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\def\runningtitle{PATTERN AND OUTCOME OF MEDICAL ADMISSIONS IN A TEACHING HOSPITAL  IN THE  S0UTH EAST REGION OF NIGERIA}
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\title{PATTERN AND OUTCOME OF MEDICAL ADMISSIONS IN A TEACHING HOSPITAL IN THE S0UTH EAST REGION OF~NIGERIA}
\articletype{}
\author{{Nkpozi MO{\color{blue}\thanks{Corresponding author.}}\ \textsuperscript{,}{\color{blue}\thanks{Email: marcelnkpozi@gmail.com.}}\ \textsuperscript{,}\textsuperscript{1},  
            Nwanke RI\textsuperscript{2},  
            Uzor EI\textsuperscript{3},  
            Ubani-Ukoma BC\textsuperscript{4}, 
            Ugwu ET\textsuperscript{5}}~\\[.3pc]~\\[.1pc]\itshape \raggedright {\fontsize{8pt}{10.5pt}\selectfont \textsuperscript{1}Department of Internal Medicine, Abia State University Teaching Hospital (ABSUTH), Aba, Nigeria}~\\[.1pc]\itshape \raggedright {\fontsize{8pt}{10.5pt}\selectfont \textsuperscript{2}Department of Internal Medicine, Abia State University Teaching Hospital (ABSUTH), Aba, Nigeria. }~\\[.1pc]\itshape \raggedright {\fontsize{8pt}{10.5pt}\selectfont \textsuperscript{3}Department of Internal Medicine, Abia State University Teaching Hospital (ABSUTH), Aba, Nigeria. }~\\[.1pc]\itshape \raggedright {\fontsize{8pt}{10.5pt}\selectfont \textsuperscript{4}Department of Internal Medicine, Abia State University Teaching Hospital (ABSUTH), Aba, Nigeria. }~\\[.1pc]\itshape \raggedright {\fontsize{8pt}{10.5pt}\selectfont \textsuperscript{5}Department of Internal Medicine, Enugu State University of Science and Technology, Enugu, Nigeria. }~\\[.5pc]\fontsize{8pt}{10.5pt}\selectfont\normalfont{\color{blue}{\ifx\cmDoi\empty\else DOI: \fi}}\url{\cmDoi} ~\\[.5pc] \ifx\cmAccepted\empty\else Accepted \fi\cmAccepted\ifx\cmReceived\empty\else\ifx\cmAccepted\empty\else ;\ \fi Received \fi\cmReceived\ifx\cmPublishedOnline\empty\else; Publish Online \cmPublishedOnline\fi}\vspace{-2pc}
  
\twocolumn[{\maketitle\parbox[t]{.22\textwidth}{\sffamily\fontsize{12pt}{14pt}\selectfont\raggedright \ifx\reviewauthor\empty\else Reviewed By: \fi\reviewauthor~\\ \ifx\reviewerdep\empty\else Department: \fi\reviewerdep}\hfill
\parbox[t]{.74\textwidth}{\fontsize{9pt}{12pt}\selectfont\textbf{{\color{airforceblue}ABSTRACT}\\}\fontsize{10pt}{10.5pt}\selectfont Background and Objective: Medical admissions in hospitals located within a certain region reflect the diseases burden in that region. The objective of this study is to determine the profile of diseases and their treatment outcome in the medical wards of the Department of Internal Medicine, Abia State University Teaching Hospital (ABSUTH), Aba, South East,Nigeria.

Materials and Methods: This was a 10-year retrospective descriptive study in which data was extracted from the Admission/Discharge registers in the male and female medical wards of ABSUTH, Aba from May 1, 2007 to April 30, 2017. Relevant data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 20.0 software.

Results: A total of 6587 admissions made up of 3153 (47.9\%) males and 3434 (52.1\%) females were seen with a mean age of 52.34 years. The elderly topped the list of the medical admissions followed by the middle aged group. Non-communicable diseases, NCDs, (73\%) caused more medical admission than communicable diseases, CDs, (27\%). The overall commonest causes of death in the medical wards were stroke and human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS). Stroke, diabetes mellitus (DM) related complications, heart failures and chronic kidney diseases (CKD) were the commonest causes of death among the NCDs. While mortality of the medical admissions was 22.6\%, 69.4\% improved and were discharged home. Mean duration of hospital stay for the medical admissions was 9.97 days and the longest was by diabetic foot/hand ulcer.

