Causes of ascites among adult patients admitted in medical wards at Muhimbili National Hospital in Dar es salaam, Tanzania

Abstract

Introduction: Ascites is a common cause of admission in Africa, especially among patients with liver cirrhosis23, and schistosomal periportal fibrosis, both of which are associated with significant morbidity and mortality21. However, other causes of ascites are also prevalent in Africa. Tuberculosis account for 23% of all patients with ascites, but contributes up to 50% among those with HIV. Malignant ascites is also a significant morbidity and mortality, and has been reported in up to 25% of ascites in Africa14,15. Renal and cardiac causes of ascites are also significant. However, much is not known about the causes of ascites, and the clinical, socio-demographic characteristics of these patients in out settings. Objectives: To determine the causes of ascites and describe the characteristics of adult patients with ascites admitted in medical wards at Muhimbili National Hospital. Methodology: Hospital Based Descriptive Cross-Sectional Study. Results:A total of 103 participants, mean age 40.9±1.51 years were included in this study, with equal sexual distribution. The mean duration of symptoms was 3 months, and majority of the participants reported history of abdominal distension, generalized body malaise, lower limb swelling, loss of appetite, and difficulty in breathing. Only a few patients had history of fever (34%), or weight loss (38%). Common causes of ascites were liver cirrhosis 34%, malignant ascites 24.2%, heart failure 17.5%, chronic kidney disease 12.6%, and TB Peritonitis 8.7%. Less common causes werenephrotic syndrome 1.9%, and chronic pancreatitis 1%.Of the 25 participants with malignant ascites, Hepatocellular carcinoma 60% was the most common malignancy. However, the primary tumor site could not be identified in nine participants. Conclusions:Ascites commonly affect the younger age group with mean age 41 years. And the common causes of ascites were liver cirrhosis, malignant ascites, heart failure, chronic kidney disease, and tuberculous peritonitis. Recommendations: We recommend another study tofurther describe patientswith malignant ascites in our settings. Another study is also needed to determine the prevalence and risk factors of Spontaneous Bacterial Peritonitis among patients with ascites in our settings.