INTRODUCTION
One
of the ways of assessing the efficiency of a health care delivery system is the
evaluation of mortality annually.
The
lung is exposed to environmental hazards including airborne infection and
injury. Respiratory diseases accounts for a high number of deaths and disability
globally. In 2016, 56.9million deaths occurred globally, out of which 54% were
caused by the top ten leading causes of death.1
In 2016, Chronic Obstructive Pulmonary
Disease [COPD] accounted for 65 million morbidities and 3 million mortalities, placing
it as the third leading cause of death globally that year, while lung cancers
[along with trachea and bronchus cancers] caused 1.7 million deaths2.
Lower respiratory infection was the most deadly
communicable disease, responsible for 3 million mortalities worldwide in 2016.
Pneumonia was responsible for millions of morbidities
and mortalities annually especially among children under 5years.2
However, the number of tuberculosis death
decreased in the same period, but it was still among the top ten causes with a
death toll of 1.3 million.2
Among newly diagnosed TB cases, 11% had
co-infection with HIV accounting for additional 400,000 deaths in 20153
Aside smoking, lung cancers have been known
to occur in non-smokers. Passive exposure to tobacco smoke, biomass fuel,
environmental and workplace carcinogens among others have been implicated as
risk factors for lung cancers.4
People with lung cancers have been noted to
have increased hospital admissions and deaths following exposure to high
concentrations of airborne fine particles .5
In a study done in Ekiti South West Nigeria,
Pulmonary Tuberculosis, Bronchial Asthma and pneumonia were the three top
causes of morbidity among respiratory diseases with pulmonary TB accounting for
most of the respiratory diseases among the subjects.6
However, there are insufficient researches on
the contribution of chest disease to mortality in Nigeria .
METHODOLOGY
2.0 Study location
This
research was carried out in NDUTH, Bayelsa State. Bayelsa State is among the
oil producing states in Nigeria.
Okolobiri Community where
NDUTH is located
has been exposed continuously to gas flaring for 14 years.
Bayelsa
State is located within latitude 05 to 23’ South and 04 to 15’ North.
It is bounded by the Atlantic Ocean on the south
and west, Delta State on the north and, Rivers State on the east.
The hospital offers health care services to
Bayelsa communities and other communities in neighboring states of Delta and
Rivers State which are also oil producing States.
2.1 Study design
This was a 3-year retrospective descriptive
study of mortality from all causes including respiratory that were recorded in
NDUTH from January 2016-December 2018. The data for the research was obtained
from records of death that took place in NDUTH during the study period.
The hospital practices quality improvement
program and has in place a quality improvement committee. The information
obtained from the record included demography, primary diagnosis, causes of
death among others.7
The gold standard for cause of death
assessment is autopsy, but it is very expensive, so not affordable to bereaved
relatives.
Cultural beliefs and traditional burial
practices were hindrances to autopsy as it was forbidden in some of the
communities so it was not practicable to carry out autopsy on all the deaths.8
Certification by a medical practitioner based
on the rules and procedures of the international classification of diseases and
related health problems (ICD) is the ideal standard .9All but cases
that were ‘brought in dead’ were certified dead by medical practitioners and
were included in the research
Data
analysis
Statistical
Package for Social Sciences version 21.0 [SPSS] software was used to summarize data.
The level of significance was put at p<0.05.
Ethical
Approval
Ethical
approval was obtained from the NDUTH hospital Ethics and Research Committee.
RESULTS
A mortality of 457 was recorded out of a total
number of 4533 patients that were admitted. The average crude mortality rate
was 10.1% (Table 1).
DISCUSSION
This
was 3 years retrospective study of mortality caused by chest diseases seen in
NDUTH, Bayelsa State, South-South Nigeria. No similar
study has been carried out in South-South Nigeria.
In this index study, pulmonary TB accounted for
31.6% of the mortality caused by chest diseases having co-morbidity with HIV
and responsible for 66.6% of the deaths caused by co-morbid conditions.
Bayelsa State is one of the major oil and gas
producing states in Nigeria. Oil exploration activities with it attendant oil
spills and gas flaring and environmental pollution have led to a high level of
poverty in the state.10
The prevailing poverty and hunger predispose
young ladies to prostitution, which could lead to increased prevalence of STDs
including HIV and AIDS in the state.11
TB has a high prevalence in the developing
world accounting for more than 90% of global TB cases and TB-related mortality,
with 75% of those cases affecting the most productive age group .12
Obstructive lung diseases (COPD and
Bronchiectasis), and chest malignancy as cause of deaths occurred more commonly
among males than females. The gender distribution in our study has similarity
to other studies conducted in Brazil13 and India14 in
which chest diseases mortality was commoner in men than women.
However, this finding is in contrast with a
similar study done in a tertiary hospital in South-West Nigeria in which
respiratory diseases mortality was more in females than the males.6
Chronic respiratory diseases such as
sarcoidosis, collagen lung diseases and pneumoconiosis among others, were not
common in this index study. This could be as a result of misdiagnosis of these
conditions as pulmonary tuberculosis because of lack of essential, specific
diagnostic facilities.
However, contrary to the expected high
mortality from chronic respiratory conditions because of the increased exposure
of the population to gas flaring and oil pollution, this study shows that chest
diseases were responsible for only 4.2% of the total mortality during the study
period.
This could be as a result of the design of
the research which only took a look at the causes of death without considering
the morbidity of respiratory diseases during the study period.
Exposures to oil and gas pollutions could cause
chronic respiratory disease with long period of morbidity before resulting in
mortality.
Further studies should be carried out in this
population to evaluate the impact of gas and crude oil pollution on the
respiratory systems including particulate matter measurement, and lung function
test in order to have a proper physiological assessment of the lungs.
CONCLUSION
In
this index study, respiratory diseases accounted for small percentage of the
mortality during the study period.
Further
studies should be carried out in this population to evaluate the impact of gas
and crude oil pollution on the respiratory system.
LIMITATIONS
This
research could have certain inherit limitations, such as poor or incomplete
medical record keeping, missed diagnosis and lack of essential, specific
diagnostic facilities, as well as absence of autopsy.
ACKNOWLEDGEMENT
I
acknowledge the staffers of the Medical Records Department and other staff of
NDUTH Okolobiri for their assistance.
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