reliable information on morbidity and mortality is the key for evidence - based public health practice .
more emphasis on estimating burden of diseases was given at global level , especially since the launch of  global burden of disease study .
 while the decision - making priorities of global health authorities are dependent on these projected data , developing countries often lack the local data for proper public health planning .
health professionals still fights to establish vital registration , while the morbidity surveillance is still in its initial stage . in countries where information is available ,
data from ambulatory care services , primary healthcare centers , and outpatient departments ( opd ) are often lacking .
economic impacts of the mild to moderate ill health conditions are considerable given the large number of patients utilizing these services .
as an example , in sri lanka , more than 43 million visits are made to the opds in government hospitals annually .
given that the only 50% of outpatient care is delivered through public sector , the total outpatient visits are estimated to be more than 80 million , four times the sri lanka population of 20 million . despite this heavy burden , information on opd morbidities are not routinely collected and used in healthcare planning .
as a preliminary study to assess the burden of disease and morbidity pattern in opd , we conducted a rapid survey in a tertiary care hospital in sri lanka .
study sample consisted of opd patients visiting teaching hospital peradeniya , which is the teaching hospital for second largest medical school in sri lanka .
three of the six authors physical presented at the opd during the study period , explained the procedure to patients , and consented patients filled a self - administered short questionnaire .
a half - page questionnaire was used and the main problem which patients sort medical advice was inquired .
a total of 3817 patients attended opd during the study period and 1908 were recruited as the study sample using the systematic sampling strategy .
of them , 1439 completed the questionnaire with a response rate of 75.4% . a significantly higher number of females ( 924,64.2% ) visited the opd compared to males ( 515,35.8% ) ( chi square for goodness of fit 116 , p<0.001 ) .
the age of the patients attending the opd ranged from 1 year to 89 years .
the mean age of the study sample was 40 years ( sd = 19 years ) .
majority of the females attending the opd were of middle age while males were distributed evenly among all age categories .
the mean age of females was significantly higher than that of males ( t = 4.03 , p<0.001 ) .
housewives constituted the major occupational group among females , accounting for 52% of the total sample , followed by adolescents ( 15.9% ) .
ten leading cause of opd visits were nonspecific body aches and pains  225 ( 15.6% ) ; respiratory symptoms ( cough and cold )  151 ( 10.5% ) ; abdominal pain  122 ( 8.5% ) ; fever - 117 ( 8.1 ) ; backache and joint pains  112 ( 7.8 ) ; skin conditions - 106 ( 7.4 ) ; constipation - 84 ( 5.8 ) ; chest pain  66 ( 4.6 ) ; diarrhea - 59 ( 4.1 ) ; and dog bite / s  51 ( 3.5 ) . table 1 shows the leading morbidities according to sociodemographic profile of the patients . among children (  10 years)/school children , cough and cold was the commonest complaint followed by dog bites .
constipation ( 14.5% ) was the commonest presenting complaint among tamils ( 6.3% ) but was not in the leading five commonest complaints among the other ethnic groups .
main presenting symptom among adolescents was various skin conditions , which was third commonest condition among young adults .
commonest presenting complaint by demographic characteristics among patients attending outpatient department of teaching hospital peradeniya , sri lanka ( n = 1 439 )
this could be explained partly from the so - called  male - female health survival paradox 
( i.e. , males report better health than females , but encounter higher mortality at all ages ) .
there is growing evidence to conclude that men are healthier , but have substantially higher mortality rates .
however , this could be also due to a gender difference in health - seeking behavior as shown in previous studies.[46 ] children less than 10 years accounted for only 5% of the opd patients , which shows a marked difference from the private sector utilization in sri lanka where 32% of encounters were reported as children , which was completely different from the findings of the present study .
previously , respiratory tract problems were reported as the commonest encounter in government phc setting as well as in gp practice in sri lanka , with higher percentages ranging from 20% to 55%.[79 ] in our study , respiratory problems was the commonest among younger age groups . however , nonspecific body aches and pains was the leading encounter .
however , this problem needs to be studied to provide meaningful services . despite having low annual numbers of rabies
, dog bite showed to be a leading problem among children . reported constipation encounters as leading reason for opd care seeking among tamil ethnic group
these observations from a single hospital could not be generalized to sri lanka or other developing countries .
however , our study provides early evidence for probability of changing morbidity patterns with demographic transitions that should be taken into account in public health program planning .
 background : global disease burden estimates often lack real data on morbidities , especially from patients treated in outpatient department ( opd ) . in sri lanka , around 40 million visits are made annually to the opds in government hospitals and we conducted a preliminary study to assess the morbidity profile of these opd patients.methods:patients attending the opd , in teaching hospital peradeniya , sri lanka , was recruited into the study using systematic random sampling procedure . 
 a self - administered , structured questionnaire was used to collect data . 
 investigators explained the study to patients and data collection was completed before seeing the physician . 
 self - reported presenting complain was used to analyze the morbidity profile of the patients.results:the study sample consisted of 1 439 patients ( male - 515 , female - 924 ) . 
 the mean age of the study sample was 40 years ( sd = 19 years ) . 
 the mean age of the females were statistically significantly higher than that of the males ( t = 4.03 , p<0.001 ) . 
 housewives constituted the major occupational group ( 52% ) followed by students ( 15.9% ) . 
 the most common presenting complains reported were body aches and pains ( 15.6% ) , cough and cold ( 10.5% ) , and abdominal pain ( 8.5% ) . 
 leading cause of hospital visit among different demographic categories showed statistically significant variations.conclusions:the morbidity pattern observed in this patient population was not previously reported . 
 opd surveillance should be established to understand the changing pattern of minor ailments which might have a huge impact on health of the public . 