Conclusion: The female gender and the elderly population were admitted more in the medical wards while NCDs caused more medical admissions and deaths than the CDs. Stroke followed by HIV/AIDS were the commonest overall causes of deaths in the medical wards within the study period. 

\def\keywordstitle{Keywords}

\medskip\noindent\textbf{Key words:} {medical admissions--diseases pattern--admission outcome--communicable and non-communicable diseases--South East--Nigeria}}}\vspace{3pc}]\saythanks 

\baselineskip=\the\baselineskip plus.25pt minus.25pt

    
\section{Introduction}
Tertiary health institutions offer services to patients that are self-referred or those referred by primary, secondary and other tertiary health facilities depending on the available facilities and skilled manpower. Hospital admission patterns give an insight into the disease burden in a particular region and assists in health care planning and performance evaluations of a hospital. Medical admissions are important as a reflection of common diseases in the society \unskip~\cite{706981:16766419,706981:16766420} . It is worthy of note that medical diseases constitute the most common cause of death in adults \unskip~\cite{706981:16766421} . The pattern of medical admissions varies from one health facility to another depending on the prevailing medical diseases in the region, education, hygiene, lifestyle and health-seeking behaviors of the population vis-a-vis available health services. 

However, hospital based studies cannot replace population based studies which are the gold standard for determining the incidence, prevalence, morbidity and mortality of diseases in a community. Population based studies are not available in most parts of the world because of lack of the expertise, reliable data bases, disease registries and resource constraints\unskip~\cite{706981:16766422} . Hospital based studies give an insight into disease burden in a community and help clinicians, public health professionals and policy makers to make informed decisions regarding individual patient and population care in addition to planning health care delivery system\unskip~\cite{706981:16766423} . In the past, communicable diseases accounted for most of the medical admissions across sub Saharan Africa\unskip~\cite{706981:16766424} . But, there is a current global trend towards NCDs as documented in some literatures\unskip~\cite{706981:16766425,706981:16766426} . Adult mortality in sub Saharan Africa is 4 {\textendash} 40 times more than in developed countries \unskip~\cite{706981:16766427,706981:16766428,706981:16766429}  and the pattern of diseases responsible for this high adult mortality is not well characterized \unskip~\cite{706981:16766430,706981:16766431,706981:16766432} .

There seems to be wide variations in the patterns and outcomes of medical admissions observed in hospital-based studies across many cities in Nigeria \unskip~\cite{706981:16766433,706981:16766434,706981:16766435,706981:16766436,706981:16766437,706981:16766438,706981:16766439,706981:16766440} , Uganda \unskip~\cite{706981:16766441} . India \unskip~\cite{706981:16766442}  and Saudi Arabia\unskip~\cite{706981:16766443} . It has been projected by the WHO that by 2020, NCDs would surpass infectious diseases as the main cause of medical admissions and adult deaths \unskip~\cite{706981:16766444} . However, Etyang and Gerard Scott in their systematic review concluded that cardiovascular and infectious diseases were currently the leading causes of admissions and in-patient deaths in sub Saharan Africa\unskip~\cite{706981:16766445} . 

There is a dearth of published literatures on the diseases burden and treatment outcome in the only tertiary health facility in the commercial city of Aba in Abia state, Nigeria where lots of mercantile activities take place. We, therefore, set out to study the disease patterns and outcome of treatment in the medical wards of ABSUTH, Aba. 
    
