title: Disease diagnosis in primary care in Uganda.
abstract: BACKGROUND
  The overall burden of disease (BOD) especially for infectious diseases is higher in Sub-Saharan Africa than other regions of the world. Existing data collected through the Health Management Information System (HMIS) may not be optimal to measure BOD. The Infectious Diseases Capacity Building Evaluation (IDCAP) cooperated with the Ugandan Ministry of Health to improve the quality of HMIS data. We describe diagnoses with associated clinical assessments and laboratory investigations of outpatients attending primary care in Uganda.
  
  
  METHODS
  IDCAP supported HMIS data collection at 36 health center IVs in Uganda for five months (November 2009 to March 2010) prior to implementation of the IDCAP interventions. Descriptive analyses were performed on a cross-sectional dataset of 209,734 outpatient visits during this period.
  
  
  RESULTS
  Over 500 illnesses were diagnosed. Infectious diseases accounted for 76.3% of these and over 30% of visits resulted in multiple diagnoses. Malaria (48.3%), cough/cold (19.4%), and intestinal worms (6.6%) were the most frequently diagnosed illnesses. Body weight was recorded for 36.8% of patients and less than 10% had other clinical assessments recorded. Malaria smears (64.2%) and HIV tests (12.2%) accounted for the majority of 84,638 laboratory tests ordered. Fewer than 30% of patients for whom a laboratory investigation was available to confirm the clinical impression had the specific test performed.
  
  
  CONCLUSIONS
  We observed a broad range of diagnoses, a high percentage of multiple diagnoses including true co-morbidities, and underutilization of laboratory support. This emphasizes the complexity of illnesses to be addressed by primary healthcare workers. An improved HMIS collecting timely, quality data is needed. This would adequately describe the burden of disease and processes of care at primary care level, enable appropriate national guidelines, programs and policies and improve accountability for the quality of care.
authors.affiliation: Infectious Diseases Institute, Makerere University, Mulago Hospital Complex, P,O, BOX 22418, Kampala, Uganda. mbonyemarti@yahoo.com.
authors.forename: Martin Kayitale
authors.initials: MK
authors.lastname: Mbonye
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Burnett
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.forename: Sarah
authors.initials: S
authors.lastname: Naikoba
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Van Geertruyden
authors.forename: Marcia R
authors.initials: MR
authors.lastname: Weaver
authors.forename: Allan
authors.initials: A
authors.lastname: Ronald
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003139:Common Cold / Q000175:diagnosis / Q000453:epidemiology; D003141:Communicable Diseases / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003371:Cough / Q000175:diagnosis / Q000453:epidemiology; D019937:Diagnostic Techniques and Procedures / Q000706:statistics & numerical data; D005260:Female; D063005:Health Information Systems; D006373:Helminthiasis / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007411:Intestinal Diseases, Parasitic / Q000175:diagnosis / Q000453:epidemiology; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult