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

Barnett, Brian S.; Kusunzi, Veronica; Magola, Lucy; Borba, Christina P.C.; Udedi, Michael; Kulisewa, Kazione; Hosseinipour, Mina C.

doi:10.1007/s00127-018-1611-1

Cited by 10 publications

(15 citation statements)

References 12 publications

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“…Ninety-two publications were from high-income countries (HIC), most from the United Kingdom and the United States. Fourteen studies referred to LMIC including Bhutan (68), Brazil (35,53,104), China (94), Ghana (74,114), Moldova (88), Malawi (76), South Africa (55, 62), Uganda (103) and two publications referred to South America (8,105). In 59 studies, recommendations were based on local or national epidemiological and demographical data.…”

Section: Resultsmentioning

confidence: 99%

“…There is a need to decentralize inpatient services from urban to rural areas, as this uneven distribution of beds has resulted in prolonged lengths of stay in emergency departments, along with a higher risk of transfer outside of patients' community for care leading to significant hardships as they have to travel long distances to access treatment (55,66,73,76).…”

Section: Lack Of Locally Available Bedsmentioning

confidence: 99%

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Expert Arguments for Trends of Psychiatric Bed Numbers: A Systematic Review of Qualitative Data

et al. 2021

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Introduction: Mental health policies have encouraged removals of psychiatric beds in many countries. It is under debate whether to continue those trends. We conducted a systematic review of expert arguments for trends of psychiatric bed numbers.Methods: We searched seven electronic databases and screened 15,479 papers to identify expert opinions, arguments and recommendations for trends of psychiatric bed numbers, published until December 2020. Data were synthesized using thematic analysis and classified into arguments to maintain or increase numbers and to reduce numbers.Results: One hundred six publications from 25 countries were included. The most common themes arguing for reductions of psychiatric bed numbers were inadequate use of inpatient care, better integration of care and better use of community care. Arguments to maintain or increase bed numbers included high demand of psychiatric beds, high occupancy rates, increasing admission rates, criminalization of mentally ill, lack of community care and inadequately short length of stay. Cost effectiveness and quality of care were used as arguments for increase or decrease.Conclusions: The expert arguments presented here may guide and focus future debate on the required psychiatric bed numbers. The recommendations may help policymakers to define targets for psychiatric bed numbers. Arguments need careful local evaluation, especially when supporting opposite directions of trends in different contexts.

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Section: Resultsmentioning

confidence: 99%

Section: Lack Of Locally Available Bedsmentioning

confidence: 99%

Expert Arguments for Trends of Psychiatric Bed Numbers: A Systematic Review of Qualitative Data

et al. 2021

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“…Using average LoS from studies done in some randomly chosen Sub-Sahara African countries; Ethiopia (28.7), Nigeria (22, 25 and 23.9), Malawi (22), and Uganda hospitals i.e. Mulago National referral Hospital (12), Butabika National Referral Hospital (21), Lira Regional Referral hospital (21), MRRH (14), Soroti Regional Referral Hospital ( 14), Mubende Regional Referral Hospital ( 14), Mbale Regional Referral Hospital ( 14), Hoima Regional Referral Hospital ( 14), Gulu Regional Referral Hospital ( 14), Moroto Regional Referral Hospital ( 14), Jinja Regional Referral hospital ( 14), Arua Regional Referral Hospital (21), Masaka Regional Referral Hospital ( 14), Kabale Regional Referral Hospital (14), and Fort Portal Regional Referral Hospital (14) [3,[10][11][12][13]29], a standard deviation (SD) of 4.9 days was obtained.…”

Section: Sample Sizementioning

confidence: 99%

Length of stay of hospitalized patients at tertiary psychiatry facilities in Uganda: the role of caregiver’s presence

