Medical records and participant characteristics
A total of 6093 records 2027 (33.3%) from HC III level, and 4066 (66.7%) from HC IV were entered in the Microsoft Access data entry form. Of these 5948 (97.6%) did not have any mental health related entry. The records entered were nearly equal in number – 2977 (48.9%) during the intervention period (November to December 2018), and 3116 (51.1%) during the post-intervention period (March and April 2019).
Majority, 4259 (69.9%) of the entries were of female patients. The mean age of the patients was 30.3 ± 21. Over half, 3517 (57.7%) of the patients were aged 19–60 years.
Table 1
Participant characteristics
Characteristics
|
Description
|
Frequency n (%)
|
Health Facility
|
HC III level
|
4066 (66.7)
|
HC IV level
|
2027 (33.3)
|
Intervention period
|
During
|
2977 (48.9)
|
Post
|
3116 (51.1)
|
Age category (years)
|
1–18
|
1956 (32.1)
|
19–60
|
3517 (57.7)
|
61+
|
620 (10.2)
|
Sex
|
Female
|
4259 (69.9)
|
Male
|
1834 (30.1)
|
Mental illness
|
Yes
|
145 (2.4)
|
No
|
5948 (97.6)
|
Mental diagnosis
|
Depression
|
16 (0.3)
|
Epilepsy
|
91 (1.5)
|
Bipolar
|
25 (0.4)
|
Alcohol use
|
14 (0.2)
|
Prevalence of mental disorder diagnoses in the health facilities
Of the 6093 records reviewed at the study health facilities during the study period, 146 (2.4%) had a mental diagnosis. Out of the 146 records, 76 were recorded during the intervention when the psychiatrists were offering training and support supervision, and 70 recorded after the intervention (in the fifth and sixth month of the study period).
Of those whose mental disorders were identified, 66/1834 (3.4%) were males compared to females 80/4259 (1.9%), 87 (2.1%) were from HC IV level, and 91 (2.6%) were 19–60 years (Table 2). Of the 146 records, 91 (62.3%) were epilepsy, 25 (17.1%) bipolar, 16 (11%) depression, and 14 (10.6%) alcohol dependence.
Table 2
Participant characteristics and Mental disorder diagnoses
|
Mental disorder diagnosis (n = 146)
|
|
Characteristics
|
Description
|
Epilepsy
|
Bipolar
|
Depression
|
Alcohol
|
Total
|
Intervention period
|
During
|
48 (32.9%)
|
9 (6.1%)
|
8 (5.5%)
|
11 (7.5%)
|
76 (52.1%)
|
Post
|
43 (29.4%)
|
16 (10.9%)
|
8 (5.5%)
|
3 (2.1%)
|
70 (47.9%)
|
Health facility level
|
HC III
|
30 (20.5%)
|
9 (6.1%)
|
13 (9%)
|
7 (4.8%)
|
59 (40.4%)
|
HC IV
|
61 (41.8%)
|
16 (10.9%)
|
3 (2.1%)
|
7 (4.8%)
|
87 (59.6%)
|
Sex
|
Female
|
50 (34.2%)
|
14 (9.6%)
|
12 (8.2%)
|
4 (2.7%)
|
80 (54.8%)
|
Male
|
41 (28.1%)
|
11 (7.5%)
|
4 (2.7%)
|
10 (6.9%)
|
66 (45.2%)
|
Age category
|
1–18
|
35 (24%)
|
4 (2.7%)
|
4 (2.7%)
|
3 (2.1%)
|
46 (31.5%)
|
19–60
|
51 (34.9%)
|
21 (14.4%)
|
11 (7.5%)
|
9 (6.1%)
|
92 (63%)
|
61+
|
5 (3.4%)
|
-
|
1 (0.7%)
|
2 (1.4%)
|
8 (5.5%)
|
Medication appropriateness for mental disorder diagnosis and facility level
The most prescribed medications were carbamazepine 65 (44.5%), and phenobarbital 26 (17.8%). The medicines which were prescribed but not aligned with the UCG were chlorpromazine for epilepsy 3 (2.1%) and haloperidol for epilepsy 1 (0.7%) at HCIII. One of the patients newly diagnosed with depression at HCIII was prescribed only folic acid (Table 3).
Table 3
Medications prescribed for mental disorder diagnosis
|
Epilepsy
|
Bipolar
|
Depression
|
Alcohol
|
Total
|
Amitriptyline
|
-
|
2
|
13
|
-
|
15
|
Chlorpromazine
|
3
|
8
|
1
|
-
|
12
|
Carbamazepine
|
53
|
12
|
-
|
-
|
65
|
Haloperidol
|
1
|
3
|
-
|
-
|
4
|
Phenobarbital
|
26
|
-
|
-
|
-
|
26
|
Phenytoin
|
8
|
-
|
-
|
-
|
8
|
Counselling
|
-
|
-
|
1
|
14
|
15
|
Non psychiatric medicine*
|
-
|
-
|
1
|
-
|
1
|
*The patient was given only folic acid |
Of the 15 amitriptyline prescriptions, 12 were given at HC III facility for patients newly diagnosed with depression.
Factors associated with mental disorder diagnosis in health centers III and IV
In our study, sex was significantly associated with being diagnosed with a mental illness (p < 0.000). The other factors assessed including health facility type, data collection period, and age category were not associated with being diagnosed with mental illness (p > 0.05).
In the bivariable logistical regression analysis, the factors that were significantly associated with mental illness diagnosis in the health facilities in southwestern Uganda included: Female (p < 0.000, 95% CI: 0.42–0.72); Age category 1-18year (p = 0.02, 95% CI: 1.16–4.15); and age category 61+ (p = 0.006, 95% CI: 1.28–4.38). Those that were not significant included: Health facility (p = 0.057, 95% CI: 0.99–1.70); and Follow-up period (p = 0.19, 95% CI: 0.63–1.09).
In the multivariable logistic regression analysis, the predictors of a healthcare worker diagnosing a mental illness included, being female (aOR:0.52, 95% CI: 0.39–0.69) and being of age 61 + years (aOR:3.02, 95% CI: 1.40–6.49) (Table 4).
Table 4
Predictors of mental disorders diagnosis
Characteristics
|
Description
|
cOR (95% CI)
|
aOR (95% CI)
|
p-value
|
Health Facility
|
HC IV
|
1.0
|
1.0
|
|
|
HC III
|
1.29 (0.99- 1.70)
|
1.25 (0.95 - 1.65)
|
0.107
|
Intervention period
|
During
|
1.0
|
1.0
|
|
|
Post
|
0.83 (0.63 – 1.09)
|
0.85 (0.64 – 1.12)
|
0.248
|
Age category (years)
|
19-60
|
1.0
|
1.0
|
|
|
1-18
|
2.19 (1.16 - 4.15)
|
2.63 (0.96 – 7.24)
|
0.060
|
|
61+
|
2.36 (1.28 – 4.38)
|
3.02 (1.40 – 6.49)
|
0.005
|
Sex
|
Male
|
1.0
|
1.0
|
|
|
Female
|
0.55 (0.42 – 0.78)
|
0.52 (0.39 -0.69)
|
<0.000
|