{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T18:29:34Z","timestamp":1788373774627,"version":"build-2803163510"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2022,5,2]],"date-time":"2022-05-02T00:00:00Z","timestamp":1651449600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>With the Covid-19 pandemic and the introduction of the WHO\u2019s Essential Diagnostics List (EDL), increasing global attention is focused on the crucial role of diagnostics in achieving universal health coverage. To create national EDLs and to aid health system planning, it is vital to understand the most common conditions with which people present at primary care health facilities. We undertook a systematic review of the most common reasons for primary care visits in low- and middle-income countries. Six databases were searched for articles published between January 2009 and December 2019, with the search updated on MEDLINE to January 2021. Data on the most common patient reasons for encounter (RFEs) and provider diagnoses were collected. 17 of 22,279 screened articles were included. Most studies used unvalidated diagnostic classification systems or presented provider diagnosis data grouped by organ system, rather than presenting specific diagnoses. No studies included data from low-income countries. Only four studies (from Brazil, India, Nigeria and South Africa) using the ICPC-2 classification system contained RFE and provider diagnosis data and could be pooled. The top five RFEs from the four studies were headache, fever, back or low back symptom, cough and pain general\/multiple sites. The top five diagnoses were uncomplicated hypertension, upper respiratory tract infection, type 2 diabetes, malaria and health maintenance\/prevention. No psychological symptoms were among the top 10 pooled RFEs. There was more variation in top diagnoses between studies than top RFEs, showing the importance of creating location-specific lists of essential diagnostics for primary care. Future studies should aim to sample primary care facilities from across their country of study and use ICPC-3 to report both patient RFEs and provider diagnoses.<\/jats:p>","DOI":"10.1371\/journal.pgph.0000196","type":"journal-article","created":{"date-parts":[[2022,5,2]],"date-time":"2022-05-02T13:23:24Z","timestamp":1651497804000},"page":"e0000196","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":27,"title":["Most common reasons for primary care visits in low- and middle-income countries: A systematic review"],"prefix":"10.1371","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2929-4252","authenticated-orcid":true,"given":"Jacob","family":"Bigio","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9272-0985","authenticated-orcid":true,"given":"Emily","family":"MacLean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1019-8597","authenticated-orcid":true,"given":"Nathaly Aguilera","family":"Vasquez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7835-0372","authenticated-orcid":true,"given":"Lavanya","family":"Huria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7402-5791","authenticated-orcid":true,"given":"Mikashmi","family":"Kohli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1072-2683","authenticated-orcid":true,"given":"Genevieve","family":"Gore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0464-3882","authenticated-orcid":true,"given":"Emma","family":"Hannay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3667-4536","authenticated-orcid":true,"given":"Madhukar","family":"Pai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2986-4641","authenticated-orcid":true,"given":"Pierrick","family":"Adam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,5,2]]},"reference":[{"key":"pgph.0000196.ref001","article-title":"A vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development Goals","author":"World Health Organization UNCsFU","year":"2018"},{"key":"pgph.0000196.ref002","unstructured":"World Health Organization. Primary health care 2021. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/primary-health-care."},{"key":"pgph.0000196.ref003","unstructured":"World Health Organization. The selection and use of essential in vitro diagnostics: report of the third meeting of the WHO Strategic Advisory Group of Experts on In Vitro Diagnostics, 2020 (including the third WHO model list of essential in vitro diagnostics). Geneva: World Health Organization, 2021."},{"issue":"10185","key":"pgph.0000196.ref004","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1016\/S0140-6736(19)31052-9","article-title":"The Lancet Commission on diagnostics: advancing equitable access to diagnostics","volume":"393","author":"ML Wilson","year":"2019","journal-title":"The Lancet"},{"issue":"10","key":"pgph.0000196.ref005","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1016\/S1473-3099(18)30539-5","article-title":"Availability of essential diagnostics in primary care in India","volume":"18","author":"M Kohli","year":"2018","journal-title":"The Lancet Infectious Diseases"},{"key":"pgph.0000196.ref006","unstructured":"Foundation for Innovative New Diagnostics. About the ACT-Accelerator 2021. Available from: https:\/\/www.finddx.org\/covid-19\/act-accelerator\/."