Mental disorders more prevalent in rural than urban settings in Mozambique

Advocacy to improve understanding of mental disorders, investment in mental-health resources in rural areas, and collaboration with traditional medical practitioners are urgently needed, especially in poor areas. These are the conclusions of authors of an Article in this week’s edition of The Lancet.

Dr Vikram Patel and Dr Helen Weiss, London School of Hygiene and Tropical Medicine, UK and colleagues studied 2739 households in Mozambique, 1796 in Maputo City and 943 in the rural town of Cuamba. A person from each household was asked to identify household members who had symptoms matching the three disorders above, as well as causes of the disorders, and their treatment and current state.

The researchers found that lifetime prevalence rates for all the three disorders were higher in rural than in urban settings. Prevalence of psychoses (in adults) was 4.4% in the rural town versus 1.6% in the city. For mental retardation, the prevalence was 1.9% (rural) versus 1.3 % (city), and for seizure disorders 4.0% (rural) versus 1.6% (city).

Informants in each house most frequently attributed psychoses to supernatural causes, followed by seizure disorder. In about three-quarters of all cases, households had consulted a traditional practitioner. Further, nearly half the people with these disorders in rural areas were rated as being in poor health.

The authors conclude: “These findings imply that mental-health policies in sub-Saharan Africa should focus on advocacy activities to raise awareness about severe mental and neurological disorders; investment in mental-health resources in community care settings, especially in rural areas; and close co-operation with traditional medical practitioners to promote recognition and appropriate management of people with severe mental and neurological disorders.”

In an accompanying Comment, Dr Julio Arboleda-Flórez, Ontario, Canada, says: “The results of this study should provide authorities in Mozambique, at whose behest the study was done, with a basis for planning health services…epidemiological and health-services research to determine the burden of mental illness are urgently needed in developing countries. The integration of mental health services into primary-care systems might be the only way to cope with that burden worldwide.”