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 Limpopo Province primary health care : a prospective cross-sectional survey

Thesis (MFamMed)--Stellenbosch University, 2015.ENGLISH ABSTRACT: Introduction Since 1994 the South African health care system has been undergoing considerable transformation as new health challenges emerges locally and globally. Limpopo and Mopani primary healthcare in particular is not an exception. The information on the reasons for encounter and diagnosis in primary care will create an opportunity to focus on proper planning for the delivery of quality health care that is relevant to the people, socially justifiable and cost effective. The study aimed to determine the range and prevalence of reasons for encounter and diagnoses found among patients attending primary care facilities in Limpopo. Methods Design: A prospective cross-sectional survey Setting: Primary health care centers, clinics and mobile clinics in Mopani district of Limpopo Province, South Africa. Selection of facilities, primary care providers and patients: Patient encounters were obtained from twenty-nine randomnly selected primary care facilities by trained primary care practitioners with data collection sheets. Data collection: The data collection days were spread across all days of the week and across the whole period from July 2009 to March 2010. Analysis: The international classification of primary care (ICPC-2) was used to code and analyse the data. Results A total of 6,666 patient encounters were recorded. Females 4598 (69%), accounted for more than two thirds of all contacts and children aged 0-4 years were the largest age group. Overall the commonest reasons for encounter were cough (13.0%), repeat family planning (8.4%) and headaches (5.7%). The commonest diagnoses were cough/upper respiratory tract infection (16.9%), hypertension (5.7%) and HIV/AIDS (2.6%). The top 20 reasons for encounter (RFE) and diagnoses are presented for all patients, men and women as well as children < 5 years. Conclusion Primary care nurse practitioners, clinical associates and general medical practitioners need to be competent to assess and manage the common RFE and diagnoses in order to deliver comprehensive health care at the primary level.AFRIKAANSE OPSOMMING: Nie beskikbaa

Patterns of selected reasons for encounter by age.

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

RFE associated with chronic care (N = 31451).

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

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

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

Commonest complaints in primary care (N = 31451).

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

Summary of sampling strategy.

<p>*Community Health Centre.</p

Distribution of RFEs between body systems in ICPC-2 (N = 31451).

<p>Distribution of RFEs between body systems in ICPC-2 (N = 31451).</p

Patterns of selected diagnoses by age.

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