Abstract
BackgroundIn sub-Saharan Africa, the number of psychiatric beds per population is disproportionately low. Moreover, there is a lack of data regarding the patterns of psychiatric admissions and the factors leading to long psychiatric hospitalization in this region. This study aimed to investigate the average length of stay (LOS) and the factors associated with prolonged hospitalizations.MethodsA ten-year retrospective chart review of patients admitted to the psychiatric facility of Jimma University Specialized Hospital in southwest Ethiopia was conducted. The medical charts of 846 admissions spanning the period from January 2001 to December 2010 were reviewed. LOS greater than 21 days was considered as a cut-off point for lengthier stay. Bivariate and multivariable logistic regression analyses were conducted to identify factors independently associated with LOS.ResultsThe most common discharge diagnoses were schizophrenia and other psychotic disorders (27.6%), and bipolar disorder (23.4%). A global clinical rating taken on discharge showed 90.3% improved outcome. The median (25th, 75th percentiles) LOS was 22 (15, 36) days. Patients with major depressive disorder [aOR = 0.51 (0.32 – 0.81)] and brief psychotic disorder [aOR = 0.52 (0.33 – 0.84)] were less likely than patients with schizophrenia and other psychotic disorders to have long hospital stays. Presence of extrapyramidal side-effects and out of pocket expenditures predicted LOS.ConclusionsPatients with psychoses and bipolar disorder have lengthier hospital stays burdening the cost of care of psychiatric treatment in a general hospital setting. Our findings call for identifying those cases quickly, attending to their needs with evidence-based efficient treatment and for improving and developing an aftercare system such that the utilization of acute inpatient beds, already a scarce resource, could achieve higher efficiency.
Highlights
In sub-Saharan Africa, the number of psychiatric beds per population is disproportionately low
Last but not least, subsidized psychiatric care, socio-economic status of patients and their families could negatively impact length of stay (LOS). In this context and searching for studies tackling the issue of LOS in Ethiopia, we found only one study describing the pattern of psychiatric admissions to the State mental hospital [9]
Despite the study limitations enumerated above, this study is first of its kind to explore the topic of LOS in a general hospital setting in Ethiopia such as Jimma University Specialized Hospital (JUSH)
Summary
In sub-Saharan Africa, the number of psychiatric beds per population is disproportionately low. The lack of infrastructure in sub-Saharan Africa remains to be a significant barrier to improving mental health services in the region [2]. According to the World Health Organization (WHO), sub-Saharan Africa and Southeast Asia have the lowest number of psychiatric beds per population [3,4]. Current mental health service models for low-income countries recommend establishment of psychiatric service within primary care and psychiatric inpatient units within general hospitals [5,6,7]. For many years in Ethiopia, mental health services were limited to one hospital situated in the capital, Addis Ababa [8,9]. A small number of psychiatric inpatient facilities were established in different Ethiopian cities [10]
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