\section{\textbf{METHODOLOGY}}
A retrospective descriptive analysis was carried out on medical records of patients admitted into the male and female medical wards of ABSUTH, Aba. Aba is a commercial city in the Southeastern region of Nigeria known for her industrial, mercantile and craftwork activities. The hospital is the only tertiary health facility in Aba and gets referrals from all the primary and secondary health facilities in Aba and the neighboring states. The study covered a period of ten years between May 1, 2007 and April 30, 2017. Using the Nurse's Inpatient Admissions/Discharge Registers in the male and female medical wards, nurses report books and in some cases, case notes of some patients from the Medical Records Department of the hospital, all the patients admitted in the medical wards were recruited. Patients whose data were incomplete were excluded and all the diagnoses were based on the final diagnoses made by the supervising consultants. These diagnoses were arrived at on combination of clinical and laboratory parameters of the patients. Co morbid conditions were not included as diagnosis. Duration of hospital stay of 1 day refers to patients in whom the outcome of admission occurred within 24 hours of admission in the medical wards.

The following data were collected from each patient's record {\textendash} age, gender, definitive diagnosis, duration of hospital stay and outcome during admission. In this study, the outcome measures were discharged home, died, discharged against medical advice (DAMA) or transferred to another specialty outside the medical wards or to another health facility. The diseases diagnosed were grouped into body systems according to the WHO International Statistical Classification of Diseases version 10 (ICD-10) guidelines \unskip~\cite{706981:16766446} . 

Ethical approval was obtained from the Institution's Ethics and Research Committee before commencing the study. Data obtained were analyzed using the Statistical Package for Social Sciences (SPSS Inc. Chicago IL) version 20.0 software. Qualitative data were expressed as frequencies and percentages while quantitative data were summarized as means and standard deviations. P values of {\textless}0.05 was regarded as statistically significant.
    
\section{\textbf{RESULTS}}
A total of 6587 admissions were recorded in the medical wards within the study period. There were 3153 males (47.9\%) and 3434 females (52.1\%) with a ratio of 1: 1.08. The age range was 15 {\textendash} 103 years with a mean age of 52.34 \ensuremath{\pm} 18.17; male 53.10 \ensuremath{\pm} 18.29, female 51.64 \ensuremath{\pm} 18.04. The differences in the mean ages of the male and female patients admitted in the medical wards of ABSUTH was statistically significant (p{\textless}0.05). The minimum age of both male and female participants in the study was 15 years but the maximum ages of the males and females were 99 and 103 years respectively. The middle aged (33.4\%) and the elderly patients (39.6\%) formed a majority of the medical admissions while the teenagers (2.9\%) were the least admitted in the medical wards (table 5). The mean duration of hospital stay was 9.97\ensuremath{\pm}9.77 days with a range of hospital stay of 1 {\textendash} 123 days; male 9.86\ensuremath{\pm}9.33, female 10.07\ensuremath{\pm}10.15. The demographic characteristics of the participants were as shown in Tables~\ref{tw-d21c6b6ea0aa} and~\ref{tw-2a8511f5fd67} .


\begin{table}[!htbp]
\caption{{\textbf{Demographic characteristics of medical admissions in ABSUTH}} }
\label{tw-d21c6b6ea0aa}
\def\arraystretch{1}
\ignorespaces 
\centering \small 
\begin{tabulary}{\linewidth}{LL}
\hline~\\[-8pt] 
Indices  &
  Frequency (n=6587) (\%) \\
 &
  \\
Age categories (years) \mbox{}\protect\newline {\textless}20 \mbox{}\protect\newline 20-39 \mbox{}\protect\newline 40-59 \mbox{}\protect\newline 60 and above \mbox{}\protect\newline Total &
  193 (2.9) \mbox{}\protect\newline 1584 (24.0) \mbox{}\protect\newline 2197 (33.4) \mbox{}\protect\newline 2613 (39.7) \mbox{}\protect\newline 6587 (100)\\
Gender: \mbox{}\protect\newline Male \mbox{}\protect\newline Female &
  3153 (47.9) \mbox{}\protect\newline 3434 (52.1)\\
\hline 
\end{tabulary}\par 
\end{table}

\begin{table}[!htbp]
\caption{{\textbf{Age distribution of the subjects}} }
\label{tw-2a8511f5fd67}
\def\arraystretch{1}
\ignorespaces 
\centering \small 
\begin{tabulary}{\linewidth}{LL}
\hline~\\[-8pt] 
Mean age (\ensuremath{\pm}SD) \mbox{}\protect\newline Mean age male (\ensuremath{\pm}SD) \mbox{}\protect\newline Mean age female (\ensuremath{\pm}SD) &
  52.34\ensuremath{\pm}18.17 \mbox{}\protect\newline 53.10\ensuremath{\pm}18.30 \mbox{}\protect\newline 51.64\ensuremath{\pm}18.04 (t=3.268, p=0.001)\\
\hline 
\end{tabulary}\par 
\end{table}
\textbf{Pattern of diseases causing medical admissions in ABSUTH, Aba}. 

