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PreprintCited by 0Global Health and EpidemiologyHealthcare Systems and ReformsChronic Disease Management Strategies

The DOI matches its Crossref record; 35 of the 35 references it cites were found in a registry or an index; none of the 35 sources its claims cite is checked for support yet.

The Burden of Hospital Morbidity and Mortality in Ghana: A Four-Year Retrospective Analysis of National Data

Open access
Manyeh, Alfred Kwesi, Odopey, Christopher Tetteh, Ackon, Angela Nana Esi, Gmayinaam, Vincent Uwumboriyhie, Dzissem, Patrick, Acquah, Evelyn, Immurana, Mustapha·2026·medRxiv
DOI 10.64898/2026.01.13.26344071
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Abstract

Background: Understanding hospital admission and mortality trends is essential for enhancing health system performance in low- and middle-income countries. In Ghana, systemic challenges such as unequal access to care, workforce shortages, and changing disease patterns – exacerbated by the COVID-19 pandemic – underscore the need for comprehensive health data analysis. This study examines national hospital morbidity and mortality trends from 2019 to 2023, identifying demographic and clinical factors that predict mortality to inform policy and health system reforms. Methods: A retrospective analysis was performed using data from Ghana’s District Health Information Management System-2 (DHIMS-2), covering 2,357,535 hospital admissions across 15 regions from 2019 to 2023. Descriptive statistics and multivariate logistic regression were employed to investigate patterns in morbidity, mortality, and associated risk factors, based on patient demographics, insurance status, disease classification (ICD-11), and length of hospital stay. Results: Hospital mortality throughout the study period was 2.6%. Infectious and parasitic diseases were the primary causes of admission (30.1%), while diseases of the nervous system exhibited the highest case fatality rate (13.8%). Mortality was significantly greater from 2020 to 2023 compared with 2019, with the highest odds observed in 2023 (AOR = 1.50; 95% CI: 1.46–1.54). Advanced age (≥65 years), male sex, lack of insurance, short hospital stays (<1 day), and comorbid conditions were all linked to higher mortality. Admissions due to neoplasms, circulatory, respiratory, and neurological conditions demonstrated notably high adjusted odds of mortality. Conversely, admissions covered by health insurance, female patients, and those with stays of 3–7 days had a reduced mortality risk. Conclusion: This national review highlights ongoing gaps in the health system that lead to hospital mortality, especially for complex conditions and vulnerable groups. While the National Health Insurance Scheme looks protective, disparities still exist across age, sex, region, and disease types. Urgent investments in diagnostic and critical care, along with expanding insurance coverage and regional resource distribution, are needed to reduce preventable hospital deaths in Ghana.

Overview

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TL;DR

This retrospective analysis of 2,357,535 Ghanaian hospital admissions from 2019–2023 found an overall hospital mortality rate of 2.6%, with mortality odds rising significantly after 2019 and peaking in 2023. Infectious/parasitic diseases caused most admissions, but nervous system diseases had the highest case fatality rate, and older age, male sex, lack of insurance, short stays, and comorbidities predicted higher mortality.

Key findings

  • Among 2,357,535 admissions, 61,192 (2.6%) died; infectious or parasitic diseases accounted for 30.1% of admissions, while diseases of the nervous system had the highest case fatality rate at 13.8%.
  • Mortality odds were significantly higher in 2020–2023 than in 2019: 2020 AOR = 1.29 (95% CI 1.26–1.33), 2021 AOR = 1.27 (1.23–1.30), 2022 AOR = 1.30 (1.26–1.33), and 2023 AOR = 1.50 (1.46–1.54), all p < 0.001.
  • Higher adjusted mortality odds were found for age ≥65 years (AOR = 2.41; 95% CI 2.23–2.60), another diagnosis besides the primary diagnosis (AOR = 1.40; 1.38–1.43), and admissions due to nervous system diseases (AOR = 4.01; 3.88–4.14), respiratory diseases (AOR = 2.00; 1.93–2.06), neoplasms (AOR = 1.74; 1.64–1.85), and circulatory diseases (AOR = 1.20; 1.16–1.24) compared with infectious/parasitic diseases.
  • Protective factors included health insurance (AOR = 0.68; 95% CI 0.67–0.70), female sex (AOR = 0.74; 0.72–0.75), and hospital stays of 3–7 days versus <1 day (AOR = 0.29; 0.28–0.30); Greater Accra had the highest mortality proportion (27.7%) and AOR = 1.90 (1.76–2.06) versus Ahafo, while Savannah had lower odds (AOR = 0.57; 0.48–0.67).

