title: Five-year mortality in a cohort of people with schizophrenia in Ethiopia.
abstract: BACKGROUND
  Schizophrenia is associated with a two to three fold excess mortality. Both natural and unnatural causes were reported. However, there is dearth of evidence from low and middle income (LAMIC) countries, particularly in Africa. To our knowledge this is the first community based report from Africa.
  
  
  METHODS
  We followed a cohort of 307 (82.1% males) patients with schizophrenia for five years in Butajira, rural Ethiopia. Mortality was recorded using broad rating schedule as well as verbal autopsy. Standardized Mortality Ratio (SMR) was calculated using the mortality in the demographic and surveillance site as a reference.
  
  
  RESULTS
  Thirty eight (12.4%) patients, 34 men (11.1%) and 4 women (1.3%), died during the five-year follow up period. The mean age (SD) of the deceased for both sexes was 35 (7.35). The difference was not statistically significant (p = 0.69). It was 35.3 (7.4) for men and 32.3 (6.8) for women. The most common cause of death was infection, 18/38 (47.4%) followed by severe malnutrition, 5/38 (13.2%) and suicide 4/38 (10.5%). The overall SMR was 5.98 (95% CI = 4.09 to 7.87). Rural residents had lower mortality with adjusted hazard ratio (HR) of 0.30 (95% CI = 0.12-0.69) but insidious onset and antipsychotic treatment for less than 50% of the follow up period were associated with higher mortality, adjusted HR 2.37 (95% CI = 1.04-5. 41) and 2.66(1.054-6.72) respectively.
  
  
  CONCLUSIONS
  The alarmingly high mortality observed in this patient population is of major concern. Most patients died from potentially treatable conditions. Improving medical and psychiatric care as well as provision of basic needs is recommended.
authors: Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. soloteferra@yahoo.com
authors: Solomon
authors: S
authors: Teferra
authors: Teshome
authors: T
authors: Shibre
authors: Abebaw
authors: A
authors: Fekadu
authors: Girmay
authors: G
authors: Medhin
authors: Asfaw
authors: A
authors: Wakwoya
authors: Atalay
authors: A
authors: Alem
authors: Gunnar
authors: G
authors: Kullgren
authors: Lars
authors: L
authors: Jacobsson
mesh_terms: D000328:Adult; D002423:Cause of Death; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000401:mortality*