Author Affiliations: Division of Tropical Medicine, Liverpool School of Tropical Medicine, Liverpool, England (Ms Floyd and Drs Reid, Wilkinson, and Gilks); Hlabisa Hospital, Hlabisa (Dr Reid), and Centre for Epidemiological Research in South Africa (Hlabisa) Medical Research Council, Mtubatuba (Dr Wilkinson), KwaZulu-Natal, South Africa. Dr Wilkinson is now with the Centre for Rural and Remote Health, University of South Australia, Whyalla Campus, Whyalla Norrie.
Edited by Annette Flanagin, RN, MA, Managing
Context Few studies have attempted to quantify the effect of the epidemic of
human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)
on demand for health care in developing countries. More data are required
to improve understanding of its impact and to guide development of appropriate
Objective To assess the HIV/AIDS epidemic's impact on demand for inpatient hospital
care in a rural area of South Africa.
Design Retrospective analysis of data from general hospital and individual
ward admission registers, a tuberculosis program database, and patient case
Setting and Patients Patients admitted between 1991 and 1998 to a 450-bed hospital that serves
Hlabisa District, South Africa (population ≈200,000), where HIV seroprevalence
among antenatal clinic attendees increased from 4% in 1992 to 29% in 1998.
Main Outcome Measures Number of admissions to 9 hospital wards, number of clinical AIDS and
general medical admissions (both excluding tuberculosis), and number of tuberculosis
admissions to adult medical wards during the study period.
Results Total hospital admissions increased by 81%, from 6562 in 1991 to 11,872
in 1998. Adult tuberculosis ward admissions increased by 360%, from 303 to
1393. In 1998, tuberculosis patients accounted for 47% and 30% of adult male
and female medical ward admissions, respectively, and for 11% of total hospital
admissions. Nontuberculosis clinical AIDS cases increased 43-fold, accounting
for 4% of adult medical admissions in 1997 vs 0.2% in 1991. Tuberculosis and
nontuberculosis clinical AIDS cases were the only types of admission to show
a clear and consistent upward trend over the period studied. Patterns in other
types of admissions varied more and changes were smaller.
Conclusions The HIV/AIDS epidemic has had an important impact on demand for adult
tuberculosis and general medical care in a rural South African district hospital.
If this impact is shown to extend to other rural South African areas, response
strategies are urgently needed.
Floyd K, Reid RA, Wilkinson D, Gilks CF. Admission Trends in a Rural South African Hospital During the Early Years of the HIV Epidemic. JAMA. 1999;282(11):1087–1091. doi:10.1001/jama.282.11.1087