The commonest diseases responsible for admissions in the medical wards within the study period were diabetes mellitus related complications (18.5\%) followed by HIV/AIDS (12.9\%), stroke (12.6\%), heart failures (12.1\%), chronic kidney diseases (CKD) (5.6\%), systemic arterial hypertension (4.8\%), chronic liver diseases (4.7\%) and acute malaria (4.1\%). Communicable diseases (infectious and parasitic diseases) constituted 26.7\% of the medical admissions while non-communicable diseases accounted for 73.3\%. When presented according to systems of the body, infectious and parasitic diseases came up top, followed by the cardiovascular system, endocrine diseases (diabetes mellitus mainly), and the nervous system. Details are shown in Tables~\ref{tw-cc9fe021d74b} and~\ref{tw-943283f9837c} . 


\begin{table}[!htbp]
\caption{{\textbf{Spectrum of the major diseases causing hospitalization in the medical wards of ABSUTH, Aba, within the study period isshown below:}} }
\label{tw-cc9fe021d74b}
\centering 
\begin{threeparttable}

\def\arraystretch{1}
\ignorespaces 
\centering \small 
\begin{tabulary}{\linewidth}{LL}
\hline~\\[-8pt] 
Diseases  &
  Male Female Total (n=6587) (\%)) \\
HIV/AIDS &
   365 487 852 (12.9)\\
Malaria &
   138 135 273 (4.1)\\
Sepsis &
   88 72 160 (2.4)\\
PTB / extrapulmonary TB  &
   89 61 150 (2.3)\\
Stroke &
   382 449 831 (12.6)\\
Diabetes mellitus related complications &
   599 621 1220 (18.5)\\
Heart failure &
   373 421 794 (12.1)\\
Hypertension &
   103 213 316 (4.8)\\
Chronic liver diseases &
   175 135 310 (4.7)\\
Acute viral hepatitis &
   39 27 66 (1.0)\\
PUD &
   24 43 67 (1.0)\\
CAP/suppurative lung disease &
   57 76 133 (2.0)\\
COPD/chronic bronchitis/emphysema &
   33 36 69 (1.0)\\
CKD/nephrolithiasis &
   209 163 372 (5.6)\\
Lymphoma/breast CA/other malignancies &
   33 30 63(1.0)\\
Miscellaneous diseases &
   446 465 911(13.8)\\
Communicable diseases (Infectious and parasitic diseases) &
   1757 (26.7)\\
NCD &
  4830 (73.3\%)\\
 &
  \\
\hline 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{Key: HIV/AIDS = human immunodeficiencyvirus/ acquired immunodeficiency syndrome, PTB = pulmonary tuberculosis, TB =tuberculosis, CLD = chronic liver disease, PUD = peptic ulcer }
    
\item{ disease,  CAP = community acquired pneumonia, COPD = chronic obstructive pulmonarydisease, CKD = chronic kidney disease, NCD = non-communicable disease.}
    
\item{NB: Miscellaneous diseases - any diseasethat contributed \textless\ 63 (1\%) of medical admissions was included in themiscellaneous diseases.}
\end{tablenotes}
\end{threeparttable}

\end{table}

\begin{table}[!htbp]
\caption{{\textbf{Spectrum of diseases causing medical} \textbf{admissions in ABSUTH based on the ICD-10}} }
\label{tw-943283f9837c}
\def\arraystretch{1}
\ignorespaces 
\centering \small 
\begin{tabulary}{\linewidth}{LLL}
\hline~\\[-8pt] 
Code &
  Diseases &
  Frequency (n=6587) (\%)\\
A or B &
  Infectious and parasitic diseases &
  1757 (26.7\%)\\
C &
  Malignant neoplasms &
  130 (2.0\%)\\
D &
  Anemia &
  72 (1.1\%)\\
E &
  Endocrine, nutritional and metabolism &
  1229 (18.7\%)\\
F &
  Mental and behavioural disease &
  33 (0.5\%)\\
2 &
  Diseases of the nervous system &
  971 (14.7\%)\\
I &
  Diseases of the circulatory system  &
  1265 (19.2\%)\\
J &
  Diseases of the respiratory system &
  268 (4.1\%)\\
K &
  Diseases of the digestive system &
  464 (7.1\%\\
M &
  Diseases of the musculoskeletal system and connective tissues &
  23 (0.4\%)\\
 &
  Diseases of the genitourinary system &
  255 (3.9\%)\\
R &
  Others &
  120 (1.8\%)\\
\hline 
\end{tabulary}\par 
\end{table}
\textbf{Outcome of hospitalization in the medical wards}

A total of 4569 admissions (69.4\%) into the medical wards improved and were discharged home, 1491 (22.6\%) died, 289 (4.4\%) were discharged home against medical advice and 238 (3.6\%) were transferred to other centres or specialtiesTable~\ref{tw-3929850e77b9}  . With a medical ward mortality of 22.6\%, the major causes of death within the study period were stroke (5.34\%), HIV/AIDS (4.24\%), DM related complications (3.78\%), heart failures (1.61\%) and CKD (1.69\%) as shown in Table~\ref{tw-05fc7c98b2ed} . The differences in the outcome of the male and female patients were not statistically significant (X\ensuremath{^{2 }} = 5.811, p {\textgreater} 0.05). The outcome for the different age groups admitted in the medical wards of ABSUTH as shown inTable~\ref{tw-3929850e77b9}  is statistically significant (X\ensuremath{^{2 }} = 111.91, p \textless\ 0.05)


\begin{table}[!htbp]
\caption{{\textbf{Outcome of medical admissions stratified by age groups in ABSUTH }} }
\label{tw-3929850e77b9}
\def\arraystretch{1}
\ignorespaces 
\centering \small 
\begin{tabulary}{\linewidth}{LLLLLL}
\hline~\\[-8pt] 
 &
  Discharged home alive &
  Died &
  DAMA &
  Referred to other centres/specialties &
  Total\\
Age (years): \mbox{}\protect\newline  {\textless}20  &
  152 &
  19 &
  10 &
  12 &
  193\\
20-39 &
  1055 &
  341 &
  83 &
  105 &
  1584\\
40-59 &
  1503 &
  506 &
  101 &
  87 &
  2197\\
60 and above &
  1859 &
  625 &
  95 &
  34 &
  2613\\
Total &
  4569 &
  1491 &
  289 &
  238 &
  6587\\
\hline 
\end{tabulary}\par 
\end{table}

\begin{table}[!htbp]
\caption{{\textbf{Outcome of treatment of the major diseases that caused medical admissions}} }
\label{tw-05fc7c98b2ed}
\centering 
\begin{threeparttable}

\def\arraystretch{1}
\ignorespaces 
\centering \small 
\begin{tabulary}{\linewidth}{LLLLLLLL}
\hline~\\[-8pt] 
 &
  HIV/AIDS &
   DM complications &
  stroke &
  HF &
  CKD &
  HTN &
  malaria\\
Home &
  390 &
   915 &
   437 &
   646 &
  220 &
  302 &
  256\\
Dead &
  279(4.24\%) &
   249(3.78\%) &
  352(5.34\%) &
   106 &
  111(1.69\%) &
  6 &
  7\\
DAMA &
  55 &
   46 &
   36 &
   20 &
  17 &
  8 &
  10\\
Referred &
  128 &
   10 &
   6 &
   5 &
  24 &
  0 &
  0\\
Total &
  852 &
  1220 &
   831 &
  777 &
  372 &
  316 &
  273\\
\hline 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{Key: HIV/AIDS = human immunodeficiencyvirus/acquired immune deficiency syndrome, DM = diabetes mellitus, HF = heart failures, CKD = chronic kidneydiseases, HTN =systemic arterial hypertension, DAMA = discharged against medical advice.}
\end{tablenotes}
\end{threeparttable}

