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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

Proportion of outpatient mental health consultations by ICD-10 diagnosis code in Sofala Province, Mozambique from January 2012 to June 2014
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Fig2: Proportion of outpatient mental health consultations by ICD-10 diagnosis code in Sofala Province, Mozambique from January 2012 to June 2014

Mentions: Across Sofala Province, mental health services conducted 6,629 outpatient consultations in 2012, 8,522 in 2013, and 5,858 through June of 2014, representing a significant increase in total consultations (from 552 per month in 2012 to 976 in 2014, p < 0.001); (Table 2). Absolute utilization numbers increased significantly for most ICD-10 sub-groups, except no significant change in utilization for mental and behavioral disorders due to substance use and a significant decrease for schizophrenia, schizotypal, and delusional disorders (177.4 consults per month in 2012 to 125.8 in 2014, p = 0.045). The proportion of consults increased significantly for many ICD-10 categories, save a proportional decrease for mental and behavioral disorders due to substance use, a large proportional decrease in schizophrenia, schizotypal, and delusional disorders, and no change for mood disorders, neurotic and stress-related disorders, and mental retardation (See Table 2 and Fig. 2).Table 2


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)

Proportion of outpatient mental health consultations by ICD-10 diagnosis code in Sofala Province, Mozambique from January 2012 to June 2014
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Proportion of outpatient mental health consultations by ICD-10 diagnosis code in Sofala Province, Mozambique from January 2012 to June 2014
Mentions: Across Sofala Province, mental health services conducted 6,629 outpatient consultations in 2012, 8,522 in 2013, and 5,858 through June of 2014, representing a significant increase in total consultations (from 552 per month in 2012 to 976 in 2014, p < 0.001); (Table 2). Absolute utilization numbers increased significantly for most ICD-10 sub-groups, except no significant change in utilization for mental and behavioral disorders due to substance use and a significant decrease for schizophrenia, schizotypal, and delusional disorders (177.4 consults per month in 2012 to 125.8 in 2014, p = 0.045). The proportion of consults increased significantly for many ICD-10 categories, save a proportional decrease for mental and behavioral disorders due to substance use, a large proportional decrease in schizophrenia, schizotypal, and delusional disorders, and no change for mood disorders, neurotic and stress-related disorders, and mental retardation (See Table 2 and Fig. 2).Table 2

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