Trends in adult medical admissions in a rural South African hospital between 1991 and 2002.

South Africa is one of the countries most severely affected by the global HIV/AIDS pandemic. The effects of increased numbers of sick patients on rural district hospitals are not well documented. This study summarizes the changes in number and type of hospital admissions to the medical wards of a small rural district hospital in Northern KwaZulu/Natal, South Africa, between 1991 and 2002. For the same 2-month period, across the study period total admissions rose by 228 to 626 patients with no increase in hospital staff or capacity. Length of inpatient stay fell from 10.9 to 7.9 days, and inpatient mortality rose from 8% to 20%. The median age of female patients fell from 50 to 34 years, and the median male patient's age fell from 45 from 39 years over the study period. After 1991, tuberculosis became the most frequent diagnosis, and in 2002 it was the leading cause of death. The HIV epidemic has increased the number of medical hospital admissions, primarily infectious diseases such as tuberculosis, lower respiratory infection, and diarrheal illness. Comprehensive strategies are needed to reduce the community burden of disease and minimize the impact of HIV on the health services.