Abstract
Little is known about the extent of mental, neurological and substance-use (MNS) disorders re-hospitalization in South Africa. We examined the extent of one-year MNS re-hospitalization (MNS-R) in a rural South African primary health care facility (PHCF). We conducted a retrospective analysis of hospital administrative data from 10,525 adults discharged from a rural PHCF in KwaZulu-Natal Province, South Africa. Chi-squared tests were utilized to describe MNS-R within one year of an index hospital admission in individuals with MNS, with a sub-analysis also being conducted to describe schizophrenia re-hospitalization (S-R). The prevalence of MNS and schizophrenia recorded at an index hospitalization was 5% and 1%, respectively. A total of 44/67 (66%) individuals with a diagnosis of MNS at the index hospitalization were classified as having MNS-R during oneyear follow-up period. Half of those diagnosed with schizophrenia at the index hospitalization (6/12 patients) were classified as having S-R during one-year follow-up period. There was a significant association between re-hospitalization outcomes (MNS-R and S-R) and MNS (p<0.01) or schizophrenia diagnosis (p<0.01) at index baseline hospitalization. The extent of MNS-R and S-R remains relatively high in rural South Africa, and needs further health systems strengthening to prevent revolving door occurrences.
Highlights
Despite evidence that mental, neurological and substance-use (MNS) disorders accounts for a substantial proportion of premature mortality and disability globally[1], a deficit of services to treat the condition is a persistent challenge throughout sub-Saharan Africa[2], including South Africa
Our study investigated the extent of MNS re-hospitalization (MNS-R) and schizophrenia re-hospitalization (S-R) among a cohort of rural patients accessing mental health care services at a rural primary healthcare facility
When the dataset was limited to a study cohort who experience re-hospitalization from all causes within a year from index hospitalization, the sample size was 1,112 adults
Summary
Neurological and substance-use (MNS) disorders accounts for a substantial proportion of premature mortality and disability globally[1], a deficit of services to treat the condition is a persistent challenge throughout sub-Saharan Africa[2], including South Africa. In South Africa, post-apartheid urban-rural inequality in health services remains an ongoing challenge[4], and nowhere is this more evident and challenging than for mental health services in KwaZulu-Natal (KZN) Province[5]. Two thirds of people diagnosed with schizophrenia relapse[10], with unmet needs for mental health treatment in rural areas being well documented in a large U.S.-based National Comorbidity Survey Replication study[11]. Cohort studies of non-tertiary rural patients with MNS, including schizophrenia, remains limited. Our study investigated the extent of MNS re-hospitalization (MNS-R) and schizophrenia re-hospitalization (S-R) among a cohort of rural patients accessing mental health care services at a rural primary healthcare facility
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