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]: • • • • • • • • 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.

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