Disease diagnosis in primary care in Uganda

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• 作者：Martin Kayitale Mbonye (16) (18)
  Sarah M Burnett (17) (18)
  Robert Colebunders (18) (19)
  Sarah Naikoba (16) (18)
  Jean-Pierre Van Geertruyden (18)
  Marcia R Weaver (20)
  Allan Ronald (21)
  
  16. Infectious Diseases Institute ; Makerere University ; Mulago Hospital Complex ; P.O. BOX 22418 ; Kampala ; Uganda
  18. Department of Epidemiology and Social Medicine ; University of Antwerp ; Campus Drie Eiken ; S.4.10 Universiteitsplein 1 ; B-2610 ; Wilrijk ; Antwerp ; Belgium
  17. Accordia Global Health Foundation ; Washington ; DC ; USA
  19. Department of Clinical Sciences ; Institute of Tropical Medicine ; Antwerp ; Belgium
  20. International Training and Education Center for Health (I-TECH) ; Department of Global Health ; University of Washington ; Seattle ; USA
  21. Department of Medicine ; University of Manitoba ; Winnipeg ; Manitoba ; Canada
  
• 关键词：Primary care ; Disease diagnosis ; Uganda
• 刊名：BMC Family Practice
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：15
• 期：1
• 全文大小：1,304 KB
• 参考文献：The Global Burden of Disease: Generating Evidence, Guiding Policy 鈥?Sub-Saharan Africa Regional Edition. Seattle, Washington
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  44. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2296/15/165/prepub
  
• 刊物主题：General Practice / Family Medicine; Primary Care Medicine;
• 出版者：BioMed Central
• ISSN：1471-2296

文摘

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.