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Disease diagnosis in primary care in Uganda.

Mbonye MK, Burnett SM, Colebunders R, Naikoba S, Van Geertruyden JP, Weaver MR, Ronald A - BMC Fam Pract (2014)

Bottom Line: We describe diagnoses with associated clinical assessments and laboratory investigations of outpatients attending primary care in Uganda.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.

View Article: PubMed Central - PubMed

Affiliation: Infectious Diseases Institute, Makerere University, Mulago Hospital Complex, P,O, BOX 22418, Kampala, Uganda. mbonyemarti@yahoo.com.

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.

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Related in: MedlinePlus

Map of Uganda showing location of IDCAP sites. It is a map of Uganda showing location of all the health facilities that participated in the IDCAP study.
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Fig1: Map of Uganda showing location of IDCAP sites. It is a map of Uganda showing location of all the health facilities that participated in the IDCAP study.

Mentions: IDCAP was implemented at 36 health center IVs (HCIV) or comparable health facilities from all administrative regions of Uganda, as depicted in a map in FigureĀ 1, that met the inclusion criteria [30]. The government of Uganda managed thirty sites, five were private not-for-profit sites and one was a private for-profit site with government subsidies. Five sites are small hospitals while 31 are HCIVs. All are the highest healthcare referral point for a health sub-district [31, 32]. Each is expected to serve a population of about 100,000 people in the health sub-district, providing basic preventive, curative and referral services with limited inpatient wards. HCIVs also conduct some emergency and surgical and obstetric procedures [17, 32]. Staffing norms and level of staffing for a HCIV can be obtained from the 2010 MoH Human Resources for Health Audit Report [33]. Participants included all outpatients at these health facilities.Figure 1


Disease diagnosis in primary care in Uganda.

Mbonye MK, Burnett SM, Colebunders R, Naikoba S, Van Geertruyden JP, Weaver MR, Ronald A - BMC Fam Pract (2014)

Map of Uganda showing location of IDCAP sites. It is a map of Uganda showing location of all the health facilities that participated in the IDCAP study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4288627&req=5

Fig1: Map of Uganda showing location of IDCAP sites. It is a map of Uganda showing location of all the health facilities that participated in the IDCAP study.
Mentions: IDCAP was implemented at 36 health center IVs (HCIV) or comparable health facilities from all administrative regions of Uganda, as depicted in a map in FigureĀ 1, that met the inclusion criteria [30]. The government of Uganda managed thirty sites, five were private not-for-profit sites and one was a private for-profit site with government subsidies. Five sites are small hospitals while 31 are HCIVs. All are the highest healthcare referral point for a health sub-district [31, 32]. Each is expected to serve a population of about 100,000 people in the health sub-district, providing basic preventive, curative and referral services with limited inpatient wards. HCIVs also conduct some emergency and surgical and obstetric procedures [17, 32]. Staffing norms and level of staffing for a HCIV can be obtained from the 2010 MoH Human Resources for Health Audit Report [33]. Participants included all outpatients at these health facilities.Figure 1

Bottom Line: We describe diagnoses with associated clinical assessments and laboratory investigations of outpatients attending primary care in Uganda.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.

View Article: PubMed Central - PubMed

Affiliation: Infectious Diseases Institute, Makerere University, Mulago Hospital Complex, P,O, BOX 22418, Kampala, Uganda. mbonyemarti@yahoo.com.

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.

Show MeSH
Related in: MedlinePlus