The revolving door of mental, neurological, and substance use disorders  re-hospitalization in rural KwaZulu-Natal Province, South Africa.

Andrew Tomita1, Yoshan Moodley
1. Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa.
2. Discipline of Anesthesiology and Critical Care Medicine, Nelson R. Mandela School of Medicine,
University of KwaZulu-Natal, South Africa.

Abstract
Objective: Little is known about the extent of mental, neurological and substance-use (MNS) disorders re-hospitalization in  South Africa. We examined the extent of one-year MNS re-hospitalization (MNS-R) in a rural South African primary health care  facility (PHCF).

Methods: We conducted a retrospective analysis of hospital administrative data from 10,525 adults discharged from a rural  PHCF in KwaZulu-Natal Province, South Africa. Chi-squared tests were utilized to describe MNS-R within one year of an index  hospital admission in individuals with MNS, with a sub-analysis also being conducted to describe schizophrenia re-hospitalization (S-R).

Results:The prevalence of MNS and schizophrenia recorded at an index hospitalization was 5% and 1%, respectively. A total  of 44/67 (66%) individuals with a diagnosis of MNS at the index hospitalization were classified as having MNS-R during oneyear follow-up period. Half of those diagnosed with schizophrenia at the index hospitalization (6/12 patients) were classified as  having S-R during one-year follow-up period. There was a significant association between re-hospitalization outcomes (MNS-R  and S-R) and MNS (p<0.01) or schizophrenia diagnosis (p<0.01) at index baseline hospitalization.

Conclusion:The extent of MNS-R and S-R remains relatively high in rural South Africa, and needs further health systems  strengthening to prevent revolving door occurrences.

Keywords: Rural mental health, severe mental illness, administrative data, South Africa.