Abstract
Purpose
Studies of factors affecting length of stay during psychiatric hospitalization in sub-Saharan Africa are sparse. A better understanding of such factors may lead to interventions resulting in quicker patient stabilization and discharge, freeing up needed psychiatric beds and reducing health care system expenditures. Therefore, we sought to identify factors associated with long length of stay in Malawi.
Methods
We reviewed the charts of 417 patients hospitalized at Kamuzu Central Hospital’s Bwaila Psychiatric Unit in Lilongwe, Malawi from January 1 to December 31, 2011. Multivariate logistic regression analysis was employed to test for associations between patient factors and long length of stay (defined as more than 28 days).
Results
Mean length of stay was 22.08 ± 27.70 days (range 0–243). 21.82% (91/417) of patients stayed longer than 28 days. Long length of stay was associated with living outside of Lilongwe district [aOR: 3.65 (1.66–8.01), p = 0.001] and treatment for antipsychotic extrapyramidal side effects (EPS) during hospitalization [aOR: 3.45 (1.32–9.03), p = 0.012]. Patients who had more interactions with medical providers for this episode of illness prior to presentation at the unit were less likely to have a long length of stay [aOR: 0.35 (0.16–0.76), p = 0.008].
Conclusions
Our findings demonstrate areas of possible intervention to reduce length of stay, including securing means for patient transport home, rapid identification and treatment of EPS, and reducing the risk of EPS by decreased use of high potency first-generation antipsychotics.
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References
World Health Organization (2011) Mental Health Atlas—2011 country profiles: Malawi. http://www.who.int/mental_health/evidence/atlas/profiles/mwi_mh_profile.pdf?ua=1. Accessed 20 Oct 2018
World Health Organization (2015) Mental health atlas. Bull World Health Organ 93:516. https://doi.org/10.1037/e360882004-001
Udedi M (2016) Improving access to mental health services in Malawi. Poster presentation at African Institute for Development Policy Conference. https://www.researchgate.net/publication/315379430_Improving_access_to_mental_health_services_in_Malawi. Accessed 20 Oct 2018
Adegunloye OA, Yussuf AD, Ajiboye PO et al (2009) Correlates of length of stay among psychiatric in-patients in a tertiary health institution in Nigeria. Res J Med Sci 3:56–61
Moosa MYH, Jeenah FY, Raghubir L et al (2004) Duration of hospitalization in an acute psychiatric unit: letter to the editor. S Afr Psychiatry Rev 7:36–38
Van der Merwe PL, Allan A, Allan MM (1999) Inappropriate involuntary admissions to psychiatric hospitals. S Afr Med J 89:1303–1307
Moosa MMYH, Jeenah FYF (2002) An analysis of acute admissions to a general hospital psychiatric unit: Commentary. S Afr Psychiatry Rev 5:16–18
Oladeji BD, Ogundele AT, Dairo M (2012) Determinants of length of stay in the psychiatric wards of the University College Hospital, Ibadan, Nigeria. Afr J Med Med Sci 41:147–152
Taiwo H, Ladapo O, Aina OF et al (2008) Long stay patients in a psychiatric hospital in Lagos, Nigeria. Afr J Psychiatry 11:128–132
Addisu F, Wondafrash M, Chemali Z et al (2015) Length of stay of psychiatric admissions in a general hospital in Ethiopia: a retrospective study. Int J Ment Health Syst 9:1–9. https://doi.org/10.1186/s13033-015-0006-x
Ukpong D, Mosaku S (2009) Demographic and clinical correlates of length of stay in a Nigerian university hospital psychiatric unit. Turk Psikiyatri Derg 20:49–55
Malawi Ministry of Health (1948) Mental Health Treatment Act (Cap. 34:02). https://www.mindbank.info/item/931. Accessed 20 Oct 2018
World Health Organization (1993) The ICD-10 classification of mental and behavioural disorders. https://www.who.int/classifications/icd/en/bluebook.pdf. Accessed 20 Oct 2018
