Ten years of tracking mental health in refugee primary health care settings: an updated analysis of data from UNHCR’s Health Information System (2009–2018)

Fine, Shoshanna L.; Kane, Jeremy C.; Spiegel, Paul B.; Tol, Wietse A.; Ventevogel, Peter

doi:10.1186/s12916-022-02371-8

Table 2 Weighted mean rates of MNS visits per 1000 refugees per month for each participating HIS country from 2009 to 2018

From: Ten years of tracking mental health in refugee primary health care settings: an updated analysis of data from UNHCR’s Health Information System (2009–2018)

Country (number of camps)	Years	Epilepsy/seizures	Alcohol/substance	Intellectual disability	Psychotic disorder	Emotional disorder	Somatic complaint	Other complaint	Total
Country (number of camps)	Years	Weighted mean visit rate per 1000 per month (weighted SD)^a
Bangladesh (5)	2009–2010	0.01 (0.01)	0.00 (0.00)	0.004 (0.005)	0.04 (0.04)	0.003 (0.01)	0.001 (0.002)	0.03 (0.03)	0.08 (0.07)
	2011–2012	0.08 (0.06)	0.001 (0.001)	0.09 (0.12)	0.05 (0.03)	0.06 (0.07)	0.02 (0.02)	0.06 (0.06)	0.35 (0.35)
	2013–2014	0.07 (0.04)	0.00 (0.00)	0.04 (0.05)	0.13 (0.12)	0.14 (0.18)	0.02 (0.01)	0.12 (0.17)	0.53 (0.57)
	2015–2016	0.25 (0.02)	0.01 (0.01)	0.02 (0.003)	0.16 (0.04)	0.01 (0.01)	0.08 (0.02)	0.21 (0.07)	0.74 (0.07)
	2017–2018	0.24 (0.18)	0.01 (0.01)	0.07 (0.04)	0.20 (0.14)	0.19 (0.13)	0.13 (0.09)	0.29 (0.19)	1.13 (0.50)
Burkina Faso (2)	2011–2012	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)
	2013–2014	0.06 (0.04)	0.00 (0.00)	0.002 (0.002)	0.05 (0.05)	0.00 (0.00)	0.00 (0.00)	0.03 (0.03)	0.14 (0.12)
	2015–2016	0.26 (0.15)	0.00 (0.00)	0.02 (0.01)	0.28 (0.10)	0.02 (0.02)	0.01 (0.01)	0.06 (0.04)	0.66 (0.34)
	2017–2018	0.11 (0.02)	0.00 (0.00)	0.01 (0.01)	0.29 (0.17)	0.00 (0.00)	0.01 (0.005)	0.07 (0.05)	0.49 (0.24)
Burundi (4)	2011–2012	5.50 (0.69)	0.11 (0.07)	1.00 (0.73)	3.03 (1.02)	0.83 (0.86)	0.71 (0.61)	1.76 (1.15)	12.94 (1.68)
	2013–2014	4.67 (1.53)	0.02 (0.02)	1.00 (0.75)	2.36 (0.71)	0.61 (0.74)	0.17 (0.13)	0.97 (0.66)	9.81 (3.14)
	2015–2016	4.47 (1.22)	0.04 (0.02)	1.01 (0.45)	1.86 (0.18)	0.44 (0.69)	0.32 (0.17)	0.80 (0.26)	8.93 (1.81)
	2017–2018	2.40 (1.15)	0.04 (0.02)	0.54 (0.15)	0.97 (0.60)	0.27 (0.46)	0.05 (0.05)	0.40 (0.25)	4.67 (2.21)
