title: Multimorbidity, control and treatment of noncommunicable diseases among primary healthcare attenders in the Western Cape, South Africa.
abstract: BACKGROUND
  South Africa (SA) is facing a heavy burden of non-communicable diseases (NCDs). Few studies address multimorbidity, control and treatment of NCDs in patients attending primary healthcare (PHC) clinics.
  
  
  OBJECTIVE
  To describe multimorbidity, related risk factors, disease severity and treatment status of patients with four important NCDs attending public sector PHC clinics in two districts in SA.
  
  
  METHODS
  A cross-sectional sample of patients completed baseline data collection for a randomised controlled trial of a health systems intervention. The study population comprised adults attending PHC clinics in the Eden and Overberg districts of the Western Cape in 2011. Four subgroups of patients were identified: hypertension, diabetes, chronic respiratory disease and depression. A total of 4 393 participants enrolled from 38 clinics completed a baseline structured questionnaire and had measurements taken. Prescription data were recorded.
  
  
  RESULTS
  Of participants with hypertension, diabetes, respiratory disease and depression, 80%, 92%, 88% and 80%, respectively, had at least one of the other three conditions. There were low levels of control and treatment: 59% of participants with hypertension had a blood pressure ≥140/90 mmHg, the mean haemoglobin A1c (HbA1c) value in participants with diabetes was 9%, 12% of participants in the depression group were prescribed an antidepressant at a therapeutic dose, and 48% of respiratory participants were prescribed a b2-agonist and 34% an inhaled corticosteroid.
  
  
  CONCLUSIONS
  Considerable multimorbidity and unmet treatment needs exist among patients with NCDs attending public sector PHC clinics. Improved strategies are required for diagnosing and managing NCDs in this sector.
authors.affiliation: University of Cape Town Lung Institute, PO Box 34560, Groote Schuur, Cape Town 7925, South Africa. naomi.folb@uct.ac.za.
authors.forename: Naomi
authors.initials: N
authors.lastname: Folb
authors.forename: Venessa
authors.initials: V
authors.lastname: Timmerman
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Levitt
authors.forename: Krisela
authors.initials: K
authors.lastname: Steyn
authors.forename: Max O
authors.initials: MO
authors.lastname: Bachmann
authors.forename: Crick
authors.initials: C
authors.lastname: Lund
authors.forename: Eric D
authors.initials: ED
authors.lastname: Bateman
authors.forename: Carl
authors.initials: C
authors.lastname: Lombard
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gaziano
authors.forename: Merrick
authors.initials: M
authors.lastname: Zwarenstein
authors.forename: Lara R
authors.initials: LR
authors.lastname: Fairall
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy; D008171:Lung Diseases / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D013019:South Africa / Q000453:epidemiology