Ahid Parvez ( PMRC Research Centre, Punjab Medical College, Faisalabad. )
Naseer Ahmed Chaudhary ( Department of Pathology, Punjab Medical College, Faisalabad. )
F.M. Chaudhary ( Department of Pathology, Punjab Medical College, Faisalabad. )
Mian Zahid Malik ( Department of Pathology, Punjab Medical College, Faisalabad. )
A pilot study was undertaken to assess the pattern of diseases, fatality and some other ratios among the patients treated at District Headquarters Hospital, Faisalabad during 1984. Out of 4,506 in-patients, maximum admissions 1,196 (26.54%) were of gastrointestinal diseases followed by795 (17.64%) cases of injuries. Overall fatality was found to be6,35%. Te highest case fatality was found in the infectious diseases group, while maximum of the total deaths (20.98%) occurred due to injuries. Consistency in provisional and final diagnosis was found in 86.20% of total oases. The annual turnover was 41 patients per bed per year (JPMA 43: 52, 1993).
Urbanization, industrialization and pollution especially in developing countries is probably creating a new disease pattern in the communities. Occupational diseases, injuries and accidents are gaining more and more importance. in this situation morbidity statistics become more important and provide information about fatal and non-fatal illnesses. Grant1 emphasized the need of health statistics for public health workers whereas Ahmed and Smythe2 described hospital based study, the only available approximation of community needs. A pilot study was undertaken to assess the pattern of diseases, fatality caused by them and some other ratios from record of patients treated at District Headquarters Hospital, Faisalabad. The hospital consists of 504 beds3, covering a 3.56 million population4 of district Faisalabad while the number of hospital beds in the district was 1,246 during the study year 1984.
The specific objectives of the study were:
i) to find out relative frequency of different diseases; ii) to determine case fatality rate; iii) to study the consistency in provisional and final diagnosis and iv) to determine annual turnover, i.e., discharges per year per bed.
The universe of this pilot study contained all surgical and medical beds of District Headquarters Hospital Faisalabad during 1984. Thirty-three percent of these beds were included in .the sample. The data regarding sex, provisional diagnosis, final diagnosis, date of admission, date of discharge and outcome of treatment, of in-patients were collected from the hospital records (bed head tickets) and compiled for presentation and statistical analysis. Case fatality rate was determined by the following formula5:
No. of deaths due a particular far disease
case fatality rate (cFR) = x 100
No. of cases of the same disease
Of the total 4,506 patients, 2,678 were males and 1,828 females, with 1,196(26.54%) having gastrointestinal diseases, this being the highest among all the disease groups, followed by 795 (17.64%) patients with injuries. Of 2,678 male patients, 675 (25.21%) had gastrointestinal diseases and 569 (21.25%) injuries as against 521 (28.50%) and 226(12.36%) of 1,828 female patients in the respective disease groups. Relative occurrence of genitourinary tract, cardiovascular system and respiratory cases were 548 (12.16%), 339 (7.52%) and 296 (6.57%) respectively (Table I).
The overall fatality was 6.35%. The highest case fatality rate was found to be 24.5 1% in infectious diseases group followed by 10.92%, 9.80%, 7.55% in cardiovascular diseases, respiratory diseases and injuries group respectively whereas maximum of total deaths i.e., 20.98% occurred due to injuries (Table II).
The consistency in provisional and final diagnosis was 86.20% of total cases (Table III).
The annual turnover (the number of patients per bed per year) was 41 while average stay of patients at hospital was 7.52 days.
The present study shows that gastrointestinal diseases are most prevalent in the area mounting to 26.54% of total admissions. This could be due to usual ingestion of adulterated food and poor quality of drinking water. The injuries group which includes accidents and homicidal cases is second in frequency and accounts for 17.64% of total cases. As Faisalabad is the third largest city of Pakistan after Karachi and Lahore, with a population4 of 1.10 million, the thickly populated industrial area where road traffic is also a big problem may possibly be the reason for the second high admission rate of injuries cases. The high case fatality (24.51%) caused byinfectious diseases including tetanus and gangrene as welt as maximum of the total deaths (20.98%) due to injuries, is in accordance with the government statistics for Faisalabad district3. Both these figures are alarming. A consistency of 86.20 percent in provisional and final diagnosis of the total cases is very encouraging. However, diagnostic inaccuracy may probably be affected by the training, skills and interests of the attending physician, advances in medical knowledge of pathogenesis, differences in the availability and use of special investigations. The turnover of the patients (41) in the present study is an extremely high figure as compared to many other institutions and countries of the world where it ranges from 22 to 28 patients3,6-9 per bed per year. The reason may be that the patients are discharged early than required to meet the shortage of beds. This is also supported by the average duration of hospital stay, 7.52 days as compared to the available figure 12.4 days7 for Jinnah Postgraduate Medical Centre, Karachi. The recommendations requiring immediate attention by the authorities, are training of doctors according to relative occurrence of diseases, more facilities at emergency care unit, hospital beds according to population requirement and improvement in case recording and maintenance of morbidity data.
1. Grsnl, M.Hand book of community hesith. Philadelphia, Lea and Febiger, 1981, p.18.
2. Ahmed, M. and Smythe, C.M. The epidemiology and spectrum of surgical care in district hospitals of Pakistan. MPH., 1987;77: 1439.
3. Government of the Punjab, Statisties of hospitalsand dispensaries in Faisalabad Division of year 1984. Office of the Deputy Director of Health 5ervices Faisalabad Division, faisalabad. pp.3,6,28,29,68.
4. Government of Pakistan, 1981 District Census Report of Faisalabad. Islamabad Population census Organisation, Statistics Division, 1984;49: p. 3,19.
5. Mahajan, B.K. Methods in biostatistics, 4th ed New Delhi, Smt. Indu. Mahajan, 1984, p.236.
6. Government of the Punjab, Statistics of 1-lospitalsand Dispensaries in the Punjab for the year 1981, Lahore, Provincial Health Directorate, 1981, p. 2,4,
7. Government of Pakistan, Annual Report of Director General Health, July 1981-June 1982. Islamabad, Biostatistics Section, Ministry of health, Social Welfare and Special Education, 1982,p. 69.
8. Kingdom of Saudi Arabia, Makkah Region Comprehensive Development plans, Final Report; Ministry of Municipsl and Rural Affairs, Kingdom of Saudi Arabia, 1984, p.62.
9, The World almanac and book of facts, 1983. New York, Newspaper Enterprises Association, 1983, p. 960.