Determinants of length of hospitalization in a federal psychiatric hospital in Nigeria

Objective: The present study aims to determine the association between clinical-demographic variables and length of stay of patients admitted into Federal Psychiatric Hospital, Calabar.Design: Retrospective review of case records.Methods: 280 case records of patients (discharged from September 1st, 2015 to August 31st, 2016) were assembled for review, out of which twelve cases were excluded for various reasons. Clinical and demographic data collected from the remaining 268 case records were subjected to univariate and multivariate analyses to determine variables associated with prolonged length of stay.Results: Mean length of stay was 56.2 ± 40.9 and the commonest clinical diagnosis was schizophrenia (45.9%). Although gender, age, marital status and clinical diagnoses tended to influence length of stay, gender (p =0.007) and clinical diagnosis of schizophrenia (p =0.044) were the only variables that significantly predicted prolonged length of stay.Conclusion: We found that gender and clinical diagnoses were important determinants of length of stay. If validated in future studies, these factors may help in accurate identification of cases at risk of prolonged hospitalization and act as guide to clinicians who may need to optimize intervention strategies early enough in managing such cases.Keywords: Psychiatric hospitalization, Length of stay, Prolonged hospitalization, Psychiatric patients, Calaba

Protocol for process evaluation of integration of mental health into primary healthcare in two states in Nigeria: the mhSUN programme.

BACKGROUND: Current international recommendations to address the large treatment gap for mental healthcare in low- and middle-income countries are to scale up integration of mental health into primary care. There are good outcome studies to support this, but less robust evidence for effectively carrying out integration and scale-up of such services, or for understanding how to address contextual issues that routinely arise. AIMS: This protocol is for a process evaluation of a programme called Mental Health Scale Up Nigeria. The study aims are to determine the extent to which the intervention was carried out according to the plans developed (fidelity), to examine the effect of postulated moderating factors and local context, and the perception of the programme by primary care staff and implementers. METHOD: We use a theoretical framework for process evaluation based on the Medical Research Council's Guidelines on Process Evaluation. A Theory of Change workshop was carried out in programme development, to highlight relevant factors influencing the process, ensure good adaptation of global normative guidelines and gain buy-in from local stakeholders. We will use mixed methods to examine programme implementation and outcomes, and influence of moderating factors. RESULTS: Data sources will include the routine health information system, facility records (for staff, medication and infrastructure), log books of intervention activities, supervision records, patient questionnaires and qualitative interviews. CONCLUSIONS: Evidence from this process evaluation will help guide implementers aiming to scale up mental health services in primary care in low- and middle-income countries

Psychological Distress in Women with Chronic Bronchitis in a Fishing Community in the Niger Delta Region of Nigeria

Background. Biomass smoke exposure is a known risk factor for chronic bronchitis. Psychiatric comorbidities may have significant impact on the quality of life of patients with chronic bronchitis. Methods. Women who engage in fish preservation by drying over burning firewood in a fishing community were recruited for this survey. The British medical research questionnaire was used to determine chronic bronchitis, and psychological distress was determined using the hospital anxiety and depression scale. Results. A total of 342 women were recruited for this study and 63 of them had chronic bronchitis. 96 women had features suggestive of psychological distress: 57 (16.6%) women with anxiety, 51 (14.9%) women with depression and 12 women (3.5%) had combined features. Psychological distress was more common among women with chronic bronchitis. Anxiety was significantly associated with chronic bronchitis and the level of biomass exposure while depression was significantly associated with chronic bronchitis, level of exposure, and a history of sleeping in the fish smoking room. Conclusion. Anxiety and depression show significant association with chronic bronchitis among women with biomass smoke exposure with the level of exposure having an aggravating effect on the relationship