\end{table}

    
\section{\textbf{DISCUSSION}}
The finding in this report that diabetes mellitus related complications, HIV/AIDS, stroke, heart failures, CKD, systemic hypertension, chronic liver diseases and acute malaria were the major diseases responsible for medical admissions in ABSUTH within the study period is comparable to what was found in many Nigerian studies \unskip~\cite{706981:16766433,706981:16766434,706981:16766437}  and in Assir region of Saudi Arabia \unskip~\cite{706981:16766443} . That NCDs contributed 73\% of the medical admissions in this study is similar to findings in Ido Ekiti \unskip~\cite{706981:16766433}  . Abakiliki \unskip~\cite{706981:16766434}  and Enugu \unskip~\cite{706981:16766437} ; and, this is in keeping with the current trend of increasing burden of non-communicable diseases in Africa. The explanation for this finding could be as a result of the westernized diets, sedentary lifestyles, resultant obesity and rapid urbanization taking place in sub-Saharan African countries including Nigeria. Our findings differ from those reported in Asaba \unskip~\cite{706981:16766438}  and the rural community of Okada \unskip~\cite{706981:16766435}  where infectious and parasitic diseases were predominant causes of hospitalization in the medical wards. 

In the index study, the elderly participants (60 years and above) were in majority among the age groups admitted in the medical wards just as was found in the Ido Ekiti \unskip~\cite{706981:16766433}  study. The reason for this is, probably, because the elderly are prone to decreased body immunity with increased disease susceptibility and degenerative diseases. In addition, advancing age is an established risk factor for NCDs which, in this study, were topmost in the profile of diseases that caused hospitalizations. It could, also, be because the developing world is experiencing an ageing population with increasing burden of chronic diseases \unskip~\cite{706981:16766447} . Again, this may be in keeping with the WHO projection that the total geriatric population \unskip~\cite{706981:16766447}  will double from 605 million in 2002 to 1.2 billion in 2025 while their population in sub Saharan Africa will double between 2000 and 2030. This finding is a contrast to the situation in Okada \unskip~\cite{706981:16766435}  community of Igbinediom University Teaching hospital, Abakiliki \unskip~\cite{706981:16766434}  and \unskip~\cite{706981:16766438}  Asaba where infectious and parasitic diseases (communicable diseases) were the major causes of hospitalization. The middle aged (40 {\textendash} 59 years) came second as the age group most commonly admitted in the medical wards in this report just as was found in the Ido Ekiti \unskip~\cite{706981:16766433}  study. The implication of this is the loss of man-hours and the negative economic consequences.

More females than males were hospitalized over the study period. Similar finding was reported in Uganda \unskip~\cite{706981:16766441}  but contradicts those of some other researchers from within and outside Nigeria \unskip~\cite{706981:16766433,706981:16766434,706981:16766435,706981:16766436,706981:16766437,706981:16766440,706981:16766448} . This could be because the present study spanned over 10 years with more participants than the other studies which were for a period of 2-3 years with fewer study 

population. It\textit{\space } could, also, be due to a better health seeking behavior among females \unskip~\cite{706981:16766449}\ensuremath{^{}} as reported by Omemu et al despite that it has been documented that males are at more risks than females for DM, strokes, CKD and other NCDs \unskip~\cite{706981:16766450} . The teenagers (under-20 age group) had the least number of medical admissions in this study probably because NCDs which were predominant causes of hospitalization are uncommon in this age group. 

The mortality rate of 22.6\% in this report is higher than what was reported in some previous Nigerian studies \unskip~\cite{706981:16766433,706981:16766434,706981:16766435,706981:16766436,706981:16766437}  and Assir region of Saudi Arabia \unskip~\cite{706981:16766443}  but lower than the rate reported in Kano \unskip~\cite{706981:16766439} . Reason for these differences in mortality in the published studies is not clear. In the index study, the contribution of stroke, heart failures, DM related complications and CKD to the medical wards mortality within the study period is comparable to the findings in related studies in Nigeria \unskip~\cite{706981:16766433,706981:16766434,706981:16766438,706981:16766440} ). Stroke was the predominant cause of death probably because of the high prevalence of cerebrovascular risk factors (systemic arterial hypertension and DM) and increasing age of the study population. Similar to some other studies \unskip~\cite{706981:16766433,706981:16766438} , this study showed that HIV/AIDS was a leading cause of death among the communicable diseases. This is not surprising since, unlike other CDs, HIV/AIDS is associated with many life-threatening opportunistic infections such as tuberculosis and viral infections. Infectious and parasitic diseases were not the leading cause of medical admissions or the commonest cause of death in this study unlike the situation in the Okada \unskip~\cite{706981:16766435} study. A possible explanation for this could be increased personal hygiene and environmental sanitation due to the monthly cleaning exercise embarked upon by the states in the South East region of Nigeria for over a decade now. 

