title: A morbidity survey of South African primary care.
abstract: 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.
  
  
  RESULTS
  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
  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.
authors.affiliation: Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, Western Cape, South Africa. rm@sun.ac.za
authors.forename: Bob
authors.initials: B
authors.lastname: Mash
authors.forename: Lara
authors.initials: L
authors.lastname: Fairall
authors.forename: Olubunmi
authors.initials: O
authors.lastname: Adejayan
authors.forename: Omozuanvbo
authors.initials: O
authors.lastname: Ikpefan
authors.forename: Jyoti
authors.initials: J
authors.lastname: Kumari
authors.forename: Shaheed
authors.initials: S
authors.lastname: Mathee
authors.forename: Ronit
authors.initials: R
authors.lastname: Okun
authors.forename: Willy
authors.initials: W
authors.lastname: Yogolelo
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000191:economics / Q000401:mortality*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D011320:Primary Health Care; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000191:economics / Q000401:mortality*