The Trends of In-Patient Mortality between 2018 and 2019 at Kisumu County Level Four Hospital, Kenya

Introduction: Due to a lack of information on patient mortality, healthcare planners rarely use local data for resource allocation and hospital management. This results in missed opportunities to build hospital capacity to address common causes of death, as well as a poor hospital reputation, fewer patients seeking hospital care, increased medical errors, and increased inpatient mortality.

Objective: To determine trends of hospital mortality between 2018 and 2019 at Level Four Kisumu County Hospital, Kenya.

Methods: The study was a cross sectional retrospective study design. The study targeted files of patients who died between January 2018 and December 2022. Systematic sampling was used in which every file per ward was given a serial number. Each department formed a stratum. Sample size was determined using Yamane Taro formula (N/1+N(e2) which yielded 203 as sample size from population of 680. The risk of death based on the presence or absence of doctor and nurse was analyzed by odds ratio. Chi-square was used to check association of appropriateness of facility, delay of care and distance and mortality. Variation in ward mortalities was analyzed using ANOVA to assess and data presented as line graphs.

Results: According to the current study, the medical ward had the highest 2-year in-hospital mortality rate of 13.86%, while obstetrics and gynecology (reproductive health) had the lowest mortality rate of 0.47 percent. Infections were responsible for 42% of hospital deaths in patients under the age of 35, while noncommunicable diseases were responsible for 41% of hospital deaths in patients over the age of 60. According to the study, 3% of hospital deaths could have been avoided. When a nurse and a doctor were all present, there was a significant difference in the odds of a patient dying (OR=0.697). Comorbidity was a significant risk factor for death among patients who died in 2018 and 2019 (p=0.05). Patient characteristics such as age, education level, and gender were not associated with hospital deaths (p>0.05).

Conclusion: The study found that 3% of hospital deaths were avoidable. More deaths occurred in medical ward from infectious diseases such as pneumonia and pulmonary TB among patients aged <35 years while non-communicable diseases such as cancer, hypertension and diabetes mellitus were important causes of death among the people aged >60 years. The results seem to suggest that more deaths occurred during rainy season between February and August. Patient factors such as age, sex and education level were not significantly associated with hospital mortality. Comorbidities particularly the non-infectious diseases were associated with more deaths.