By Jumbo, J; Ambakederemo, TE; Ikuabe, OP (2023). Greener Journal of Epidemiology and Public Health, 11(1): 23-28.

Greener Journal of Epidemiology and Public Health ISSN: 2354-2381 Vol. 11(1), pp. 23-28, 2023 Copyright ©2023, Creative Commons Attribution 4.0 International. DOI: https://doi.org/10.5281/zenodo.7856902 https://gjournals.org/GJEPH

The Contribution of Respiratory Diseases to Mortality in Niger Delta University Teaching Hospital (NDUTH), Bayelsa State Nigeria.

Jumbo Johnbull¹, Ambakederemo T. Emmanuella¹, Ikuabe O. Peter

Department of Internal Medicine, Niger Delta University, Bayelsa State, Nigeria.

ARTICLE INFO	ABSTRACT
Article No.: 050122043 Type: Research Full Text: PDF, HTML, PHP, MP3, EPUB DOI: 10.5281/zenodo.7856902	Background: One of the most important ways of knowing the efficiency of a health care delivery system in a health facility is by assessing of the causes and the number of deaths per annum. Diseases of the respiratory system are leading causes of death and disability globally. However, there are insufficient researches on the contribution of respiratory diseases to mortality in Nigeria. This study researched the impact of respiratory diseases on mortality in NDUTH, Bayelsa State, Nigeria. Methodology: This was a 3-year retrospective descriptive study of mortality from all causes including respiratory that were recorded in NDUTH from January 2016-December 2018. The data for the research was obtained from records of death that took place in NDUTH during the study period. Statistical Programme for Social Sciences version 21.0 (SPSS) software was used in the analysis of the data. Results: Respiratory diseases constituted 4.2% of the mortality while the highest cause of death was infectious diseases (27.8%) and neurological diseases was 15.6%, while mortality from hematological conditions was the lowest (1.5%). Pulmonary Tuberculosis was the highest cause of mortality among the respiratory diseases (31.6%). HIV-TB co-infection constituted the commonest co-morbid condition that contributed to the mortality (66.6%). Obstructive Lung Diseases (COPD and Bronchiectasis), and chest malignancy as causes of deaths occurred more commonly among males than females. Conclusion: In this index study, respiratory diseases accounted for a small percentage of the mortality during this period. Further studies are needed in this population to explore the effects of gas and crude oil pollution on the respiratory system.
Accepted: 13/04/2023 Published: 25/04/2023
*Corresponding Author Dr. Johnbull Jumbo E-mail: johnbulljumbo@ gmail.com Phone: +2348036774159
Keywords: Causes of Mortality, Respiratory Diseases, Gas and Crude Oil pollution, Niger Delta University Teaching Hospital (NDUTH).

INTRODUCTION

One of the ways of assessing the efficiency of a health care delivery system is the evaluation of mortality annually.

The lung is exposed to environmental hazards including airborne infection and injury. Respiratory diseases accounts for a high number of deaths and disability globally. In 2016, 56.9million deaths occurred globally, out of which 54% were caused by the top ten leading causes of death.¹

In 2016, Chronic Obstructive Pulmonary Disease [COPD] accounted for 65 million morbidities and 3 million mortalities, placing it as the third leading cause of death globally that year, while lung cancers [along with trachea and bronchus cancers] caused 1.7 million deaths².

Lower respiratory infection was the most deadly communicable disease, responsible for 3 million mortalities worldwide in 2016.

Pneumonia was responsible for millions of morbidities and mortalities annually especially among children under 5years.²

However, the number of tuberculosis death decreased in the same period, but it was still among the top ten causes with a death toll of 1.3 million.²

Among newly diagnosed TB cases, 11% had co-infection with HIV accounting for additional 400,000 deaths in 2015³

Aside smoking, lung cancers have been known to occur in non-smokers. Passive exposure to tobacco smoke, biomass fuel, environmental and workplace carcinogens among others have been implicated as risk factors for lung cancers.⁴

People with lung cancers have been noted to have increased hospital admissions and deaths following exposure to high concentrations of airborne fine particles .⁵

In a study done in Ekiti South West Nigeria, Pulmonary Tuberculosis, Bronchial Asthma and pneumonia were the three top causes of morbidity among respiratory diseases with pulmonary TB accounting for most of the respiratory diseases among the subjects.⁶

However, there are insufficient researches on the contribution of chest disease to mortality in Nigeria .

METHODOLOGY

2.0 Study location

This research was carried out in NDUTH, Bayelsa State. Bayelsa State is among the oil producing states in Nigeria.

Okolobiri Community where NDUTH is located has been exposed continuously to gas flaring for 14 years.

Bayelsa State is located within latitude 05 to 23’ South and 04 to 15’ North.

It is bounded by the Atlantic Ocean on the south and west, Delta State on the north and, Rivers State on the east.

The hospital offers health care services to Bayelsa communities and other communities in neighboring states of Delta and Rivers State which are also oil producing States.

