Social Psychiatry and Psychiatric Epidemiology

, Volume 54, Issue 2, pp 235–242 | Cite as

Factors associated with long length of stay in an inpatient psychiatric unit in Lilongwe, Malawi

  • Brian S. BarnettEmail author
  • Veronica Kusunzi
  • Lucy Magola
  • Christina P. C. Borba
  • Michael Udedi
  • Kazione Kulisewa
  • Mina C. Hosseinipour
Original Paper



Studies of factors affecting length of stay during psychiatric hospitalization in sub-Saharan Africa are sparse. A better understanding of such factors may lead to interventions resulting in quicker patient stabilization and discharge, freeing up needed psychiatric beds and reducing health care system expenditures. Therefore, we sought to identify factors associated with long length of stay in Malawi.


We reviewed the charts of 417 patients hospitalized at Kamuzu Central Hospital’s Bwaila Psychiatric Unit in Lilongwe, Malawi from January 1 to December 31, 2011. Multivariate logistic regression analysis was employed to test for associations between patient factors and long length of stay (defined as more than 28 days).


Mean length of stay was 22.08 ± 27.70 days (range 0–243). 21.82% (91/417) of patients stayed longer than 28 days. Long length of stay was associated with living outside of Lilongwe district [aOR: 3.65 (1.66–8.01), p = 0.001] and treatment for antipsychotic extrapyramidal side effects (EPS) during hospitalization [aOR: 3.45 (1.32–9.03), p = 0.012]. Patients who had more interactions with medical providers for this episode of illness prior to presentation at the unit were less likely to have a long length of stay [aOR: 0.35 (0.16–0.76), p = 0.008].


Our findings demonstrate areas of possible intervention to reduce length of stay, including securing means for patient transport home, rapid identification and treatment of EPS, and reducing the risk of EPS by decreased use of high potency first-generation antipsychotics.