et al. 2022

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Background Whether the presence of caregivers during the hospital stay of patients with mental illness affects the length of hospital stay (LoS) remains inconclusive. Aims (1) To determine the average LoS and the associated factors, and (2) to determine the role of caregivers’ presences during inpatient stay on LoS. Methods We conducted a cross-sectional study in two hospitals in Uganda; one with caregivers and the other without caregivers between July to November 2020. Mann-Whitney U test was used to compare LoS in the two selected hospitals and linear regression was used to determine factors associated with LoS. Results A total of 222 participants were enrolled, the majority were males (62.4%). Mean age was 36.3 (standard deviation (SD) = 13.1) years. The average LoS was 18.3 (SD = 22.3) days, with patients in a hospital without caregivers having a longer median LoS (i.e., (30 (interquartile range (IQR) = 30) vs. 7 (7) days; χ2 = 68.95, p < 0.001). The factors significantly associated a longer LoS among our study participants included; being admitted in a hospital without caregivers (adjusted coefficient [aCoef]: 14.88, 95% CI 7.98–21.79, p < 0.001), a diagnosis of schizophrenia (aCoef: 10.68, 95 %CI 5.53–15.83, p < 0.001), being separated or divorced (aCoef: 7.68, 95% CI 1.09–14.27, p = 0.023), and increase in money spent during the admission (aCoef: 0.14, 95% CI 0.09–0.18, p < 0.001). Conclusion Patients with mental illness in southwestern Uganda have a short LoS (below 28 days), and the stay was much shorter for patients with fulltime caregivers. We recommend caregivers presence during patient’s hospital stay to reduce the LoS and minimize healthcare expenditure.

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“…12 Stay in the hospital for longer than four weeks due to infection was defined as prolonged hospitalization. 13 Berlin Heart Excor patients were excluded from calculation of duration of hospitalization.…”

Section: Patient Populationmentioning

confidence: 99%

Infections in children with left ventricular assist device

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et al. 2020

Transplant Infectious Dis

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Background: There are limited data about pediatric left ventricular assist device (VAD) infections in developing countries. This study aimed to investigate device postimplantation infectious complications and their pathogenic profile. Methods: Data were analyzed from patient charts involving 27 patients with dilated cardiomyopathy who underwent left VAD implantation at a leading tertiary care center in Turkey. Results: The study included 17 boys and ten girls with a median age of 12.22 years (range 17 months to 18 years). Nineteen patients were diagnosed with idiopathic, and three were diagnosed with familial dilated cardiomyopathy. Twenty-two out of 27 subjects (%81.48) developed 80 infection episodes in total. The most common type of left VAD-specific infection was the exit site of the driveline. Infected patients with left VAD had a significantly prolonged hospitalization compared with the patients without infection (P = .014). Infection-induced pediatric intensive care unit (ICU) admission was higher in patients with fungal infection(P = .023). Gram-positive staphylococci were the most commonly isolated bacterial pathogens, followed by Gram-negative bacteria. Five patients developed fungal infections. None of the fungal infection patients underwent transplantation(P = .035). Seven deaths occurred in our study group. All deaths were in the infected group. Mortality was associated with the presence of multidrug-resistant Gram-negative bacterial infections (P = .015), an increased number of infection episodes (P = .003), and hospitalization due to infection (P = .003). Conclusion: Ventricular assist device-related infections were frequent among our study patients. The predominantly isolated agents were Gram-positive bacterial pathogens. However, the emergence of relatively high rate of Gram-negative bacterial and fungal infections was associated with mortality before the transplantation. Establishing local programs for surveillance data, controlling for infection rates, and antibiotic stewardship are essential to reduce mortality of VAD patients in developing countries. K E Y W O R D S children, heart failure, infection, ventricular assist device TA B L E 3 Microorganisms isolated from all sites Microorganism No. Percent (%) Gram-positive microorganisms (n = 38) (60.32%) Methicillin-susceptible Staphylococcus aureus 20 31.75 Coagulase-negative Staphylococcus 8 12.69 Methicillin-resistant Staphylococcus aureus 5 7.93 Enterococcus faecium 2 3.17 Vancomycin-resistant enterococci 2 3.17 Nocardia 1 1.58 Gram-negative microorganism (n = 20) (31.75%) Pseudomonas aeroginusae 5 7.93 Acinetobacter baumanii 5 7.93 Klebsiella pneumonia 3 4.76 Stenotrophomonas maltophilia 3 4.76 ESBL E Coli 2 3.17 Proteus mirabilis 1 1.58 Elizabethkingea meningoceptica 1 1.58 Fungal isolates (n = 5) (7.93%

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

Cited by 10 publications

References 12 publications

Expert Arguments for Trends of Psychiatric Bed Numbers: A Systematic Review of Qualitative Data

Expert Arguments for Trends of Psychiatric Bed Numbers: A Systematic Review of Qualitative Data

Length of stay of hospitalized patients at tertiary psychiatry facilities in Uganda: the role of caregiver’s presence

Infections in children with left ventricular assist device

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