Admission outcome data in this study are comparable to findings in the Kano study \unskip~\cite{706981:16766439} . The implication of these findings is the need to improve public health programs aimed at preventing and controlling NCDs such as increase in health awareness and education programs. With this in place, cultural and superstitious beliefs that resulted to late presentations to hospitals and increased rate of DAMA will be minimized. It is important to note that systemic arterial hypertension and acute malaria were common causes of medical admission in this study but death as a result of either of them was scanty. Again, no case of snake bite was managed in the medical wards within the study period despite referral of patients from neighboring agrarian communities. Reasons for this are not clear but it could be that the superstitious tendency of the populace informed their decision not to bring snake bites patients to be treated in ABSUTH or that such patients with snake bites were treated and discharged home from or died at the Emergency unit of ABSUTH. 

In this study, the mean duration of hospital stay was comparable to other Nigerian studies \unskip~\cite{706981:16766433,706981:16766434,706981:16766435,706981:16766436,706981:16766437,706981:16766438,706981:16766439,706981:16766440}  It is important to note that the longest duration of hospital stay was recorded among patients managed for diabetic foot/hand ulcers and gangrene and patients that had stroke while short duration of hospitalization (24 hours) was common in those that died. The latter could be because of late presentation to the hospitals as a result of illiteracy, poverty and superstitions. 

Finally, findings from the index study could serve as a clinical audit of the medical wards of ABSUTH, Aba. Our findings could serve as a useful guide to the hospital management and other relevant stakeholders in the health sector in allocation of healthcare resources and other strategies to improve healthcare in the state. It will, also, serve as an important monitoring and evaluation tool for the Department of Internal Medicine, ABSUTH, Aba.
    
\section{\textbf{CONCLUSION/RECOMMENDATION}}
This study has shown that the elderly aged persons and females were predominantly admitted in the medical wards of ABSUTH, Aba within the period under review. Again, diseases responsible for most admissions in the medical wards were diabetes mellitus related complications, HIV/AIDS, stroke, heart failures, chronic kidney diseases, systemic arterial hypertension, chronic liver diseases and acute malaria. While NCDs constituted a majority of the medical admissions in ABSUTH, Aba, stroke, HIV/AIDS and DM related complications were the major causes of death in the medical wards..It is, hereby, recommended that effective health education programmes be put in place to check the increasing prevalence and impact of these diseases. 

CONFLICTS OF INTEREST {\textendash} Nil
    
{\fontsize{8}{9.6}\selectfont 

\bibliographystyle{vancouver}

\bibliography{\jobname}}

\section*{Author biography}

\bioItem{Nkpozi MO}{ Department of Internal Medicine, Abia State University Teaching Hospital (ABSUTH), Aba, Nigeria}

\smallskip\noindent 

\bioItem{Nwanke RI}{ Department of Internal Medicine, Abia State University Teaching Hospital (ABSUTH), Aba, Nigeria. }

\smallskip\noindent 

\bioItem{Uzor EI}{ Department of Internal Medicine, Abia State University Teaching Hospital (ABSUTH), Aba, Nigeria. }

\smallskip\noindent 

\bioItem{Ubani-Ukoma BC}{ Department of Internal Medicine, Abia State University Teaching Hospital (ABSUTH), Aba, Nigeria. }

\smallskip\noindent 

\bioItem{Ugwu ET}{ Department of Internal Medicine, Enugu State University of Science and Technology, Enugu, Nigeria. }
\printBio 
\end{document}
