Multimorbidity in non-communicable diseases in South African primary healthcare

Abstract

Corresponding author : R Mash (rm@sun.ac.za) Background. Multimorbidity in non-communicable diseases (NCDs) is a complex global healthcare challenge that is becoming increasingly prevalent. In Africa, comorbidity of communicable diseases and NCDs is also increasing. Objectives. To evaluate the extent of multimorbidity among patients with NCDs in South African (SA) primary healthcare (PHC). Methods. A dataset obtained from a previous morbidity survey of SA ambulatory PHC was analysed. Data on conditions considered active and ongoing at consultations by PHC providers were obtained. Results. Altogether 18 856 consultations were included in the dataset and generated 31 451 reasons for encounter and 24 561 diagnoses. Hypertension was the commonest NCD diagnosis encountered (13.1%), followed by type 2 diabetes (3.9%), osteoarthritis (2.2%), asthma (2.0%), epilepsy (1.9%) and chronic obstructive pulmonary disease (COPD) (0.6%). The majority of patients (66.9%) consulted a nurse and 33.1% a doctor. Overall 48.4% of patients had comorbidity and 14.4% multimorbidity. Multimorbidity (two or more conditions) was present in 36.4% of patients with COPD, 23.7% with osteoarthritis, 16.3% with diabetes, 15.3% with asthma, 12.0% with hypertension and 6.7% with epilepsy. Only 1.1% also had HIV, 1.0% TB, 0.4% depression and 0.04% anxiety disorders. Conclusion. About half of the patients with NCDs had comorbidity, and multimorbidity was most common in patients with COPD and osteoarthritis. However, levels of multimorbidity were substantially lower than reported in high-income countries. Future clinical guidelines, training of PHC nurses and involvement of doctors in the continuum of care should address the complexity of patients with NCDs and multimorbidity.

Multimorbidity, control and treatment of non- communicable diseases among primary healthcare attenders in the Western Cape, South Africa

“…[4] A more recent survey of SA PHC found that 18% of patients with hypertension also had diabetes, and 63% of patients with diabetes also had hypertension. [3] Our study demonstrated higher levels of comorbidity than these studies, with 47% of participants with hypertension also having diabetes, and 84% of participants with diabetes also having hypertension. A study of urban SA women demonstrated high rates of comorbid psychological distress with physical disease, [13] consistent with our finding of 51% of participants with hypertension, diabetes or chronic respiratory disease also having symptoms of depression.…”

“…A recent cross-sectional survey of reasons for consultations in PHC in four SA provinces confirmed that management of hypertension was the most common reason for attendance, with NCDs accounting for 14% of visits. [2,3] …”

On getting published in the SAMJ

“…Two articles in this issue address comorbidity and multimorbidity in NCDs in the SA setting, [8,9] the former suggesting that future clinical guidelines, training of primary care nurses and involvement of doctors in the continuum of care should address the complexity of patients with NCDs and multimorbidity, and the latter warning against mobilisation of scarce resources to implement mass screening for diabetes and hypertension in the absence of adequate evidence of benefit.…”

“…All articles submitted to all the HMPG titles are 'seen' by the iThenticate plagiarism screening system, which screens submitted papers for originality and can tell whether a paper contains passages of text that also appear in other publications or resources. [8] This means that we can (generally, but not always) catch articles with plagiarised content.…”

Rehabilitation needs in individuals with knee OA in rural Western Cape, South Africa: an exploratory qualitative study

“…Ideally, the core services would be delivered by a multidisciplinary team (MDT) which consists of the doctor, nurse, physiotherapist, occupational therapist and dietician, all focusing on their respective areas of expertise. However, the primary health care (PHC) system in South Africa, especially in the rural areas, is not readily equipped with full time MDTs, and patients are often only seen by one or two of the members in the team (Bateman, 2012;Lalkhen and Mash, 2015). In addition, underutilisation of rehabilitation services and the lack of adherence to evidence-based guidelines is a concern previously found in PHC settings of South Africa for patients suffering from musculoskeletal disorders (Major-Helsloot et al, 2014).…”