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].

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BackgroundData on the use of seclusion for psychiatric inpatients in sub-Saharan Africa are extremely limited. Though seclusion is sometimes necessary for patients that pose a threat to themselves or others, adverse physical and psychological sequelae from the experience are increasingly being recognized, leading to efforts to reduce its use. The purpose of this study was to calculate the frequency of seclusion in patients hospitalized in an inpatient psychiatric unit in Lilongwe, Malawi, and to identify factors associated with its use.MethodsRecords of 419 psychiatric inpatients hospitalized at Kamuzu Central Hospital's Bwaila Psychiatric Unit in Lilongwe, Malawi, from January 1, 2011 to December 31, 2011, were reviewed. Multivariate logistic regression analysis was employed to identify factors associated with the use of seclusion.ResultsSeclusion was used for 30.3% (127/419) of patients during the study period. Male patients had increased odds of being secluded (aOR: 2.22, p=0.02). Assaulting other patients on the unit (aOR 7.92, p<0.01) and presenting to the unit in mechanical restraints (aOR 2.33, p<0.01) were also associated with seclusion. There was no association between seclusion and age; diagnosis of alcohol use disorder, marijuana use disorder, or schizophrenia; involuntary admission; presence of extra pyramidal side effects; presence of hallucinations; suicidality; or commission of violent acts prior to admission.ConclusionsDocumentation about the rationale for the use of seclusion on the unit was minimal. Improved record keeping requirements will be essential to future efforts to study seclusion and reduce its use. Development of strategies to address patient violence on the unit could decrease the use of seclusion for aggressive patients. Patients arriving to the unit in restraints would benefit from increased efforts by staff to apply behavioural interventions or administer medications, in order to deescalate these individuals and limit the use of seclusion in their treatment.

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Introduction:Despite the high burden of mental illness worldwide, psychiatric studies in sub-Saharan Africa are sparse. Few have been conducted in Malawi and little information exists about inpatient psychiatric populations within the country.Objectives:To describe the spectrum of psychiatric diagnoses and treatment courses of patients admitted to Bwaila Hospital (BH), the inpatient psychiatric unit for the central region of the country.Methods:We reviewed medical records of all patients admitted to BH in 2011 and extracted information about demographics, diagnoses, treatments and outcomes.Results:Inpatient care was provided to 457 patients. Patients had a mean age of 30 years and 298 (67%) were male. 258 (56%) had a known psychiatric diagnosis and 222 (49%) had been hospitalized for psychiatric care previously. The most common diagnoses were primary psychotic disorder (360), alcohol dependence (96) and mood disorder (37). The most common precipitating cause for admission was medication non-adherence (132), mostly in patients with psychotic disorders. The average length of presenting symptoms was 7 days, average length of stay was 21 days, and most commonly used treatments were chlorpromazine, diazepam, fluphenazine and carbamazepine. Outcomes included stabilization/release (308), transfer to another facility (75), removal by family against medical advice (40), abscondment (25) and death (7), which was mostly due to alcohol withdrawal.Conclusions:Primary psychotic disorders and alcohol dependence are the most common reasons for inpatient psychiatric hospitalization at BH. Efforts to increase medication adherence in patients and emphasize the risks of alcohol consumption may lead to decreased psychiatric hospitalizations within Malawi.