A Morbidity Survey of South African Primary Care

Publication of this article was funded by the Stellenbosch University Open Access Fund.The original publication is available at www.plosone.org/BibliographyBackground: Recent studies have described the burden of disease in South Africa. However these studies do not tell us which of these conditions commonly present to primary care providers, how these conditions may present and how providers make sense of them in terms of their diagnoses. Clinical nurse practitioners are the main primary care providers and need to be better prepared for this role. This study aimed to determine the range and prevalence of reasons for encounter and diagnoses found among ambulatory patients attending public sector primary care facilities in South Africa. Methodology/Principal Findings: The study was a multi-centre prospective cross-sectional survey of consultations in primary care in four provinces of South Africa: Western Cape, Limpopo, Northern Cape and North West. Consultations were coded prior to analysis by using the International Classification of Primary Care-Version 2 in terms of reasons for encounter (REF) and diagnoses. Altogether 18856 consultations were included in the survey and generated 31451 reasons for encounter (RFE) and 24561 diagnoses. Women accounted for 12526 (66.6%) and men 6288 (33.4%). Nurses saw 16238 (86.1%) and doctors 2612 (13.9%) of patients. The top 80 RFE and top 25 diagnoses are reported and ongoing care for hypertension was the commonest RFE and diagnosis. The 20 commonest RFE and diagnoses by age group are also reported. Conclusions/Significance: Ambulatory primary care is dominated by non-communicable chronic diseases. HIV/AIDS and TB are common, but not to the extent predicted by the burden of disease. Pneumonia and gastroenteritis are commonly seen especially in children. Women’s health issues such as family planning and pregnancy related visits are also common. Injuries are not as common as expected from the burden of disease. Primary care providers did not recognise mental health problems. The results should guide the future training and assessment of primary care providers.Stellenbosch University Open Access FundPublishers' Versio

Reasons for encounter and diagnosis in patients seen in Frances Baard District public primary care: a prospective cross sectional study

Thesis (MFamMed)--Stellenbosch University, 2011.ENGLISH SUMMARY : Background: Information on the patient provider encounter, in terms of the most prevalent reasons for encounter and diagnoses at the primary care level, may help not only to improve the quality and efficiency of primary care service delivery, but also to develop training programmes for primary care providers. This study aimed to determine the range and prevalence of the reasons for encounter and diagnoses resulting form provider-patient encounters in public sector primary care facilities in the Frances Baard District. Methods: This descriptive cross sectional survey was conducted in the Frances Baard district situated in the Northern Cape Province. The study aimed to include 6000 consultations. This sample size was allocated to the sub-districts based on their respective populations. The facilities in each sub-district were then listed and divided into community health centres, fixed clinics or mobile clinics. Following this stratification, the required number of health centres, fixed clinics and mobile clinics were then randomly selected. In order to account for seasonality and pattern of attendance throughout the week, the 5 days on which patients were sampled were divided over a 12 month period and between different days of the week. Vertical programmes were excluded from this study as well as clinics attending to only one type of patients. Data were coded according to the International Classification of Primary Care-Version 2. Results: In total 1504 consultations were captured and resulted in 2930 RFE and 1958 diagnoses. Among these consultations 1491(99.1%) were conducted by nurses versus 13(0.9%) by doctors. Overall the sex ratio showed 591(39.3%) male to 902(59.9%) female patients. There was no significant difference between males and females in the number of RFEs (p=0.36) or diagnoses (p=0.35). Age was not related to the number of RFEs (p=0.77) but was significantly related to the number of diagnoses (p<0.01). Older clients had a significantly lower number of diagnoses in comparison to younger patients. The top 20 RFE and top 20 diagnoses are presented overall, by gender and separately for children. Conclusion: Cough, fever and throat symptoms emerged as the main RFE. In adults hypertension, acute URTI/tonsillitis, tuberculosis and HIV were the most prevalent diagnoses. Children were primarily seen for respiratory tract infection, gastrointestinal infection and immunizations. Nurses were seeing 99% of all patients and their practice was dominated by non-communicable chronic diseases and infectious diseases. Delivering quality public primary care would require a comprehensive support system for nurses to improve their capacity to respond appropriately to the common reasons for encounter and conditions identified in this survey. In particular there is a need to improve the recognition of mental health disorders and to foster a more bio-psycho-social approach.AFRIKAANSE OPSOMMING : Geen opsomming beskikbaar

Top 25 diagnoses in South African primary care (N = 24561).

<p>Top 25 diagnoses in South African primary care (N = 24561).</p

Distribution of number of consultations by age groups.

<p>Distribution of number of consultations by age groups.</p

Patterns of selected reasons for encounter by age.

<p>Patterns of selected reasons for encounter by age.</p

Commonest complaints in primary care (N = 31451).

<p>Commonest complaints in primary care (N = 31451).</p

Patterns of selected diagnoses by age.

<p>Patterns of selected diagnoses by age.</p

RFE associated with chronic care (N = 31451).

<p>RFE associated with chronic care (N = 31451).</p

Top 20 diagnoses by age group.

<p>Top 20 diagnoses by age group.</p