Risk factors for readmission among a cohort of psychiatric inpatients in Lilongwe, Malawi

Abstract

Objectives: Inpatient psychiatric capacity is limited in Malawi and no published studies have assessed psychiatric readmissions there. Information about factors associated with readmission may help guide strategies to reduce readmission rates and keep patients stabilised in the community. Our goal was to determine factors associated with readmission among a cohort of psychiatric inpatients in Lilongwe, Malawi.

Methods: We conducted a retrospective chart review of all patients admitted to an inpatient psychiatric unit in Lilongwe, Malawi from January 1 to December 31, 2011. We used logistic regression to test for associations between readmissions during the study period and patient variables.

Results: 419 patients were hospitalised during the study period. Twenty-nine patients (6.9%) were readmitted at least once during the study period. Readmission was associated only with intentional medication non-adherence at home (aOR: 3.33, p = 0.02).

Conclusions: Intentional medication non-adherence is a potentially modifiable behaviour associated with psychiatric readmission. Efforts to improve medication adherence among patients following hospital discharge may help decrease the risk of readmission.

KEY POINTS

• The prevalence of readmission among psychiatric inpatients in Lilongwe, Malawi was 6.9% during the 1-year study period.

• Readmission was associated with intentional medication non-adherence at home.

• Future research efforts in Malawi should focus on improving medication adherence among psychiatric patients in the community to help decrease rates of readmission.

Keywords:

• Africa south of the Sahara
• Malawi
• mental disorders
• mental health
• psychiatry

Acknowledgements

We thank the administration, patients and staff of the Bwaila Psychiatric Unit, for their assistance with this investigation. We would also like to thank Laura Ball and Travis Tressler for their assistance with data entry.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by funding from the University of North Carolina Centre for AIDS Research, a National Institutes of Health (NIH) funded programme [grant P30 AI50410]. CPCB was supported by a National Institute of Mental Health career development grant [K01MH100428]. KK was supported by an NIH international research training grant [D43 TW010060]. BSB was the recipient of a Fulbright-Fogarty Fellowship in Public Health [2011–12], sponsored through a partnership between the United States Fulbright Programme and the NIH through the Fogarty International Clinical Research Scholars and Fellows Programme at Vanderbilt University [grant R24 TW007988]. MU was supported by funding from the African Mental Health Research Initiative [grant DEL-15-01].