Hospital admissions attributed to adverse drug reactions in tertiary care in Uganda: burden and contributing factors

Abstract

Background:

Adverse drug reactions (ADRs) contribute to the burden of disease globally and of particular concern are ADR-related hospital admissions.

Objectives:

This study sought to determine the burden, characteristics, contributing factors and patient outcomes of ADRs that were the primary diagnosis linked to hospital admission among inpatients in Uganda.

Design:

We conducted a cross-sectional secondary analysis of data from a prospective cohort study of adult inpatients aged 18 years and older at Uganda’s Mulago National Referral Hospital from November 2013 to April 2014.

Methods:

We reviewed clinical charts to identify inpatients with an ADR as one of the admitting diagnoses and, if so, whether or not the hospital admission was primarily attributed to the ADR. Logistic regression was used to determine factors associated with hospital admissions primarily attributed to ADRs.

Results:

Among 762 inpatients, 14% had ADRs at hospital admission and 7% were primarily hospitalized due to ADRs. A total of 235 ADRs occurred among all inpatients and 57% of the ADRs were the primary diagnosis linked to hospital admission. The majority of ADRs occurred in people living with HIV and were attributed to antiretroviral drugs. HIV infection [aOR (adjusted odds ratio) = 2.97, 95% confidence interval (CI): 1.30–6.77], use of antiretroviral therapy (aOR = 5.46, 95% CI: 2.56–11.68), self-medication (aOR = 2.27, 95% CI: 1.14–4.55) and higher number of drugs used (aOR = 1.13, 95% CI: 1.01–1.26) were independently associated with hospital admissions attributed to ADRs.

Conclusion:

Antiretroviral drugs were often implicated in ADR-related hospital admissions. HIV infection (whether managed by antiretroviral therapy or not), self-medication and high pill burden were associated with hospital admissions attributable to ADRs. The high HIV burden in Sub-Saharan Africa increases the risk of ADR-related hospitalization implying the need for emphasis on early detection, monitoring and appropriate management of ADRs associated with hospital admission in people living with HIV.

Plain language summary

Prevalence and contributing factors of hospital admissions attributed to adverse drug reactions in Uganda

Introduction: Adverse drug reactions (ADRs) are a big problem in many parts of the world and of particular concern is a situation where patients are admitted primarily because of an ADR. We sought to determine the burden, characteristics, contributing factors and patient outcomes of ADRs that were the primary diagnosis linked to hospital admission in Uganda.

Methods: We analysed data collected from a prospective cohort study of adult inpatients aged 18 years and older at Uganda’s Mulago National Referral Hospital from November 2013 to April 2014. We reviewed clinical charts to identify inpatients in whom an ADR was one of the admitting diagnoses and, if so, whether or not the ADR was the primary diagnosis linked to hospital admission. We used statistical tests to assess for contributing factors of hospital admissions attributable to ADRs.

Results: Among 762 inpatients, 108 had ADRs at admission and 56 were primarily admitted due to ADRs. A total of 235 ADRs occurred among all inpatients and 135 of the ADRs were the primary diagnosis linked to hospital admission. The majority of ADRs occurred in people living with HIV and were linked to antiretroviral drugs. HIV infection, use of antiretroviral therapy, self-medication and higher number of drugs used were associated with hospital admissions primarily attributed to ADRs.

Conclusion: To prevent hospital admissions attributed to ADRs, patients need to be warned against self-medication, health workers and patients need to be reminded of the importance of early detection, monitoring and appropriate management of ADRs among the HIV-infected (whether managed by ART or not) and those patients taking many drugs.