Cameroon (17)	2009–2010	0.00 (0.00)	0.02 (0.03)	0.005 (0.01)	0.01 (0.02)	0.04 (0.06)	0.01 (0.02)	0.01 (0.02)	0.11 (0.15)
	2011–2012	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.001 (0.01)	0.002 (0.02)	0.00 (0.00)	0.00 (0.00)	0.002 (0.03)
	2013–2014	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)
	2015–2016	0.02 (0.02)	0.01 (0.01)	0.00 (0.00)	0.01 (0.02)	0.01 (0.02)	0.004 (0.01)	0.003 (0.01)	0.05 (0.05)
	2017–2018	0.23 (0.17)	0.03 (0.02)	0.00 (0.00)	0.30 (0.21)	0.29 (0.21)	0.08 (0.06)	0.06 (0.05)	1.01 (0.72)
CAR (3)	2011–2012	0.04 (0.05)	0.00 (0.00)	0.00 (0.00)	0.04 (0.05)	0.00 (0.00)	0.00 (0.00)	0.04 (0.05)	0.12 (0.14)
CAR (3)	2015–2016	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00
Chad (31)	2009–2010	0.48 (0.67)	0.05 (0.07)	0.06 (0.12)	0.12 (0.20)	0.19 (0.38)	0.01 (0.03)	0.35 (0.36)	1.27 (1.41)
	2011–2012	1.00 (0.74)	0.05 (0.10)	0.15 (0.15)	0.46 (0.32)	0.29 (0.27)	0.09 (0.32)	0.10 (0.08)	2.13 (1.52)
	2013–2014	1.01 (0.71)	0.06 (0.05)	0.15 (0.14)	0.40 (0.29)	0.17 (0.19)	0.06 (0.06)	0.08 (0.08)	1.93 (1.18)
	2015–2016	2.01 (1.56)	0.07 (0.10)	0.26 (0.47)	0.61 (0.41)	0.27 (0.52)	0.09 (0.14)	0.11 (0.11)	3.40 (2.00)
	2017–2018	1.98 (1.18)	0.08 (0.12)	0.24 (0.42)	0.72 (0.30)	0.23 (0.37)	0.07 (0.10)	0.17 (0.16)	3.47 (1.43)
DRC (6)	2013–2014	0.04 (0.17)	0.01 (0.02)	0.002 (0.003)	0.03 (0.05)	0.004 (0.01)	0.01 (0.005)	0.00 (0.00)	0.09 (0.21)
	2015–2016	1.34 (0.81)	1.48 (1.24)	0.27 (0.28)	0.31 (0.22)	0.17 (0.21)	0.30 (0.20)	0.78 (0.64)	4.66 (3.12)
	2017–2018	0.88 (0.67)	0.42 (0.51)	0.19 (0.34)	0.35 (0.25)	0.20 (0.31)	0.33 (0.46)	0.46 (0.66)	2.83 (2.93)
Republic of Congo (2)	2011–2012	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)
	2013–2014	0.001 (0.001)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.001 (0.001)	0.00 (0.00)	0.00 (0.00)	0.003 (0.002)
	2015–2016	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00
Djibouti (2)	2009–2010	2.58	0.01	0.20	0.56	0.62	0.91	0.43	5.31
	2011–2012	1.57	0.03	0.10	0.37	0.41	1.89	0.50	4.86
	2013–2014	2.22 (0.45)	0.04 (0.004)	0.05 (0.04)	0.13 (0.02)	0.06 (0.01)	1.16 (0.06)	0.19 (0.04)	3.84 (0.52)
	2015–2016	3.01 (0.35)	0.02 (0.01)	0.09 (0.03)	0.29 (0.08)	0.06 (0.05)	1.67 (0.20)	0.37 (0.11)	5.50 (0.66)
