title: Long-term clinical course and outcome of schizophrenia in rural Ethiopia: 10-year follow-up of a population-based cohort.
abstract: BACKGROUND
  Although the few available studies from LMICs report favorable outcome, the course of schizophrenia is more complex than has been indicated so far.
  
  
  METHODS
  A sample of 361 people with a standardized clinical diagnosis of schizophrenia were recruited from a predominantly rural community in Ethiopia and followed up regularly for an average of 10years. Psychiatrists used the Longitudinal Interval Follow-up Evaluation chart to carry out assessment of illness course. Duration of time in clinical remission was the primary outcome.
  
  
  RESULTS
  About 61.0% of the patients remained under active follow-up, while 18.1% (n=65) were deceased. The mean percentage of follow-up time in complete remission was 28.4% (SD=33.0). Female patients were significantly more likely to have episodic illness course with no inter-episode residual or negative symptoms (χ(2)=6.28, P=0.012). Nearly 14.0% had continuous psychotic symptoms for over 75% of their follow-up time. Only 18.1% achieved complete remission for over 75% of their follow-up time. Later onset of illness was the only significant predictor of achieving full remission for over 50% of follow-up time in a fully adjusted model. Conventional antipsychotic medications were fairly well tolerated in 80% of the patients and 4.2% (n=15) experienced tardive dyskinesia.
  
  
  CONCLUSIONS
  This population-based study is one of the very few long-term outcome studies of schizophrenia in LMICs. The study demonstrated clearly a differential and more favorable course and outcome for female patients but overall course and outcome of schizophrenia appeared less favorable in this setting than has been reported from other LMICs.
authors.affiliation: Addis Ababa University, Ethiopia; University of Toronto, Ontario Shores Centre for Mental Health Sciences, Canada. Electronic address: shibreteshome@yahoo.com.
authors.forename: Teshome
authors.initials: T
authors.lastname: Shibre
authors.affiliation: Addis Ababa University, Aklilu-Lemma Institute of Pathobiology, Ethiopia.
authors.forename: Girmay
authors.initials: G
authors.lastname: Medhin
authors.affiliation: Addis Ababa University, Ethiopia.
authors.forename: Atalay
authors.initials: A
authors.lastname: Alem
authors.affiliation: Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia; WHO Regional Office for Africa, Brazzaville, Congo.
authors.forename: Derege
authors.initials: D
authors.lastname: Kebede
authors.affiliation: Addis Ababa University, Ethiopia.
authors.forename: Solomon
authors.initials: S
authors.lastname: Teferra
authors.affiliation: Umeå University, Division of Psychiatry, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Jacobsson
authors.affiliation: Umeå University, Division of Psychiatry, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Kullgren
authors.affiliation: Addis Ababa University, Ethiopia; King's College London, Institute of Psychiatry, Health Services and Population Research Department, Centre for Global Mental Health, London, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hanlon
authors.affiliation: Addis Ababa University, Ethiopia; King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK.
authors.forename: Abebaw
authors.initials: A
authors.lastname: Fekadu
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D017109:Akathisia, Drug-Induced / Q000453:epidemiology; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D018450:Disease Progression; D005002:Ethiopia / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D012074:Remission Induction; D012424:Rural Population; D012559:Schizophrenia / Q000188:drug therapy / Q000453:epidemiology*; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: Course; Ethiopia; Follow-up study; Gender; Outcome; Schizophrenia