Harris PA, Taylor R, Thielke R et al (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381. https://doi.org/10.1016/j.jbi.2008.08.010
Barnett BS, Kusunzi V, Magola L et al (2018) Description of the inpatient population and care received at a psychiatric unit in Lilongwe, Malawi. Int J Cult Ment Health. https://doi.org/10.1080/17542863.2018.1448424
Barros REM, Marques JM, de A, Carlotti IP, et al (2010) Short admission in an emergency psychiatry unit can prevent prolonged lengths of stay in a psychiatric institution. Rev Bras Psiquiatr 32:145–151
Zhang J, Harvey C, Andrew C (2011) Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: a retrospective study. Aust N Z J Psychiatry 45:578–585. https://doi.org/10.3109/00048674.2011.585452
Smith HM (2005) Factors leading to frequent readmission to Valkenberg hospital for patients suffering from severe mental illnesses. Dissertation, University of the Western Cape
Hriso E, Kuhn T, Masdeu JC, Grundman M (1991) Extrapyramidal symptoms due to dopamine-blocking agents in patients with AIDS encephalopathy. Am J Psychiatry 148:1558–1561. https://doi.org/10.1176/ajp.148.11.1558
Mathews M, Gratz S, Adetunji B et al (2005) Antipsychotic-induced movement disorders: evaluation and treatment. Psychiatry (Edgmont) 2:36–41
Malawi Ministry of Health (2009) Malawi Standard Treatment Guidelines (MSTG) 4th edition. http://apps.who.int/medicinedocs/en/d/Js18801en/. Accessed 20 Oct 2018
Malawi Ministry of Health (2015) Malawi standard treatment guidelines (MSTG) 5th edition. http://apps.who.int/medicinedocs/documents/s23103en/s23103en.pdf. Accessed 20 Oct 2018
Lee S, Rothbard AB, Noll EL (2012) Length of inpatient stay of persons with serious mental illness: effects of hospital and regional characteristics. Psychiatr Serv 63:889–895. https://doi.org/10.1176/appi.ps.201100412
Tulloch AD, Fearon P, David AS (2011) Length of stay of general psychiatric inpatients in the United States: systematic review. Adm Policy Ment Health 38:155–168. https://doi.org/10.1007/s10488-010-0310-3
Kalseth J, Lassemo E, Wahlbeck K et al (2016) Psychiatric readmissions and their association with environmental and health system characteristics: a systematic review of the literature. BMC Psychiatry 16:376. https://doi.org/10.1186/s12888-016-1099-8
Gopalakrishna G, Ithman M, Malwitz K (2015) Predictors of length of stay in a psychiatric hospital. Int J Psychiatry Clin Pract 19:238–244. https://doi.org/10.3109/13651501.2015.1062522
Acknowledgements
This work was supported by funding from the University of North Carolina Center for AIDS Research, a National Institutes of Health (NIH) funded program (Grant P30 AI50410). CPCB was supported by a National Institute of Mental Health career development Grant (K01MH100428). KK was supported by an NIH international research training Grant (D43 TW010060). BSB was the recipient of a Fulbright-Fogarty Fellowship in Public Health (2011-12), sponsored through a partnership between the United States Fulbright Program and the NIH through the Fogarty International Clinical Research Scholars and Fellows Program at Vanderbilt University (Grant R24 TW007988). MU was supported by funding from the African Mental Health Research Initiative (Grant DEL-15-01). We thank the administration, patients and staff of the Bwaila Psychiatric Unit, for their assistance with this investigation. We would also like to thank Laura Ball and Travis Tressler for their assistance with data entry.
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Barnett, B.S., Kusunzi, V., Magola, L. et al. Factors associated with long length of stay in an inpatient psychiatric unit in Lilongwe, Malawi. Soc Psychiatry Psychiatr Epidemiol 54, 235–242 (2019). https://doi.org/10.1007/s00127-018-1611-1
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DOI: https://doi.org/10.1007/s00127-018-1611-1