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

• Published in: Social Psychiatry and Psychiatric Epidemiology Vol. 54; no. 2; pp. 235 - 242
• Main Authors: Barnett, Brian S., Kusunzi, Veronica, Magola, Lucy, Borba, Christina P. C., Udedi, Michael, Kulisewa, Kazione, Hosseinipour, Mina C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2019; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Analysis; Antipsychotic Agents - therapeutic use; Epidemiology; Expenditures; Female; Health Services Accessibility; Hospitals, Psychiatric - statistics & numerical data; Humans; Inpatients - psychology; Length of Stay - statistics & numerical data; Logistic Models; Malawi; Male; Medical care, Cost of; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Original Paper; Patients; Psychiatry; Regression analysis; Side effects; Time Factors; Malawi; Mental disorders; Malawi; Psychiatry; Sub-Saharan Africa; Mental health
• ISSN: 0933-7954; 1433-9285
• DOI: 10.1007/s00127-018-1611-1

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.