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Soc Psychiatry Psychiatr Epidemiol. 2019 Feb;54(2):235-242. doi: 10.1007/s00127-018-1611-1. Epub 2018 Oct 22.

Factors associated with long length of stay in an inpatient psychiatric unit in Lilongwe, Malawi.

Author information

1
Department of Psychiatry, McLean Hospital Outpatient Clinic, 115 Mill Street, Belmont, MA, 02478, USA. brianbarnett85@gmail.com.
2
Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA. brianbarnett85@gmail.com.
3
Vanderbilt University School of Medicine, Nashville, TN, 37232-0740, USA. brianbarnett85@gmail.com.
4
University of North Carolina Project, Lilongwe, Malawi. brianbarnett85@gmail.com.
5
Department of Mental Health, Bwaila Hospital Psychiatric Unit, Kamuzu Central Hospital, PO Box 149, Lilongwe, Malawi.
6
Department of Psychiatry, Boston Medical Center, 720 Harrison Ave, Boston, MA, 02118, USA.
7
Department of Psychiatry, Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA.
8
Non Communicable Diseases and Mental Health Unit, Clinical Services Department, Ministry of Health, PO Box 30377, Lilongwe, Malawi.
9
Department of Mental Health, College of Medicine, University of Malawi, Blantyre, Malawi.
10
Department of Psychiatry, Kamuzu Central Hospital, PO Box 149, Lilongwe, Malawi.
11
University of North Carolina Project, Lilongwe, Malawi.
12
UNC Project Private Bag A104, Kamuzu Central Hospital, Tidziwe Clinic, Lilongwe, Malawi.

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.

KEYWORDS:

Malawi; Mental disorders; Mental health; Psychiatry; Sub-Saharan Africa

PMID:
30349960
PMCID:
PMC6586467
[Available on 2020-02-01]
DOI:
10.1007/s00127-018-1611-1
[Indexed for MEDLINE]

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