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

BMC Psychiatry

Kenneth Sherr⁴  James P. Hughes²  Manuel Napúa³  Deepa Rao⁵  Manuela Raunig-Berhó⁴  Vasco Cumbe¹  Bradley H. Wagenaar⁶ 

[1] Department of Psychiatry, Beira Central Hospital, Beira, Mozambique;Department of Biostatistics, University of Washington, Seattle, WA, USA;Beira Operations Research Center, Ministry of Health, Beira, Mozambique;Department of Global Health, University of Washington, Seattle, WA, USA;Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA;Health Alliance International, Seattle, Washington, USA

关键词: Mozambique;    Gender differences;    Time-trends;    Health facility determinants;    Outpatient psychiatry;    Mental health services;   

Others  :  1229567
DOI  :  10.1186/s12888-015-0609-4

 received in 2015-04-07, accepted in 2015-09-16,  发布年份 2015

【 摘 要 】

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.

【 授权许可】

   
2015 Wagenaar et al.

【 图 表 】

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