Increasing prevalence of tuberculosis among Mulago Hospital admissions, Kampala, Uganda (1985-1989).

Tuberculosis, a major public health problem, was thought to be on the increase in Mulago Hospital, Kampala, Uganda, in the years 1985-1989. In order to verify and quantify the problem of tuberculosis in this hospital, we obtained total yearly hospital admissions and total yearly tuberculosis registrations for the years 1985-1989, and individually reviewed all available case records over the same period. From 1985-1989 the number of tuberculosis patients in this hospital practically doubled (835 patients in 1985 and 1614 patients in 1989). The prevalence of tuberculosis among hospital admissions also increased from 3% in 1987 to 3.7% in 1989. The male:female ratio was approximately 2:1. Most patients (over 70%) presented with pulmonary tuberculosis, and most of these (over 70%) were within the age group of 15-44 years. Extrapulmonary disease was most common in the childhood age group (0-14 years). This age group accounted for over 50% of all extrapulmonary forms of tuberculosis. Reasons for the increase are considered to be: (i) the breakdown in health infrastructure following repeated civil unrest; (ii) the human immunodeficiency virus (HIV) pandemic; (iii) possibly poor socio-economic condition of the population and (iv) possibly additional referral to this hospital for suspicion of tuberculosis. It is concluded that tuberculosis is a major health problem in Mulago Hospital, and further studies on the patients and trends, especially as related to the AIDS pandemic, are required.