},{"key":"pgph.0000196.ref007","author":"World Health Organization","year":"2021","journal-title":"WHO publishes new Essential Diagnostics List and urges countries to prioritize investments in testing"},{"key":"pgph.0000196.ref008","unstructured":"Indian Council of Medical Research. National Essential Diagnostics List. New Delhi: 2019."},{"issue":"11","key":"pgph.0000196.ref009","first-page":"832","article-title":"What are the most common conditions in primary care? Systematic review","volume":"64","author":"CR Finley","year":"2018","journal-title":"Can Fam Physician"},{"key":"pgph.0000196.ref010","first-page":"CRD42020159469","volume-title":"Most common reasons for primary care visits in low-and-middle income countries: a systematic review","author":"PK Adam","year":"2020"},{"key":"pgph.0000196.ref011","unstructured":"World Bank. World Bank Country and Lending Groups 2021. Available from: https:\/\/datahelpdesk.worldbank.org\/knowledgebase\/articles\/906519-world-bank-country-and-lending-groups."},{"issue":"9","key":"pgph.0000196.ref012","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.jclinepi.2011.11.014","article-title":"Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement","volume":"65","author":"D Hoy","year":"2012","journal-title":"J Clin Epidemiol"},{"issue":"4","key":"pgph.0000196.ref013","first-page":"863","article-title":"Disease Pattern among Children attending Pediatric Outpatient Department in Community Based Medical College Hospital, Bangladesh","volume":"26","author":"M Begum","year":"2017","journal-title":"Mymensingh Med J"},{"issue":"5","key":"pgph.0000196.ref014","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1093\/fampra\/cmaa029","article-title":"Reasons for encounter in primary health care in Brazil","volume":"37","author":"PS Chueiri","year":"2020","journal-title":"Fam Pract"},{"issue":"1","key":"pgph.0000196.ref015","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1186\/s12913-019-4559-2","article-title":"Primary healthcare and school health service utilisation by adolescents and young adults in KwaZulu-Natal, South Africa","volume":"19","author":"AM Doyle","year":"2019","journal-title":"BMC Health Services Research"},{"key":"pgph.0000196.ref016","doi-asserted-by":"crossref","first-page":"101","DOI":"10.4081\/jphia.2012.e25","article-title":"Assessment of disease profiles and drug prescribing patterns of health care facilities in Edo State, Nigeria","volume":"3","author":"E Enato","year":"2012","journal-title":"Journal of Public Health in Africa"},{"issue":"4","key":"pgph.0000196.ref017","first-page":"424","article-title":"Morbidity profile of out-patients attending a Primary Health Centre in rural Puducherry, south India","volume":"5","author":"A Gupta","year":"2014","journal-title":"National Journal of Community Medicine"},{"key":"pgph.0000196.ref018","article-title":"Portfolio of Outpatients Attending Centre for Urban Health, Madhya Pradesh, Central India","volume":"2","author":"A Gupta","year":"2015","journal-title":"Health Serv Res Manag Epidemiol"},{"issue":"4","key":"pgph.0000196.ref019","first-page":"363","article-title":"Morbidity profiles at three primary care clinics in Perlis, Malaysia","volume":"67","author":"MF Kamarudin","year":"2012","journal-title":"Med J Malaysia"},{"key":"pgph.0000196.ref020","first-page":"308","article-title":"Socio-Demographic Profile and Morbidity Pattern of Patients in A Rural Field Practice Area of Government Medical College, Miraj, Maharashtra","volume":"10","author":"VD Kshirsagar","year":"2019","journal-title":"National journal of community medicine"},{"key":"pgph.0000196.ref021","first-page":"10","article-title":"Morbidity Pattern of Patients Attending a Primary Healthcare Facility in an Urban Slum of Chandigarh, India","volume":"12","author":"R Kumar","year":"2018","journal-title":"Journal of Clinical and Diagnostic Research"},{"issue":"3","key":"pgph.0000196.ref022","doi-asserted-by":"crossref","first-page":"e32358","DOI":"10.1371\/journal.pone.0032358","article-title":"A Morbidity Survey of South African Primary Care","volume":"7","author":"B Mash","year":"2012","journal-title":"PLOS ONE"},{"key":"pgph.0000196.ref023","first-page":"2612","article-title":"The Lake Clinic\u2014providing primary care to isolated floating villages on the Tonle Sap Lake, Cambodia","volume":"14","author":"HS Merali","year":"2014","journal-title":"Rural Remote Health"},{"key":"pgph.0000196.ref024","doi-asserted-by":"crossref","first-page":"79","DOI":"10.5455\/jrmds.20142416","article-title":"Morbidity Pattern In Rural Area Of Jaipur District (Rajasthan)","volume":"2","author":"M Mohan","year":"2014","journal-title":"Journal of Research in Medical and Dental Science"},{"issue":"2","key":"pgph.0000196.ref025","doi-asserted-by":"crossref","first-page":"291","DOI":"10.4103\/2249-4863.192341","article-title":"International Classification of Primary Care-2 coding of primary care data at the general out-patients\u2019 clinic of General Hospital, Lagos, Nigeria","volume":"5","author":"OA Olagundoye","year":"2016","journal-title":"J Family Med Prim Care"},{"issue":"4","key":"pgph.0000196.ref026","doi-asserted-by":"crossref","DOI":"10.5958\/0976-5506.2017.00457.0","article-title":"Assessment