title: The revolving door of mental, neurological, and substance use disorders re-hospitalization in rural KwaZulu-Natal Province, 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tomita
authors.affiliation: Discipline of Anesthesiology and Critical Care Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
authors.forename: Yoshan
authors.initials: Y
authors.lastname: Moodley
mesh_terms: D000293:Adolescent; D000328:Adult; D003156:Community Mental Health Services; D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D019966:Substance-Related Disorders; D055815:Young Adult
keywords: Rural mental health; South Africa; administrative data; severe mental illness