Background: Few studies have examined the prevalence of mental, neurological and substance use disorders, case detection and treatment in primary healthcare in rural settings in Africa. We assessed needs and case detection rate at primary healthcare facilities in low-resource settings in Ghana.
Methods: A cross-sectional study was conducted at the health facility level in three demonstration districts situated in Northern, Middle and Southern belts in Ghana. These districts are Bongo (Upper East Region), Asunafo North (Ahafo Region) and Anloga (Volta Region). Data were collected on five priority mental, neurological and substance use conditions of interest including depression, psychosis, suicidal ideation, epilepsy and alcohol use disorders.
Results: Nine hundred and nine (909) people participated in the survey. The prevalence of depression was 15.6% (142/909), psychosis was 12% (109/909), suicidal ideation was 11.8% (107/909), epilepsy was 13.1% (119/909) and alcohol use disorders was 7.8% (71/909). The proportion of missed detection for cases of depression, psychosis, epilepsy and alcohol use disorders (AUD) ranged from 94.4% to 99.2%, and was similar across study districts. Depression was associated with psychosis (RR: 1.68; 95% CI: 1.12-1.54). For psychosis, a reduced risk was noted for being married (RR: 0.62; 95% CI: 0.39-0.98) and having a tertiary level education (RR: 0.12; 95% CI: 0.02-0.84). Increased risk of suicidal ideation was observed for those attending a health facility in Asunafo (RR: 2.31; 95% CI: 1.27-4.19) and Anloga districts (RR: 3.32; 95% CI: 1.93-5.71). Age group of 35 to 44 years (RR: 0.43; 95% CI: 0.20-0.90) and attending a health facility in the Anloga district (RR: 0.43; 95% CI: 0.20-0.90) were associated with reduced risk of epilepsy, but not for those more than 35 years (RR: 3.06; 95% CI:1.14-8.24). Being female (RR: 0.19; 95% CI: 0.12-0.31) and having a tertiary education were associated with reduced risk of AUD (RR: 0.27; 95% CI: 0.08-0.92).
Conclusions: Our study found a relatively high prevalence of MNS conditions, and very low detection and treatment rates in rural primary care settings in Ghana. There is a need to improve the capacity of primary care health workers to detect and manage mental health conditions, together with improved medication supply and referral pathways.