Multi-morbidity and non-communicable diseases in South African primary health care

Lalkhen, Hoosain (2013-12)

Thesis (MFamMed)--Stellenbosch University, 2013.


ENGLISH SUMMARY : INTRODUCTION: Multi-morbidity in non-communicable diseases (NCDs) is becoming more and more recognised phenomenon and this places a huge burden on the healthcare providers as the complexity of managing these patients is multi-fold. Very little research has been done to investigate the extent of multi-morbidity in South Africa. Aim and objectives The aim of the study was to evaluate the extent of multi-morbidity amongst patients with NCDs in South African primary health care. Specific objectives included: 1) What is the frequency of multi-morbidity in patients with hypertension, asthma, COPD, epilepsy, osteoarthritis and diabetes at a primary care level in South Africa? 2) What other conditions are co-morbid with these NCDs? 3) What acute diagnoses are made in patients with these NCDs? 4) What percentage of patients with NCDs are being seen by CNPs and what percentage are being seen by doctors? 5) What is the age and gender distribution of patients presenting with these NCDs? Methods Analysis of a dataset obtained from a previous morbidity survey of South African primary health care that has already been published. Using an Excel spread sheet it was possible to analyse the frequency of the following variables for each of the targeted NCDs (hypertension, asthma, COPD, epilepsy and diabetes): age distribution and mean age, gender distribution, presenting complaints and diagnoses of acute illness, other co-morbid diseases and whether the consultation was with a nurse or a doctor. Finally it was possible to calculate the percentage of patients with different numbers of co-morbid conditions for each index condition. Results Altogether 18856 consultations were included in the dataset and generated 31451 reasons for encounter and 24561 diagnoses. Hypertension was the most common diagnosis encountered (12%) followed by type 2 diabetes (3.9%), asthma (2%), epilepsy (1.9%) and COPD (0.6%). Mean age of patients in diabetes was 56.6 (SD 12.9) years, hypertension 56.4 (SD 13.3) years, epilepsy 37.9 (SD 16.4) years, osteoarthritis 56.9 (SD 13.1) years, asthma 45.5 (SD 18.1) years and COPD 56.8 (SD 10.1) years. Females were in the majority apart from in epilepsy and COPD. 67% saw a clinical nurse practitioner and 33% a doctor. Co-morbidity with other chronic diseases was found in 69% of patients with diabetes, 56% with osteoarthritis, 51% with COPD, 39% with asthma, 34% with hypertension and 22% with epilepsy. Out of all the patients with NCDs only 1% were found to also have HIV or TB and only 0.4% depression or anxiety. Conclusion Multi-morbidity is common particularly in patients with diabetes, osteoarthritis and COPD. Levels of multi-morbidity however are substantially lower than reported in more high income countries. Co-morbidity with HIV was very low. There was a lower than expected relationship between NCDs and mental health problems.

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