Methods

  • Retrospective analysis of nationally representative DHIMS-2 data covering 2,357,535 hospital admissions from 2019 to 2023 across 15 of Ghana’s 16 regions; the North East Region was excluded because of incomplete data.
  • Explanatory variables included year of admission, age, occupation, marital status, education, facility type/status, region, and health insurance status; outcome was dichotomous mortality, with morbidity and case fatality classified using ICD-11 broad categories.
  • Descriptive statistics by person, place, and time were used, followed by bivariate and multivariable logistic regression; variables with p < 0.05 in bivariate analysis entered the adjusted model, with adjusted odds ratios reported at a 5% significance level and 95% confidence intervals.

Limitations

  • The paper states that hospital-only data may miss deaths occurring outside health facilities; ICD-11 and administrative data may introduce coding errors and misclassification; detailed clinical data such as laboratory results and comorbidities beyond the second diagnosis were lacking; socioeconomic variables including housing, income, and urban/rural residence were omitted; and North East Region data were excluded due to insufficiency.
  • Evident from the text: the retrospective observational design cannot establish causality, and DHIMS-2 excludes leading teaching hospitals for specific indicators, so some national admissions may be incompletely captured.

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Integrity signals

Registry

Crossref · 10.64898/2026.01.13.26344071

Cites

35 of 35 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Figure 1 The Map of Ghana Showing the Sixteen (16) Regions. [15]
Figure 1 The Map of Ghana Showing the Sixteen (16) Regions. [15]CC-BY · From the PDF
Figure 2 Trends in mortality rate resulting from hospital admissions in Ghana, 2019 to 2023
Figure 2 Trends in mortality rate resulting from hospital admissions in Ghana, 2019 to 2023CC-BY · From the PDF
Figure 3 Percentage distribution of mortality by gender
Figure 3 Percentage distribution of mortality by genderCC-BY · From the PDF
Figure 4 Distribution of mortality by age
Figure 4 Distribution of mortality by ageCC-BY · From the PDF
Figure 5 Distribution of mortalities by sex and age
Figure 5 Distribution of mortalities by sex and ageCC-BY · From the PDF
Figure 1 The Map of Ghana Showing the Sixteen (16) Regions.
Figure 1 The Map of Ghana Showing the Sixteen (16) Regions.CC-BY · From the PDF
Image 7
CC-BY · From the PDF
Image 8
CC-BY · From the PDF
Image 9
CC-BY · From the PDF
Figure 5 Distribution of mortalities by sex and age
Figure 5 Distribution of mortalities by sex and ageCC-BY · From the PDF

Verification

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Percentages, sums and reported differences re-computed from the paper’s own numbers.

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Citations

Cites

Research works printed but not linked: 4

  1. N. J. Blanchet , G. Fink , I. Osei-Akoto , and N. J. Blanchet , “The Effect of Ghana’s National Health Insurance Scheme on Health Care Utilisation,” vol. 46, 2012.
  2. 2021, Population and Housing Census - Ghana Statistical Service.”, Accessed: Apr, 14, 2025
  3. “(PDF) Optical screening for presence of banned Sudan III and Sudan IV dyes in edible palm oils.” Accessed: Apr. 13, 2025. [Online]. Available: https://www.researchgate.net/publication/339392037_Optical_screening_for_presence_of_banned_Sudan_III_and_Sudan_IV_dyes_in_edible_palm_oils
  4. 10.1016/j.jacc.2020.11.010 · DOI · Paper page

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Metadata

Authors
Manyeh, A. K., Odopey, C. T., Ackon, A. N. E., Gmayinaam, V. U., Dzissem, P., Acquah, E., & Immurana, M.
Affiliations
  • University of Health and Allied Sciences (GH)
  • University of Health and Allied Sciences, Institute of Health Research, Ho, Ghana
Corresponding author
Odopey, Christopher Tetteh
ORCID
Venue
medRxiv
Publisher
openRxiv
Published
2026-01-16
DOI
10.64898/2026.01.13.26344071
OpenAlex
W7124604516
Semantic Scholar
2a1c54aca51ca0ec5da015e460a894e519ee2793
Cited by
0
References
35
Type
posted content
Language
en
Open access
Licence
Locations
medRxiv (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Epidemiology
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Keywords
in-hospital mortality, hospital morbidity, hospitalization, mortality risk factors, length of hospital stay, health insurance coverage, National Health Insurance Scheme, infectious and parasitic diseases, neurological disorders, comorbidities, age and sex disparities, Ghana, health system performance, COVID-19 pandemic

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.