title: Five-year clinical course and outcome of schizophrenia in Ethiopia.
abstract: BACKGROUND
  Findings from the WHO sponsored multicenter studies done a few decades ago, which reported favorable outcome of schizophrenia in developing countries both in 2 and 5 year follow-up studies, dominated the world view until recently. Emerging evidence from Low and Middle Income countries (LAMIC) started to challenge this long held view, also called 'dogma' by some authors. We reported the short-term follow-up which showed unfavorable outcome. We followed-up the cohort further to determine the 5-year outcome of schizophrenia and to compare the results with the WHO reports.
  
  
  METHODS
  Patients with schizophrenia (n=321) were identified systematically after screening 68378 adults, ages 15-49 years, in rural Ethiopia. The majority (74.9%) had chronic illness at entry and were treatment naïve (89.6%).
  
  
  RESULTS
  During 5-year follow-up, 96% had received treatment at least once although only about 6% had received antipsychotic treatments continuously. Forty five percent of participants were continuously symptomatic with 30.3% having had continuous psychotic episode. About 20% had experienced continuous remission. Being single (OR=3.41, 95% CI=1.08-10.82, P=0.037), on antipsychotic treatment for at least 50% of follow up time (OR=2.28, 95% CI=1.12-4.62, P=0.023), and having a diagnosis of paranoid subtype of schizophrenia (OR=3.68, 95% CI=1.30-10.44, P=0.014) were associated with longer period of remission
  
  
  CONCLUSIONS
  The findings from this 5-year outcome were consistent with our previous short term report which was unfavorable. Treatment has been a consistent predictor of a favorable outcome. Therefore, ensuring availability of treatment and adherence is an essential pragmatic step to improve outcome in this setting.
authors: Department of Psychiatry, Faculty 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: Lars
authors: L
authors: Jacobsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult