ABSTRACT
Background: Morbidity patterns of patients attending general practices in
Soweto, a suburban township south of Johannesburg, were studied using the
international classification of primary care (ICPC) as a coding instrument. The
ICPC was used to code reasons for encounter and diagnosis. One hundred and
one private practices were in Soweto at the time of the survey and thirty-one of
these practices were selected using random number tables to obtain as wide a
distribution of geographical and socio economic groups as possible.
Aim: The aim of this study is to determine the morbidity patterns of patients
attending general practices in Soweto during a week in November of the summer
of 1997; and a week in June of the winter of 1998.
Objectives:
1) To determine demographic details of responding general practitioners in
Soweto including sex, age and area of practice.
2) To determine socio-demographic features of patients attending practitioners in
Soweto including age, sex, highest educational level, and occupation.
Township of residence, housing details, namely number of rooms in residence,
and number of persons living in residence.
3) To determine the initiator of the consultation, namely whether it was doctor
initiated, patient initiated, or referred to the practitioner from another
practitioner or clinic.
IV
4) To determine factors related to the condition for which the patient consulted
the doctor, including reason for encounter, diagnosis and whether the
presenting problem was a new or an ongoing problem.
5) To determine the relationships between the above variables.
Design: A prospective descriptive study design was employed in which doctors
completed a survey questionnaire of all patients attended to in their practices
during two weeks, one week in summer and one week in winter.
Results: The 25 doctors in summer and the 20 doctors in winter, included in the
survey described 4,432 encounters. These patients presented with 5,710
problems. Forty point three percent of patients (1780) were male and 59,7%
patients (2,632) were female. Fifty two percent of patients (2306) were seen in
summer and 48% (2,125) patients were seen in winter allowing the comparison of
seasonal variation in morbidity patterns. The majority of patients were in the 20 to
50 year age group, followed by those under ten years of age. In all age groups,
except children under the age of ten years, there were more encounters with
females than males. In under ten year olds, male encounters were more than
female encounters for all ages and twice as frequent as female encounters in the
group under the age of one year. Most patients had a secondary education and
lived in four roomed houses. Upper respiratory tract infections constituted, 16%
(767) of the diagnoses and cough accounted for 16.1% (901) of all the reasons for
encounter in all age groups especially in children below the age of 10 years.
Digestive complaints were second most common reason for encounter and
V
diagnoses in the younger children especially in boys. Encounters and diagnoses
associated with the eye, male genital system, female genital system, pregnancy
and child bearing, ear, psychological, social and blood immune system disorders
each accounted for less than 2% of the encounters experienced. Complaints of
the musculoskeletal system were frequent in older patients. Family planning,
vaginal discharge and painful urination occurred in the 10 to 50 year old age
groups. As for encounters, diagnoses were age related with hypertension and
osteoarthritis being the most common chronic disease afflicting patients over 30
years of age.
Nineteen point seven percent (870) of the patients belonged to the trade and
technical occupation, 13.6% (604) of the patients were children, 12.2% (539) of
patients were unemployed, 9.6% (423) of patients were scholars, 9.4% (414) were
professional, 8.6% (379) of patients were students, 8.1% (360) were pensioners
and 7.6% (338) were office workers. Seven point three percent of the patients
(325) were Labourers, and 3.9% (172) of the patients were housewives.
Thirteen point seven percent of the patients (605) were from Meadowlands, 13%
(577) from Dobsonville, 7.2% (318) from other areas outside Soweto, 6.7% (298)
were from Orlando East, 6.6% (294) were from Zola and 6.1% (270) from
Chiawelo. Less then 5% of the patients came from the remaining townships.
Discussion: The present survey recorded encounters of 25 general practitioners
in Summer and 20 general practitioners in Winter, with 4,432 patients and 5,710
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problems. The week time period of the present survey is similar to that of Bourne
et al. which determined the morbidity spectrum seen by a representative sample
of 8% of the medical practitioners in South Africa in 1985. The sample size of the
present study is considerably smaller than the comprehensive Cape Morbidity
study, which was conducted over 1 year and recorded 49,347 diagnoses by 15
practitioners. This survey included 38,368 white patients and 14,979 patients of
mixed racial origin but no blacks were included. The same limitation applies to the
pilot survey conducted by Bloom et al in Cape Town between 1984 and 1988,
where 13 practices recorded 64,959 encounters. Studies conducted outside South
Africa are similar to those conducted within the country. This survey in comparison
with other countries reflects consistency in the incidence of illness encountered by
the family practitioner and also contemporary trends in morbidity seen in general
practice. Most of the inhabitants of Soweto still make use of coal-stove fires and
the town ship is usually enveloped in pall of heavy smoke coming from these coal
stove fires. The main impression of Soweto is that of overcrowding and poverty,
and still struggling in providing basic services including potable toilets to its poorer
districts. Schools in Soweto remain largely without flushed toilets, furniture and
electricity. Most of Soweto still has row upon row of so call matchbox houses
crowded into unpaved dusty streets that are poorly lit. The above conditions
explain the high reasons for encounter and diagnoses of respiratory and digestive
conditions among the patients attending the private practices. This study shows
that an enormous amount of everyday illness occurs in children and therefore
education and advice for parents on how to cope with illness in their children
remains important.
VII
Study Limitation: This survey was conducted in an impoverished township
community where many people would attend clinics. It has selected encounters
where the patients have the ability to pay for the services of a medical doctor.
Conclusion: Few studies appear to be as comprehensive as this study where the reasons of encounter, the diagnosis, patient demographic and socio-economic
data was recorded. This is also the largest survey conducted in an urbanized
South African township. This survey has found a similar trend in the spectrum of
disease, therefore providing a significant analysis of morbidity patterns
encountered by the family practitioner in Soweto. There is an on going concern of
the role of sexually transmitted diseases in the transmission of HIV, and this study
has shown a significant burden of sexually transmitted disease in the
asymptomatic population, particularly women in the age group 20 to 30 and 30 to
40 years. The overall burden of diseases in Soweto shows that respiratory
problems are significant in all age groups. Chronic diseases such hypertension,
osteoarthritis, presumed gastrointestinal infections, asthma and malignant
neoplasm of the stomach as well as the anxiety disorders also featured
prominently in the top 20 reasons for encounter and diagnoses. Information about
mental health status in South Africa is scanty and has possibly led to an
inadequate identification of a potential problem. This study has shown anxiety
disorder/anxiety state as being a common reason for encounter and diagnoses in
adults attending private practices in Soweto. To determine whether this survey
reflects the morbidity patterns in this population as a whole would require
additional data from the Government hospitals and clinics.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/6343 |
| Date | 23 February 2009 |
| Creators | Hoosain, Rehana |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf |
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