2.1 Study design

This was a 3-year retrospective descriptive study of mortality from all causes including respiratory that were recorded in NDUTH from January 2016-December 2018. The data for the research was obtained from records of death that took place in NDUTH during the study period.

The hospital practices quality improvement program and has in place a quality improvement committee. The information obtained from the record included demography, primary diagnosis, causes of death among others.⁷

The gold standard for cause of death assessment is autopsy, but it is very expensive, so not affordable to bereaved relatives.

Cultural beliefs and traditional burial practices were hindrances to autopsy as it was forbidden in some of the communities so it was not practicable to carry out autopsy on all the deaths.⁸

Certification by a medical practitioner based on the rules and procedures of the international classification of diseases and related health problems (ICD) is the ideal standard .⁹All but cases that were ‘brought in dead’ were certified dead by medical practitioners and were included in the research

Data analysis

Statistical Package for Social Sciences version 21.0 [SPSS] software was used to summarize data. The level of significance was put at p<0.05.

Ethical Approval

Ethical approval was obtained from the NDUTH hospital Ethics and Research Committee.

RESULTS

A mortality of 457 was recorded out of a total number of 4533 patients that were admitted. The average crude mortality rate was 10.1% (Table 1).

 

Table 1: Yearly variation in Mortality Rate

Year	Admissions	Mortality	Crude mortality rate (%)
2016	1457	117	8.0%
2017	1657	152	9.2%
2018	1419	188	13.2%
Total	4533	457	10.1%

Respiratory diseases constituted 4.2% of the mortality, while the highest cause of death was infectious diseases (27.8%) and the lowest (1.5%) was caused by haematological diseases (Table 2).

 

Table 2: Causes of death

Causes	Frequency	Percentage (%)
Infections Endocrinology Diseases of the cardiovascular system Diseases of the Neurological system Gynecological/ Obstetrics Chest Diseases Neonatology Trauma Hematological Diseases Oncology	126 35 33 71 10 19 43 19 7 32	27.8 7.7 7.3 15.6 2.2 4.2 9.5 4.2 1.5 7.0

As shown below, pulmonary tuberculosis remains the highest cause of death among the respiratory diseases (31.6%).

 

Table 3: Primary Respiratory Diseases causes of Death according to Adult and Childhood Status

Respiratory Diseases	Children	Adults	Total N (%)
Pulmonary Tuberculosis Bronchiectasis Bacterial chest Infection Bronchogenic Carcinoma Pulmonary Embolism COPD	– – 3 – –	6 2 3 1 2 3	6 (31.6) 2 (10.5) 3 (15.8) 1 (5.3) 2 (10.5) 3 (15.8)

Chronic Obstructive Lung Diseases (COPD), Bronchiectasis and chest malignancy as causes of deaths occurred more commonly among males than females (Table 4).

 

Table 4: Causes of Death due to Respiratory Diseases based on the gender

Causes of Respiratory Deaths	Male N (%)	Female N (%)	Total N (%)
Pulmonary Tuberculosis Bronchiectasis Bacterial Chest Infection Bronchogenic Carcinoma Pulmonary Embolism COPD Disseminated TB Total	3 (50) 2 (100) 1 (33.3) 1 (100) – 2 (66.7) 1 (50) 10 (52.6)	3 (50) – 2 (66.7) – 2 (100) 1 (33.3) 1 (50) 9 (47.4)	6 (31.6) 2 (10.5) 3 (15.8) 1 (5.3) 2 (10.5) 3 (15.8) 2 (10.5) 19 (100)

As shown below, HIV-TB co-infection constituted the commonest co-morbid condition that contributed to the mortality rate (66.6%).

 

Table 5: Deaths due to Co-Morbid conditions with respiratory disease

Causes of Deaths due to co-morbid Conditions with Respiratory Diseases	Frequency	Percentage (%)
Retroviral Diseases with Tuberculosis Co-infection Pulmonary Tuberculosis with Heart Failure Severe Pneumonia with Heart Failure Diabetes Mellitus with Bacterial Chest Infection Retroviral Disease with Bacterial Chest Infection Pulmonary Tuberculosis with Cor Pulmonale Pulmonary Tuberculosis with Occult Malignancy Severe Prematurity with Pneumonia Total	28 2 2 2 1 3 1 3 42	66.6 4.8 4.8 4.8 2.4 7.1 2.4 7.1 100.0

DISCUSSION

This was 3 years retrospective study of mortality caused by chest diseases seen in NDUTH, Bayelsa State, South-South Nigeria. No similar study has been carried out in South-South Nigeria.

In this index study, pulmonary TB accounted for 31.6% of the mortality caused by chest diseases having co-morbidity with HIV and responsible for 66.6% of the deaths caused by co-morbid conditions.

Bayelsa State is one of the major oil and gas producing states in Nigeria. Oil exploration activities with it attendant oil spills and gas flaring and environmental pollution have led to a high level of poverty in the state.¹⁰

The prevailing poverty and hunger predispose young ladies to prostitution, which could lead to increased prevalence of STDs including HIV and AIDS in the state.¹¹

TB has a high prevalence in the developing world accounting for more than 90% of global TB cases and TB-related mortality, with 75% of those cases affecting the most productive age group .¹²

Obstructive lung diseases (COPD and Bronchiectasis), and chest malignancy as cause of deaths occurred more commonly among males than females. The gender distribution in our study has similarity to other studies conducted in Brazil¹³ and India¹⁴ in which chest diseases mortality was commoner in men than women.

