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

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Naomi Folb, Venessa Timmerman, Naomi S Levitt, Krisela Steyn, Max O Bachmann, Crick Lund, Eric D Bateman, Carl Lombard, Thomas A Gaziano, Merrick Zwarenstein, Lara R Fairall

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.

Objectives. 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.

Conclusion. 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' affiliations

Naomi Folb, University of Cape Town Lung Institute, Cape Town, South Africa; Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Venessa Timmerman, University of Cape Town Lung Institute, Cape Town, South Africa

Naomi S Levitt, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Krisela Steyn, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Max O Bachmann, Norwich Medical School, University of East Anglia, Norwich, UK

Crick Lund, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, South Africa

Eric D Bateman, University of Cape Town Lung Institute, Cape Town, South Africa; Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Carl Lombard, Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Biostatistics Unit, Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Thomas A Gaziano, Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Cardiovascular Medicine, Brigham & Women’s Hospital, Boston, MA, USA

Merrick Zwarenstein, Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

Lara R Fairall, University of Cape Town Lung Institute, Cape Town, South Africa; Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

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Keywords

Primary care; South Africa; Non-communicable disease; Multimorbidity

Cite this article

South African Medical Journal 2015;105(8):642-647. DOI:10.7196/samjNEW.8794

Article History

Date submitted: 2014-08-26
Date published: 2015-09-21

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