The changing pattern of mortality in an African medical ward.

The pattern of adult medical deaths in Queen Elizabeth Central Hospital, Blantyre, Malawi was documented over a 12 month period between April 1992 and March 1993. Results were compared with mortality data collected from the same wards in the pre-AIDS era in 1973. Tuberculosis and AIDS together accounted for 49% of all medical deaths in 1992-93. Eighty-two per cent of deaths occurred in the age group 13-49 years; tuberculosis, AIDS, gastroenteritis, pneumonia, pyogenic meningitis and septicaemia were the most important causes of death in these young patients. These findings are very different to those observed in the same wards 20 years previously when tuberculosis was responsible for 13% of deaths and there were no deaths due to AIDS. The predicted upsurge in AIDS-related deaths in sub-Saharan Africa in the 1990s will have grave consequences not only for the health sector, but for the social and economic fabric of the countries concerned.