However, this finding is in contrast with a similar study done in a tertiary hospital in South-West Nigeria in which respiratory diseases mortality was more in females than the males.⁶

Chronic respiratory diseases such as sarcoidosis, collagen lung diseases and pneumoconiosis among others, were not common in this index study. This could be as a result of misdiagnosis of these conditions as pulmonary tuberculosis because of lack of essential, specific diagnostic facilities.

However, contrary to the expected high mortality from chronic respiratory conditions because of the increased exposure of the population to gas flaring and oil pollution, this study shows that chest diseases were responsible for only 4.2% of the total mortality during the study period.

This could be as a result of the design of the research which only took a look at the causes of death without considering the morbidity of respiratory diseases during the study period.

Exposures to oil and gas pollutions could cause chronic respiratory disease with long period of morbidity before resulting in mortality.

Further studies should be carried out in this population to evaluate the impact of gas and crude oil pollution on the respiratory systems including particulate matter measurement, and lung function test in order to have a proper physiological assessment of the lungs.

CONCLUSION

In this index study, respiratory diseases accounted for small percentage of the mortality during the study period.

Further studies should be carried out in this population to evaluate the impact of gas and crude oil pollution on the respiratory system.

LIMITATIONS

This research could have certain inherit limitations, such as poor or incomplete medical record keeping, missed diagnosis and lack of essential, specific diagnostic facilities, as well as absence of autopsy.

ACKNOWLEDGEMENT

I acknowledge the staffers of the Medical Records Department and other staff of NDUTH Okolobiri for their assistance.

REFERENCES

1. Anika L. Hines, Kevin C. Heslin, H. Joanna Jiang and Rosanna Coffey. High-Volume Conditions, 2002-2012 Healthcare Cost and Agency for Healthcare Utilization Project Research Quality, July 2015.
2. Global Health Estimates 2016: Deaths by cause, Age, Sex, by Country and by Religion,2000-Trends in observed Adult Inpatient Mortality for Organization,2016. Available 2016. Geneva, World Health Organizations; 2018.
3. Global Tuberculosis Report 2016. who.int/tb/publications/global report /en/
4. Loomis D, Huang W, Chen G. The International Agency for Research on Cancer (IARC) evaluation of the carcinogenicity of outdoor air pollution: focus on China. Chin J Cancer 2014; 33: 189-196. World Health Geneva , http://www.from:AniediUmoh,http://www.ncbi.nlm.nih.gov/pubmed24694836
5. World Health Organization, 2016. Ambient air pollution: a global assessment of exposure and burden of disease. Geneva. Available from: http://who.int/phe/publications/air-pollution-global-assessment/en/
6. Desalu OO, Oluwafemi JA, Ojo O . Respiratory diseases morbidity and mortality among adults attending a tertiary hospital in Nigeria J Bras Pneumol. 2009Available from: Aug;35(8):74.
7. Victor Aniedi Umoh, Akaninyene Otu, Henry Okpa, and Emmanuel Effa. The pattern of Respiratory Disease Morbidity and Mortality in a Tertiary Hospital in Southern-Eastern Nigeria. Pulm Med. 2013; 2013:581973.
8. Shojania KG, Burton EC, McDonald KM, Goldman L. Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA. 2003; 289(21): 2849-56.
9. International classification of diseases and related health problems. 10^th revision. Geneva: World Health Organization; 2007.
10. Global Gas Flaring Reduction Partnership. Gas flaring reduction. Statistical
11. Nwuche CA, Akani CL. An assessment of high risk sexual behavior and HIV transmission //www.worldbank.org/en/programs/gasflaring reduction. Accessed 13 June, Available https: at among migrant oil workers in the Niger Delta area of Nigeria. Niger J Clin Pract. 2006; 9: 48-51.
12. Ahlburg DA, Stop TB initiative (World Health Organization). The economic impacts of tuberculosis. Geneva: Stop TB initiative, World Health Organization;2000.

13. Toyoshima MT, Ito GM, Gouveia N. Trends in morbidity for respiratory diseases hospitalized patients in the city of Sao Paulo. Rev Assoc Med Bras. 2005; 51(4): 209-13.

14. Dasgupta A, Bagchi A, Nag S, Bardhan S, Bhattacharyya P. Profile of respiratory problems in among pulmonary clinic. Lung India. 2008; 25:4-7.

 

Cite this Article: Jumbo, J; Ambakederemo, TE; Ikuabe, OP (2023). The Contribution of Respiratory Diseases to Mortality in Niger Delta University Teaching Hospital (NDUTH), Bayelsa State Nigeria. Greener Journal of Epidemiology and Public Health, 11(1): 23-28. https://doi.org/10.5281/zenodo.7856902.

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