title: Length of stay of psychiatric admissions in a general hospital in Ethiopia: a retrospective study.
abstract: BACKGROUND
  In sub-Saharan Africa, the number of psychiatric beds per population is disproportionately low. Moreover, there is a lack of data regarding the patterns of psychiatric admissions and the factors leading to long psychiatric hospitalization in this region. This study aimed to investigate the average length of stay (LOS) and the factors associated with prolonged hospitalizations.
  
  
  METHODS
  A ten-year retrospective chart review of patients admitted to the psychiatric facility of Jimma University Specialized Hospital in southwest Ethiopia was conducted. The medical charts of 846 admissions spanning the period from January 2001 to December 2010 were reviewed. LOS greater than 21 days was considered as a cut-off point for lengthier stay. Bivariate and multivariable logistic regression analyses were conducted to identify factors independently associated with LOS.
  
  
  RESULTS
  The most common discharge diagnoses were schizophrenia and other psychotic disorders (27.6%), and bipolar disorder (23.4%). A global clinical rating taken on discharge showed 90.3% improved outcome. The median (25th, 75th percentiles) LOS was 22 (15, 36) days. Patients with major depressive disorder [aOR = 0.51 (0.32 - 0.81)] and brief psychotic disorder [aOR = 0.52 (0.33 - 0.84)] were less likely than patients with schizophrenia and other psychotic disorders to have long hospital stays. Presence of extrapyramidal side-effects and out of pocket expenditures predicted LOS.
  
  
  CONCLUSIONS
  Patients with psychoses and bipolar disorder have lengthier hospital stays burdening the cost of care of psychiatric treatment in a general hospital setting. Our findings call for identifying those cases quickly, attending to their needs with evidence-based efficient treatment and for improving and developing an aftercare system such that the utilization of acute inpatient beds, already a scarce resource, could achieve higher efficiency.
authors.affiliation: Department of Psychiatry, Jimma University, Jimma, Ethiopia.
authors.forename: Fikir
authors.initials: F
authors.lastname: Addisu
authors.affiliation: Department of Population and Family Health, Jimma University, Jimma, Ethiopia.
authors.forename: Mekitie
authors.initials: M
authors.lastname: Wondafrash
authors.affiliation: Department of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA USA.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Chemali
authors.affiliation: Department of Epidemiology, Jimma University, Jimma, Ethiopia.
authors.forename: Tariku
authors.initials: T
authors.lastname: Dejene
authors.affiliation: Department of Psychiatry, Jimma University, Jimma, Ethiopia ; Center for International Health, Ludwig Maxmillians University, Munich, Germany.
authors.forename: Markos
authors.initials: M
authors.lastname: Tesfaye
keywords: Ethiopia; Length of hospital stay; Mental illness; Psychiatric admission; Psychiatric care; Sub-Saharan Africa