Pattern of diseases and HIV infection among elderl y medical admissions at Muhimbili medical centre, Dar es Salaam, Tanzania

Abstract

Objectives: To determine the causes of hospitalisation, the prevalence and presentation of HIV infection, and the socio-economic status among medical • admissions aged 55 years and above. Methods: Consecutive patients aged 55 and above hospitalised at the medical wards were clinically evaluated, socio-demographic data collected, and venous blood samples drawn. HIV antibodies were determined by ELISA; all reactive sera were tested by Western Blot for confirmation. Results: Of 1,934 patients hospitalised during the study period, 276 (14.3%) were 55 years or more. 253/276 (91.7%) patients were recruited into the study and comprised of 151 (59.7%) males and 102 (40.3%) females. Diseases of the cardiovascular system accounted for 29.0% of the diagnoses, followed by infections (22.1%), and cerebrovascular accidents (8.9%). The HIV-l seroprevalence by sex was 18.5% (28/151) among males compared to 9.8% (10/102) among females (p = 0.06). The HIV-l prevalence among those aged 55 to 59 was 29.7%. There was no association between HIV -1 serostatus and whether one lived in a rural or urban area, marital status, level of education, occupation, nor socio-economic status. The presentation among HIV-l seropositive patients was wasting 44.7%, fever 3.9.5%, pallor 34.2%, weight loss 31. 6%, productive cough 28.9%, palpitations 23.7%, and 23.7% had skin

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lesions. HIV infection was correctly suspected in 6/38 (15.8%) patients. The study patients were generally of a poor economic status with low purchasing power.

Conclusions: 1. HIV infection is a major problem in the population of elderly medical admissions. 2. The possibility of HIV infection should be considered among elderly patients with clinical features of immunodeficiency. 3. mY/AIDS prevention programs directed to the elderly should be established. 4. There does not appear to be any significant change in the pattern of diseases in the elderly over time. 5. Cost sharing for medical services is an extreme burden on the elderly population.