3
Background
The reported prevalence of psychological disorders in Zimbabwe is generally high,
although this is not generally reflected in the surveillance statistics of most health
authorities of the Ministry of Health and Child Welfare. The most reliable study to date
also indicates that high prevalence rates are to be expected1. This study showed a range of
prevalence from 22% to 32% in primary care clinics, with much higher rates being seen
in the patients of general practitioners (35-47%) and traditional healers (50-73%). This
study replicated many of the earlier findings, as well as implicating the important role of
socio-economic variables. For example, it was found that those with psychological
disorders had had fewer years in education, were more likely to be unemployed, reported
more debt due to illness, with costs being incurred from consultations, medications for
lost income. The study implicated the following features as being associated with
Common Mental Disorders [CMD]:
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female gender
older age
chronicity of illness
number of presenting complaints
economic impoverishment
infertility
recent unemployment
disability
In general, this study showed marked differences between those with psychological
disorders as compared with ordinary patients, and this suggests that patients with
psychological disorders may require a special focus for the health care system. Thus, lack
of detection becomes a significant problem. A follow up study indicated that poor
prognosis was most associated with disability and economic deprivation2.
Previous research also makes it clear that patients who attend primary care facilities
receive diagnoses and treatment, whether the diagnosis is physical or psychiatric3. Many
of these patients may also have significant physical disorders, which must also not be
overlooked. Primary care workers, of course, face considerable problems, for the
population served by primary care is one in which the burden of physical illness is often
heavy. Furthermore, it is usually a population in which most indices of social adversity
are present: poor diet, poor housing, low education, and unemployment all figure highly
in the general Zimbabwean population. Health workers are thus required to keep a
decided focus on identifying and treating physical illness, and indeed many sufferers of
1
See Patel et al. [1997], Common mental disorders in primary care in Harare, Zimbabwe: associations and risk factors,
BRIT.J.PSYCHIAT. 171, 60-64.
2 See Patel et al. [1998], Outcome of common mental disorders in Harare, Zimbabwe, BRIT.J.PSYCHIAT. 172, 53-57.
3
See Reeler et al. [1993], Psychopathology in Primary Care patients: A four-year study in rural and urban settings, CENTRAL
AFRICAN JOURNAL OF MEDICINE, 39, 1-8; see also Hall & Williams. [1987](A), Hidden psychiatric morbidity Part I: study of
prevalence in an outpatient population at Bindura Provincial Hospital. CENT.AFR.J.MED. 33, 239-245
Training nurses in the assessment and management of psychological disorders: Report of AMANI Trust’s
programme in Mashonaland Central Province, Zimbabwe.