Disease profile of children under 5 years attending primary health care clinics in a high HIV prevalence setting in South Africa

Trop Med Int Health. 2011 Jan;16(1):42-52. doi: 10.1111/j.1365-3156.2010.02672.x. Epub 2010 Nov 23.


Objective: To describe the presenting complaints and disease profile of children attending primary health care (PHC) clinics in two provinces of South Africa.

Methods: Participants were sick children 2-59 months old presenting for care at PHC clinics in KwaZulu-Natal (KZN) and Limpopo provinces from 2006-2007. Children were assessed by an expert Integrated Management of Childhood Illnesses (IMCI) practitioner. Children for whom parental/guardian consent was obtained were tested for HIV.

Results: A total of 1357 children attending one of 74 clinics were assessed. HIV seroprevalence overall was 7.1%, but was significantly higher in KZN than Limpopo (7.5 vs. 2.4%; OR = 3.3, 95%CI 1.9-5.8%). Commonest presenting complaints were cough (72%), skin conditions (22%) and diarrhoea (19%). Of 1349 children, 120 (8.9%) had a weight below the third percentile; 108/1357 (8.0%) children required urgent referral, most commonly for severe pneumonia (53.7%) and severe malnutrition (16.7%). In multivariate analyses, severe pneumonia, growth faltering and urgent referral were independently associated with younger age, residence in KZN and HIV infection (P < 0.05).

Conclusions: Many children with severe illnesses and undiagnosed HIV infection present to PHC facilities. PHC staff require skills to correctly manage these conditions and undertake HIV testing. Although IMCI provides evidence-based guidelines, implementation must be improved to achieve adequate coverage of life-saving interventions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child Health Services / statistics & numerical data
  • Child, Preschool
  • Cough / epidemiology
  • Delivery of Health Care, Integrated / statistics & numerical data
  • Diarrhea / epidemiology
  • Emergencies
  • HIV Infections / epidemiology*
  • Humans
  • Infant
  • Nutritional Status
  • Prevalence
  • Primary Health Care / statistics & numerical data*
  • Referral and Consultation / statistics & numerical data
  • Respiration Disorders / epidemiology
  • South Africa / epidemiology