.9% (2/34) of inpatients with a positive TBS were also tested positive by means of mRDT and 4.3% (6/138) with a negative TBS were tested positive by means of mRDT. In other words, 94.1% (32/34) of paediatric inpatients with a positive TBS received a negative mRDT while 95.7% (132/138) of paediatric inpatients with a negative TBS received a negative mRDT result.
Table 4: Malaria RDT vs. TBS results of medical adult and paediatric inpatients where both mRDT and TBS were performed
|
Total
|
Adult medical inpatients
|
Paediatric medical inpatients
|
|
|
Total
|
TBS positive N=11
|
TBS negative N=56
|
p-value
|
Total
|
TBS positive N=34
|
TBS negative N=138
|
p-value
|
Total Number of Patients – n/N (%)
|
239
|
67
|
11/67 (16.4)
|
56/67 (83.6)
|
|
172
|
34/172 (19.8)
|
138/172 (80.2)
|
|
mRDT positive – n/N (%)
|
13/239 (5.4)
|
5/67 (7.5)
|
3/11 (27.3)
|
2/56 (3.6)
|
0.006
|
8/172 (4.7)
|
2/34 (5.9)
|
6/138 (4.3)
|
0.704
|
mRDT negative – n/N (%)
|
226/239 (94.6)
|
62/67 (92.5)
|
8/11 (72.7)
|
54/56 (96.4)
|
0.006
|
164/172 (95.3)
|
32/34 (94.1)
|
132/138 (95.7)
|
0.704
|
Overall, the most frequent discharge diagnoses of inpatients were malaria (31.3%; 222/710), respiratory infection/pneumonia (11.7%; 83/710) and salmonella gastroenteritis/typhoid (9.7%; 69/710). Within the diagnosis group infectious diseases, most common discharge diagnoses for adult inpatients were salmonella gastroenteritis/typhoid (34.2%; 40/117), malaria (20.5%; 24/117) and HIV (17.9%; 21/117). Particularly HIV was posed more frequently as discharge diagnosis than as suspected diagnosis (Fig. 5). For paediatric patients, the most frequent discharge diagnoses within the diagnosis group infectious diseases were malaria (65.3%; 198/303), respiratory infection/pneumonia (24.1%; 73/303) and salmonella gastroenteritis/typhoid (9.6%; 29/303). Within this group, particularly malaria was posed more frequently as discharge diagnosis than as suspected diagnosis (Fig. 6).
Altogether, malaria was diagnosed significantly more often compared to other diagnoses when mRDT or TBS showed positive test results (Table 5). However, 62 of 710 patients (8.6%) received a different discharge diagnosis than malaria even though positive mRDT or TBS indicated infection with P. falciparum. Similarly, 91 of 710 patients (12.8%) received malaria as discharge diagnosis even though mRDT or TBS did not indicate infection with P. falciparum.
Table 5: Malaria as final diagnosis vs. malaria diagnostic test results
|
Total
|
Adult medical inpatients
|
Paediatric medical inpatients
|
|
|
Total
|
Diagnosis malaria
N=24
|
Other diagnosis N=294
|
p-value
|
Total
|
Diagnosis malaria N=198
|
Other diagnosis N=194
|
p-value
|
Total Number of Patients – n/N (%)
|
710
|
318
|
24/318 (7.5)
|
294/318 (92.5)
|
|
392
|
198/392 (50.5)
|
194/392 (45.5)
|
|
Patients with mRDT positive – n/N (%)
|
208/710 (29.3)
|
20/318 (6.3)
|
7/24 (29.2)
|
13/294 (4.4)
|
<0.001
|
188/392 (48.0)
|
152/198 (76.8)
|
36/194 (18.6)
|
<0.001
|
Patients with mRDT negative – n/N (%)
|
350/710 (49.3)
|
148/318 (46.5)
|
16/24 (66.7)
|
132/294 (44.9)
|
<0.001
|
202/392 (51.5)
|
44/198 (22.2)
|
158/194 (81.4)
|
<0.001
|
Patients with TBS positive – n/N (%)
|
48/710 (6.8)
|
14/318 (4.4)
|
6/24 (25.0)
|
8/294 (2.7)
|
<0.001
|
34/392 (8.7)
|
29/198 (14.6)
|
5/194 (2.6)
|
<0.001
|
Patients with TBS negative – n/N (%)
|
224/710 (31.5)
|
85/318 (26.7)
|
8/24 (33.3)
|
77/294 (26.2)
|
<0.001
|
139/392 (35.5)
|
7/198 (3.5)
|
132/194 (68.0)
|
<0.001
|
Inpatient expenses
We calculated average inpatient healthcare expenses for all adult and paediatric inpatients based on laboratory expenses, expenses for medications and hospitalization costs (Table 6). Average laboratory expenses per adult inpatient were 51,700 Guinean Francs (GNF; 9000 GNF = approximately 1 USD), for medications GNF 35,9000 and hospitalization costs GNF 85,000, amounting to average healthcare expenses per adult inpatient of GNF 49,5700 or around 207 purchasing power parity (PPP) for actual health (2400 GNF = approximately 1 PPP actual health expenditure). Average laboratory expenses per paediatric inpatient were GNF 19,700, for medications GNF 229,000 and hospitalization costs GNF 80,000, amounting to average healthcare expenses per inpatient of GNF 328,700 or roughly 137 PPP for actual health.
Table 6: Inpatient healthcare expenses
|
Medical adult inpatients
|
Medical paediatric inpatients
|
Medications
|
|
|
Average price per medication (excluding 10 most expensive drugs)
|
51,700 GNF
|
51,700 GNF
|
Total medications taken by patients
|
2210
|
1735
|
Total number of patients
|
318
|
392
|
Average medications per patient
|
7
|
4
|
Total cost for medications - in GNF
|
114,257,000 GNF
|
89,699,500 GNF
|
Average cost for medications per patient - in GNF
|
359,000 GNF
|
229,000 GNF
|
Other
|
|
|
Emergency room fee - in GNF
|
15,000 GNF
|
10,000 GNF
|
Hospitalization fee - in GNF
|
70,000 GNF
|
70,000 GNF
|
Totals
|
|
|
Laboratory costs per patient - in GNF
|
51,700 GNF
|
19,700 GNF
|
Medication costs per patient - in GNF
|
359,000 GNF
|
229,000 GNF
|
Hospitalization costs per patient - in GNF
|
85,000 GNF
|
80,000 GNF
|
Total costs per patient - in GNF
|
495,700 GNF
|
328,700 GNF
|
Total costs per patient - in PPP
|
207
|
143
|
Average GNI per capita in Guinea (2018) - in USD
|
$850
|
$850
|
Total inpatient cost per patient - in % of GNI
|
6.5%
|
4.4%
|
Average per capita spending on healthcare in Guinea (2017) - in USD
|
$34
|
$34
|
Average per capita spending on healthcare in Guinea (2017) - in % of GNI
|
4.1%
|
4.1%
|