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Health facility determinants and trends of ICD-10 outpatient psychiatric consultations across Sofala, Mozambique: time-series analyses from 2012 to 2014.

Wagenaar BH, Cumbe V, Raunig-Berhó M, Rao D, Napúa M, Hughes JP, Sherr K - BMC Psychiatry (2015)

Bottom Line: Generalized estimating equations were used to model facility determinants of ICD-10 diagnoses.Epilepsy has increased significantly in absolute and proportional terms.Women are more likely to present for neurotic/stress-related conditions (12.8 % of consults for women, 5.7 % for men, p < 0.001), while men are more likely to present for substance use (1.9 % for women, 6.4 % for men, p < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, University of Washington School of Public Health, 1959 NE Pacific Street, Seattle, WA, 98195, USA. wagenaarb@gmail.com.

ABSTRACT

Background: Few peer-reviewed publications have taken a longitudinal or systems approach to mental healthcare (MH) utilization in low- and middle-income countries. We analyzed: (1) outpatient ICD-10 diagnoses over time and by gender; and (2) health facility determinants of MH service utilization.

Methods: We reviewed a census of 15,856 outpatient psychiatric consultations conducted at Ministry clinics in Sofala province, Mozambique from January 2012-June 2014. Generalized estimating equations were used to model facility determinants of ICD-10 diagnoses.

Results: Across the period, 48.9 % of consults were for epilepsy, 22.4 % for schizophrenia/delusional disorders, and 8.8 % for neurotic/stress-related disorders. The proportion of schizophrenia/delusional disorders has decreased over time (32 % in 2012; 13 % in 2014, p = 0.003), in favor of greater diversity of diagnoses. Epilepsy has increased significantly in absolute and proportional terms. Women are more likely to present for neurotic/stress-related conditions (12.8 % of consults for women, 5.7 % for men, p < 0.001), while men are more likely to present for substance use (1.9 % for women, 6.4 % for men, p < 0.001). Clinics with more psychiatric technicians have a 2.1-fold (CI: 1.2, 3.6) increased rate of schizophrenia/delusional disorder diagnoses. Rural clinics saw a higher proportion of epilepsy cases and a lower proportion of organic, substance use, schizophrenia, and mood disorder cases.

Discussion and conclusions: Outpatient MH service provision is increasing in Mozambique, although currently focuses on epilepsy and schizophrenia/delusional disorders. Mid-level psychiatric providers appear to be associated with a higher proportion of schizophrenia/delusional disorder diagnoses. Due to diagnostic or utilization differences, rural clinics may be missing important cases of organic, substance use, schizophrenia, and mood disorders. Models and decision-support tools for mental healthcare integration with primary care practice are needed in Mozambique to allow further scale-up of mental health services.

No MeSH data available.


Related in: MedlinePlus

Map of health facilities providing outpatient mental healthcare services in Sofala Province, Mozambique, as of 2014
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Fig1: Map of health facilities providing outpatient mental healthcare services in Sofala Province, Mozambique, as of 2014

Mentions: Currently, Sofala province has at least one facility providing outpatient mental healthcare in 12 of 13 districts. With the exception of Beira City which houses 7 clinics, each district houses one facility with trained mental health professionals conducting routine outpatient consultations (thus, 18 total clinics providing services across the province; see Fig. 1 for a map of mental health facilities). Outside of Beira City, all facilities providing mental healthcare are located at the largest district-level facility (generally a district or rural hospital). Two separate clinics report from the Beira Central Hospital: the general psychiatric service and the child psychiatric service. In the province as a whole, as of the end of 2014, there were 14 psychiatric technicians, 2 adult psychiatrists, 1 child psychiatrist, and 11 clinical psychologists. Mental health diagnoses across all of Mozambique are made using the ICD-10 disease classification system [19].Fig. 1


Health facility determinants and trends of ICD-10 outpatient psychiatric consultations across Sofala, Mozambique: time-series analyses from 2012 to 2014.

Wagenaar BH, Cumbe V, Raunig-Berhó M, Rao D, Napúa M, Hughes JP, Sherr K - BMC Psychiatry (2015)

Map of health facilities providing outpatient mental healthcare services in Sofala Province, Mozambique, as of 2014
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4581480&req=5

Fig1: Map of health facilities providing outpatient mental healthcare services in Sofala Province, Mozambique, as of 2014
Mentions: Currently, Sofala province has at least one facility providing outpatient mental healthcare in 12 of 13 districts. With the exception of Beira City which houses 7 clinics, each district houses one facility with trained mental health professionals conducting routine outpatient consultations (thus, 18 total clinics providing services across the province; see Fig. 1 for a map of mental health facilities). Outside of Beira City, all facilities providing mental healthcare are located at the largest district-level facility (generally a district or rural hospital). Two separate clinics report from the Beira Central Hospital: the general psychiatric service and the child psychiatric service. In the province as a whole, as of the end of 2014, there were 14 psychiatric technicians, 2 adult psychiatrists, 1 child psychiatrist, and 11 clinical psychologists. Mental health diagnoses across all of Mozambique are made using the ICD-10 disease classification system [19].Fig. 1

Bottom Line: Generalized estimating equations were used to model facility determinants of ICD-10 diagnoses.Epilepsy has increased significantly in absolute and proportional terms.Women are more likely to present for neurotic/stress-related conditions (12.8 % of consults for women, 5.7 % for men, p < 0.001), while men are more likely to present for substance use (1.9 % for women, 6.4 % for men, p < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, University of Washington School of Public Health, 1959 NE Pacific Street, Seattle, WA, 98195, USA. wagenaarb@gmail.com.

ABSTRACT

Background: Few peer-reviewed publications have taken a longitudinal or systems approach to mental healthcare (MH) utilization in low- and middle-income countries. We analyzed: (1) outpatient ICD-10 diagnoses over time and by gender; and (2) health facility determinants of MH service utilization.

Methods: We reviewed a census of 15,856 outpatient psychiatric consultations conducted at Ministry clinics in Sofala province, Mozambique from January 2012-June 2014. Generalized estimating equations were used to model facility determinants of ICD-10 diagnoses.

Results: Across the period, 48.9 % of consults were for epilepsy, 22.4 % for schizophrenia/delusional disorders, and 8.8 % for neurotic/stress-related disorders. The proportion of schizophrenia/delusional disorders has decreased over time (32 % in 2012; 13 % in 2014, p = 0.003), in favor of greater diversity of diagnoses. Epilepsy has increased significantly in absolute and proportional terms. Women are more likely to present for neurotic/stress-related conditions (12.8 % of consults for women, 5.7 % for men, p < 0.001), while men are more likely to present for substance use (1.9 % for women, 6.4 % for men, p < 0.001). Clinics with more psychiatric technicians have a 2.1-fold (CI: 1.2, 3.6) increased rate of schizophrenia/delusional disorder diagnoses. Rural clinics saw a higher proportion of epilepsy cases and a lower proportion of organic, substance use, schizophrenia, and mood disorder cases.

Discussion and conclusions: Outpatient MH service provision is increasing in Mozambique, although currently focuses on epilepsy and schizophrenia/delusional disorders. Mid-level psychiatric providers appear to be associated with a higher proportion of schizophrenia/delusional disorder diagnoses. Due to diagnostic or utilization differences, rural clinics may be missing important cases of organic, substance use, schizophrenia, and mood disorders. Models and decision-support tools for mental healthcare integration with primary care practice are needed in Mozambique to allow further scale-up of mental health services.

No MeSH data available.


Related in: MedlinePlus