Browsing by Author "Mathee, Shaheed"

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    A morbidity survey of South African primary care
    (Public Library of Science (PLoS), 2012-03) Mash, Bob; Fairall, Lara; Adejayan, Olubunmi; Ikpefan, Omozuanvbo; Kumari, Jyoti; Mathee, Shaheed; Okun, Ronit; Yogolelo, Willy
    Background: 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.
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    Reasons for encounter and diagnoses of patients attending primary care clinics in the Saldanha Bay and Swartland rural sub districts, Western Cape Province : a prospective cross-sectional survey
    (Stellenbosch : Stellenbosch University, 2012-03) Mathee, Shaheed; Mash, Bob; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.
    ENGLISH SUMMARY : Background: The public health sector is the principal provider of healthcare to the majority of South Africans. The primary health care (PHC) system was designed to provide equitable and accessible healthcare to all, but the system remains plagued by many challenges. Key to overcoming these challenges is to have a better understanding of the reasons why patients access the service in the first instance and also of the case mix of diseases affecting the population. Studies outlining the reasons for patients’ encounter and the diagnoses offered are scant. Objectives: The aim of the study was to assess the main reasons for encounter (RFE) and the diagnoses made by the healthcare provider of patients attending primary health care clinics in the two rural sub districts of Saldanha Bay and Swartland in the Western Cape. Methods: The prospective cross-sectional study involved 13 healthcare providers (mainly clinical nurse practitioners) working at 10 randomly selected primary healthcare facilities in the two sub districts. The participants were asked to record the RFE’s and diagnoses of all the patients they consulted on a data collection sheet. Data was collected on six days over a 12 month period from August 2009 to June 2010. The International Classification of Primary Care, second edition (ICPC-2) system was used to code the RFE’s and problems defined during all patient encounters. Results: During 1277 patient encounters, 2091 RFE’s were recorded and 1706 diagnoses were offered. The majority of complaints were respiratory (19.9%), digestive (11.2%), musculoskeletal (9.6%), cardiovascular (9.3%), skin (8.8%) and general and unspecified (7.6%). The majority of diagnoses offered by the providers were respiratory (21.4%), cardiovascular (14.2%), skin (9.1%) and digestive (8.6%). Hypertension (10.8%) was the commonest condition managed. Infectious diseases, TB and HIV, occurred at low prevalence (2.9% and 1.5% respectively) Gender did not influence the number of RFE’s and diagnoses. There was a significant difference in the mean numbers of RFE’s and diagnoses between the different age groups(p values 0.0237 and 0.0000 respectively). The majority of patients seen during all encounters were children under the age of 4 (17.3%), who presented mainly with symptoms of, and were diagnosed with respiratory disorders. Conclusion: During the study we were able to ascertain the main reasons for encounters and the diagnoses made by the health care providers of patients attending public primary care facilities in the rural sub districts of Saldanha Bay and Swartland. The study has demonstrated that the concept of the RFE is useful to describe the content of primary care practice in this setting. It can also be concluded that the ICPC-2 as a coding system, is an excellent tool for the description of the RFE’s, and can provide us with morbidity patterns in any setting.