Sub-Saharan Africa Malawi Mental disorders Mental health Psychiatry 



This work was supported by funding from the University of North Carolina Center for AIDS Research, a National Institutes of Health (NIH) funded program (Grant P30 AI50410). CPCB was supported by a National Institute of Mental Health career development Grant (K01MH100428). KK was supported by an NIH international research training Grant (D43 TW010060). BSB was the recipient of a Fulbright-Fogarty Fellowship in Public Health (2011-12), sponsored through a partnership between the United States Fulbright Program and the NIH through the Fogarty International Clinical Research Scholars and Fellows Program at Vanderbilt University (Grant R24 TW007988). MU was supported by funding from the African Mental Health Research Initiative (Grant DEL-15-01). We thank the administration, patients and staff of the Bwaila Psychiatric Unit, for their assistance with this investigation. We would also like to thank Laura Ball and Travis Tressler for their assistance with data entry.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    World Health Organization (2011) Mental Health Atlas—2011 country profiles: Malawi. Accessed 20 Oct 2018
  2. 2.
    World Health Organization (2015) Mental health atlas. Bull World Health Organ 93:516. Google Scholar
  3. 3.
    Udedi M (2016) Improving access to mental health services in Malawi. Poster presentation at African Institute for Development Policy Conference. Accessed 20 Oct 2018
  4. 4.
    Adegunloye OA, Yussuf AD, Ajiboye PO et al (2009) Correlates of length of stay among psychiatric in-patients in a tertiary health institution in Nigeria. Res J Med Sci 3:56–61Google Scholar
  5. 5.
    Moosa MYH, Jeenah FY, Raghubir L et al (2004) Duration of hospitalization in an acute psychiatric unit: letter to the editor. S Afr Psychiatry Rev 7:36–38Google Scholar
  6. 6.
    Van der Merwe PL, Allan A, Allan MM (1999) Inappropriate involuntary admissions to psychiatric hospitals. S Afr Med J 89:1303–1307Google Scholar
  7. 7.
    Moosa MMYH, Jeenah FYF (2002) An analysis of acute admissions to a general hospital psychiatric unit: Commentary. S Afr Psychiatry Rev 5:16–18Google Scholar
  8. 8.
    Oladeji BD, Ogundele AT, Dairo M (2012) Determinants of length of stay in the psychiatric wards of the University College Hospital, Ibadan, Nigeria. Afr J Med Med Sci 41:147–152Google Scholar
  9. 9.
    Taiwo H, Ladapo O, Aina OF et al (2008) Long stay patients in a psychiatric hospital in Lagos, Nigeria. Afr J Psychiatry 11:128–132CrossRefGoogle Scholar
  10. 10.
    Addisu F, Wondafrash M, Chemali Z et al (2015) Length of stay of psychiatric admissions in a general hospital in Ethiopia: a retrospective study. Int J Ment Health Syst 9:1–9. CrossRefGoogle Scholar
  11. 11.
    Ukpong D, Mosaku S (2009) Demographic and clinical correlates of length of stay in a Nigerian university hospital psychiatric unit. Turk Psikiyatri Derg 20:49–55Google Scholar
  12. 12.
    Malawi Ministry of Health (1948) Mental Health Treatment Act (Cap. 34:02). Accessed 20 Oct 2018
  13. 13.
    World Health Organization (1993) The ICD-10 classification of mental and behavioural disorders. Accessed 20 Oct 2018
  14. 14.
    Harris PA, Taylor R, Thielke R et al (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381. CrossRefGoogle Scholar
  15. 15.
    Barnett BS, Kusunzi V, Magola L et al (2018) Description of the inpatient population and care received at a psychiatric unit in Lilongwe, Malawi. Int J Cult Ment Health. Google Scholar
  16. 16.
    Barros REM, Marques JM, de A, Carlotti IP, et al (2010) Short admission in an emergency psychiatry unit can prevent prolonged lengths of stay in a psychiatric institution. Rev Bras Psiquiatr 32:145–151CrossRefGoogle Scholar
  17. 17.
    Zhang J, Harvey C, Andrew C (2011) Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: a retrospective study. Aust N Z J Psychiatry 45:578–585. CrossRefGoogle Scholar
  18. 18.
    Smith HM (2005) Factors leading to frequent readmission to Valkenberg hospital for patients suffering from severe mental illnesses. Dissertation, University of the Western CapeGoogle Scholar
  19. 19.
    Hriso E, Kuhn T, Masdeu JC, Grundman M (1991) Extrapyramidal symptoms due to dopamine-blocking agents in patients with AIDS encephalopathy. Am J Psychiatry 148:1558–1561. CrossRefGoogle Scholar
  20. 20.
    Mathews M, Gratz S, Adetunji B et al (2005) Antipsychotic-induced movement disorders: evaluation and treatment. Psychiatry (Edgmont) 2:36–41Google Scholar
  21. 21.
    Malawi Ministry of Health (2009) Malawi Standard Treatment Guidelines (MSTG) 4th edition. Accessed 20 Oct 2018
  22. 22.
    Malawi Ministry of Health (2015) Malawi standard treatment guidelines (MSTG) 5th edition. Accessed 20 Oct 2018
  23. 23.
    Lee S, Rothbard AB, Noll EL (2012) Length of inpatient stay of persons with serious mental illness: effects of hospital and regional characteristics. Psychiatr Serv 63:889–895. CrossRefGoogle Scholar
  24. 24.
    Tulloch AD, Fearon P, David AS (2011) Length of stay of general psychiatric inpatients in the United States: systematic review. Adm Policy Ment Health 38:155–168. CrossRefGoogle Scholar
  25. 25.
    Kalseth J, Lassemo E, Wahlbeck K et al (2016) Psychiatric readmissions and their association with environmental and health system characteristics: a systematic review of the literature. BMC Psychiatry 16:376. CrossRefGoogle Scholar
  26. 26.
    Gopalakrishna G, Ithman M, Malwitz K (2015) Predictors of length of stay in a psychiatric hospital. Int J Psychiatry Clin Pract 19:238–244. CrossRefGoogle Scholar

Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2018

Authors and Affiliations

  1. 1.Department of PsychiatryMcLean Hospital Outpatient ClinicBelmontUSA
  2. 2.Department of PsychiatryHarvard Medical SchoolBostonUSA
  3. 3.Vanderbilt University School of MedicineNashvilleUSA
  4. 4.University of North Carolina ProjectLilongweMalawi
  5. 5.Department of Mental Health, Bwaila Hospital Psychiatric UnitKamuzu Central HospitalLilongweMalawi
  6. 6.Department of PsychiatryBoston Medical CenterBostonUSA
  7. 7.Department of PsychiatryBoston University School of MedicineBostonUSA
  8. 8.Non Communicable Diseases and Mental Health Unit, Clinical Services DepartmentMinistry of HealthLilongweMalawi
  9. 9.Department of Mental Health, College of MedicineUniversity of MalawiBlantyreMalawi
  10. 10.Department of PsychiatryKamuzu Central HospitalLilongweMalawi
  11. 11.UNC Project Private Bag A104, Kamuzu Central Hospital, Tidziwe ClinicLilongweMalawi

Personalised recommendations