Prevalence of probable mental, neurological and substance use conditions and case detection at primary healthcare facilities across three districts in Ghana: findings from a cross-sectional health facility survey

Abstract

Background Few studies have examined the prevalence of mental, neurological and substance use (MNS) conditions, case detection and treatment in primary healthcare in rural settings in Africa. We assessed prevalence and case detection at primary healthcare facilities in low-resource rural settings in Ghana. Methods A cross-sectional survey was conducted at the health facility level in three demonstration districts situated in Bongo (Upper East Region), Asunafo North (Ahafo Region) and Anloga (Volta Region) in Ghana. The study participants were resident adult (> 17 years) out-patients seeking healthcare at primary care facilities in each of the three demonstration districts. Data were collected on five priority MNS conditions: depression, psychosis, suicidal behaviour, epilepsy and alcohol use disorders. Results Nine hundred and nine (909) people participated in the survey. The prevalence of probable depression was 15.6% (142/909), probable psychotic symptoms was 12% (109/909), probable suicidal behaviour was 11.8% (107/909), probable epilepsy was 13.1% (119/909) and probable alcohol use disorders was 7.8% (71/909). The proportion of missed detection for cases of depression, self-reported psychotic symptoms, epilepsy and alcohol use disorders (AUD) ranged from 94.4 to 99.2%, and was similar across study districts. Depression was associated with self-reported psychotic symptoms (RR: 1.68; 95% CI: 1.12–1.54). For self-reported psychotic symptoms, a reduced risk was noted for being married (RR: 0.62; 95% CI: 0.39–0.98) and having a tertiary level education (RR: 0.12; 95% CI: 0.02–0.84). Increased risk of suicidal behaviour was observed for those attending a health facility in Asunafo (RR: 2.31; 95% CI: 1.27–4.19) and Anloga districts (RR: 3.32; 95% CI: 1.93–5.71). Age group of 35 to 44 years (RR: 0.43; 95% CI: 0.20–0.90) was associated with reduced risk of epilepsy. Being female (RR: 0.19; 95% CI: 0.12–0.31) and having a tertiary education (RR: 0.27; 95% CI: 0.08–0.92) were associated with reduced risk of AUD. Conclusions Our study found a relatively high prevalence of probable MNS conditions, and very low detection and treatment rates in rural primary care settings in Ghana. There is a need to improve the capacity of primary care health workers to detect and manage MNS conditions.

Diagnostic pattern of mental, neurological and substance use disorders at primary health care facilities in Uganda

“…This is consistent with findings from a study by Ae-Ngibise and others, 2023 who found a low detection rate of people with MNS conditions in routine primary healthcare facilities. Up to 98% of MNS conditions were not detected [ 12 ].…”

“…Those who would have benefited from the services at the lower public health facilities may also have poor health seeking behaviour. As hypothesized above for mental disorders, a lack of knowledge and skills in the management of substance use disorders among primary health care workers could also be a factor in under/misdiagnosis of these health conditions [ 12 , 18 ].…”

“…Evidence from elsewhere has shown that stigma by health workers is a major factor in access to services for MNS disorders [ 19 – 21 ]. This has been complicated by a lack of diagnostic skills among general health workers to manage mental health disorders at primary health centres [ 12 , 19 ].Stigma and lack of awareness in local communities has been cited as one of the barriers to access and utilization of mental health services at the lower level public health facilities [ 10 , 20 , 21 ].…”