Health facility determinants and trends of ICD-10 outpatient psychiatric consultations across Sofala, Mozambique: time-series analyses from 2012 to 2014

Table 4 Health system factors associated with the distribution of outpatient ICD-10 consultations for mental disorders in Sofala, Mozambique, October 2012 – June 2014

Health system factor	F00-F09	P-value	F10-F19	P-value	F20-F29	P-value	F30-F39	P-value	F40-F48	P-value	F70-F79	P-value	G40-41	P-value
Health system factor	aRR^a (95 % CI)	P-value	aRR^a (95 % CI)	P-value	aRR^a (95 % CI)	P-value	aRR^a (95 % CI)	P-value	aRR^a (95 % CI)	P-value	aRR^a (95 % CI)	P-value	aRR^a (95 % CI)	P-value
Num. outpatient consultations (per 10,000 increase)	1.06 (0.89, 1.24)	0.52	0.93 (0.84, 1.02)	0.13	0.90 (0.82, 0.97)	0.01	1.2 (0.88, 1.6)	0.26	1.1 (0.93, 1.3)	0.28	1.07 (0.96, 1.2)	0.23	0.98 (0.91, 1.1)	0.56
Rural clinic location	0.32 (0.13, 0.75)	0.009	0.14 (0.06, 0.30)	<0.001	0.50 (0.40, 0.63)	<0.001	0.22 (0.07, 0.72)	0.01	3.5 (0.82, 14.7)	0.09	1.2 (0.45, 3.1)	0.73	1.8 (1.2, 2.8)	0.009
Level of health facility
Primary	1 (reference)		1 (reference)		1 (reference)		1 (reference)		1 (reference)		1 (reference)		1 (reference)
Secondary	1.6 (0.46, 5.6)	0.45	0.72 (0.24, 2.2)	0.56	0.95 (0.53, 1.7)	0.85	2.1 (0.72, 6.2)	0.18	0.14 (0.03, 0.69)	0.02	0.23 (0.05, 1.01)	0.05	1.5 (0.93, 2.3)	0.10
Quaternary	1.5 (0.29, 8.0)	0.61	1.36 (0.48, 3.9)	0.57	7.7 (1.3, 44.7)	0.02	0.18 (0.009, 3.3)	0.24	0.59 (0.09, 3.9)	0.58	11.3 (1.8, 71.6)	0.01	0.16 (0.02, 1.3)	0.09
Mental health staffing^b
Psychiatrists	Excluded		Excluded		0.71 (0.25, 2.0)	0.52	Excluded		Excluded		Excluded		0.62 (0.27, 1.5)	0.27
Psychologists	Excluded		Excluded		0.68 (0.46, 0.99)	0.05	Excluded		Excluded		Excluded		2.3 (1.2, 4.6)	0.01
Psychiatric technicians	Excluded		Excluded		2.1 (1.2, 3.6)	0.006	Excluded		Excluded		Excluded		0.89 (0.58, 1.4)	0.59

^aAll adjusted rate ratios (aRR) represent fully-adjusted coefficients adjusting for system factors simultaneously in a negative binomial regression model using generalized estimating equations and an exchangeable correlation matrix to control for facility-level correlation
^bStaffing variables are excluded from F00-F09, F10-F19, F30-F39, F40-F48, and F70-F79 models due to small sample size and instability in estimates if included

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