of Healthcare Utilization in a Community-Centric Model of Primary Healthcare for Rural Populations","volume":"8","author":"A Prabhune","year":"2017","journal-title":"Indian Journal of Public Health Research & Development"},{"key":"pgph.0000196.ref027","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1590\/1809-4503201400040013","article-title":"Morbidity in users of Family Health teams in the northeast of Minas Gerais based on the International Classification of Primary Care","volume":"17","author":"V Silva","year":"2014","journal-title":"Revista Brasileira de Epidemiologia"},{"issue":"2","key":"pgph.0000196.ref028","doi-asserted-by":"crossref","first-page":"316","DOI":"10.4103\/2249-4863.220029","article-title":"A chart review of morbidity patterns among adult patients attending primary care setting in urban Odisha, India: An International Classification of Primary Care experience","volume":"6","author":"S Swain","year":"2017","journal-title":"J Family Med Prim Care"},{"issue":"4","key":"pgph.0000196.ref029","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1590\/1516-3180.2014.9490902","article-title":"Main reasons for medical consultations in family healthcare units in the city of Recife, Brazil: a cross-sectional study","volume":"133","author":"C Torres Rde","year":"2015","journal-title":"Sao Paulo Med J"},{"key":"pgph.0000196.ref030","doi-asserted-by":"crossref","first-page":"c930","DOI":"10.1136\/bmj.c930","article-title":"Rapid testing for malaria in settings where microscopy is available and peripheral clinics where only presumptive treatment is available: a randomised controlled trial in Ghana","volume":"340","author":"EK Ansah","year":"2010","journal-title":"Bmj"},{"key":"pgph.0000196.ref031","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.actatropica.2017.03.022","article-title":"Malaria overdiagnosis and subsequent overconsumption of antimalarial drugs in Angola: Consequences and effects on human health","volume":"171","author":"S Manguin","year":"2017","journal-title":"Acta Trop"},{"key":"pgph.0000196.ref032","doi-asserted-by":"crossref","first-page":"e4389","DOI":"10.1136\/bmj.e4389","article-title":"Overdiagnosis and mistreatment of malaria among febrile patients at primary healthcare level in Afghanistan: observational study","volume":"345","author":"T Leslie","year":"2012","journal-title":"BMJ: British Medical Journal"},{"key":"pgph.0000196.ref033","doi-asserted-by":"crossref","first-page":"914675","DOI":"10.5402\/2013\/914675","article-title":"Overdiagnosis and Overtreatment of Malaria in Children That Presented with Fever in Lagos, Nigeria","volume":"2013","author":"OO Oladosu","year":"2013","journal-title":"ISRN Infectious Diseases"},{"key":"pgph.0000196.ref034","unstructured":"Unitaid. Fever diagnostic technology landscape, 1st edition. 2018."},{"issue":"6","key":"pgph.0000196.ref035","doi-asserted-by":"crossref","first-page":"e002259","DOI":"10.1136\/bmjgh-2019-002259","article-title":"Operational research to support equitable non-communicable disease policy in low-income and middle-income countries in the sustainable development era: a scoping review","volume":"5","author":"N Gibbs","year":"2020","journal-title":"BMJ Global Health"},{"issue":"10199","key":"pgph.0000196.ref036","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/S0140-6736(19)30955-9","article-title":"The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1\u00b71 million adults","volume":"394","author":"P Geldsetzer","year":"2019","journal-title":"Lancet"},{"issue":"3","key":"pgph.0000196.ref037","doi-asserted-by":"crossref","first-page":"e1002751","DOI":"10.1371\/journal.pmed.1002751","article-title":"Health system performance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally representative surveys","volume":"16","author":"J Manne-Goehler","year":"2019","journal-title":"PLOS Medicine"},{"issue":"2","key":"pgph.0000196.ref038","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s11920-019-0997-0","article-title":"Global Burden of Disease and the Impact of Mental and Addictive Disorders","volume":"21","author":"J Rehm","year":"2019","journal-title":"Curr Psychiatry Rep"},{"issue":"10149","key":"pgph.0000196.ref039","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/S0140-6736(18)31221-2","article-title":"Burden of disease in Brazil, 1990\u20132016: a systematic subnational analysis for the Global Burden of Disease Study 2016","volume":"392","author":"F Marinho","year":"2018","journal-title":"The Lancet"},{"key":"pgph.0000196.ref040","unstructured":"ICPC-3 Consortium. ICPC-3 Browser 2021 [08\/07\/21]. Available from: https:\/\/browser.icpc-3.info\/."}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0000196","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,2]],"date-time":"2022-05-02T13:24:02Z","timestamp":1651497842000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0000196"}},"subtitle":[],"editor":[{"given":"Joel Msafiri","family":"Francis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,5,2]]},"references-count":40,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0000196","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,2]]}}}