Eritrea (1)	2013–2014	0.00	0.00	0.00	0.06	0.00	0.00	0.17	0.23
Eritrea (1)	2015–2016	0.00	0.00	0.00	0.00	0.00	0.42	0.00	0.42
Ethiopia (28)	2009–2010	0.78 (0.82)	0.04 (0.11)	0.06 (0.16)	0.26 (0.54)	0.11 (0.22)	0.07 (0.22)	0.10 (0.17)	1.41 (1.78)
	2011–2012	0.34 (0.51)	0.02 (0.04)	0.09 (0.21)	0.37 (0.77)	0.09 (0.12)	0.07 (0.10)	0.06 (0.11)	1.03 (1.52)
	2013–2014	0.78 (1.19)	0.01 (0.02)	0.09 (0.26)	0.35 (0.73)	0.10 (0.24)	0.02 (0.03)	0.05 (0.08)	1.39 (2.31)
	2015–2016	0.82 (1.13)	0.01 (0.06)	0.07 (0.26)	0.32 (0.47)	0.18 (0.24)	0.06 (0.16)	0.06 (0.11)	1.52 (2.08)
	2017–2018	0.73 (1.06)	0.02 (0.09)	0.05 (0.16)	0.28 (0.51)	0.16 (0.26)	0.03 (0.09)	0.06 (0.18)	1.33 (1.95)
Ghana (4)	2011–2012	0.12 (0.18)	0.00 (0.00)	0.00 (0.00)	0.09 (0.19)	0.00 (0.00)	0.00 (0.00)	0.12 (0.25)	0.33 (0.44)
	2013–2014	0.005 (0.01)	0.005 (0.01)	0.005 (0.01)	0.01 (0.01)	0.02 (0.04)	0.01 (0.03)	0.00 (0.00)	0.06 (0.10)
	2015–2016	0.15 (0.43)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.15 (0.43)
Kenya (7)	2009–2010	0.48 (0.42)	0.04 (0.02)	0.08 (0.04)	0.42 (0.21)	0.29 (0.24)	0.11 (0.08)	0.38 (0.34)	1.81 (1.15)
	2011–2012	1.44 (1.10)	0.05 (0.04)	0.12 (0.06)	0.94 (0.39)	0.63 (0.78)	0.20 (0.19)	0.24 (0.23)	3.61 (2.46)
	2013–2014	1.67 (1.28)	0.03 (0.04)	0.07 (0.03)	0.94 (0.50)	0.58 (0.81)	0.28 (0.32)	0.07 (0.07)	3.64 (2.54)
	2015–2016	1.59 (1.15)	0.02 (0.02)	0.06 (0.04)	0.92 (0.65)	0.27 (0.31)	0.27 (0.42)	0.09 (0.09)	3.22 (2.05)
	2017–2018	2.40 (1.38)	0.05 (0.03)	0.13 (0.05)	1.24 (0.83)	0.22 (0.18)	0.30 (0.51)	0.10 (0.13)	4.44 (2.43)
Liberia (3)	2011–2012	2.59 (1.36)	0.82 (0.43)	1.21 (0.64)	2.20 (1.15)	11.97 (6.29)	0.92 (0.48)	6.56 (3.45)	26.28 (13.80)
	2013–2014	3.22 (0.41)	0.51 (0.46)	0.76 (0.78)	0.83 (0.51)	0.99 (0.77)	0.64 (0.50)	0.60 (0.49)	7.55 (3.52)
	2015–2016	6.41 (1.61)	0.39 (0.13)	1.21 (0.93)	0.94 (0.54)	2.05 (0.65)	0.48 (0.36)	0.63 (0.42)	12.10 (1.67)
Namibia (1)	2009–2010	1.31	0.15	0.07	0.87	0.00	0.00	0.00	2.40
	2011–2012	0.77	0.09	0.50	1.05	0.00	0.01	0.00	2.42
	2013–2014	0.60	0.00	0.02	0.96	0.00	0.02	0.09	1.69
Nepal (2)	2009–2010	2.56	0.04	0.22	3.11	0.31	0.09	4.79	11.13
	2011–2012	2.55 (0.54)	0.28 (0.06)	0.19 (0.11)	3.27 (0.41)	0.77 (0.30)	2.76 (0.88)	2.27 (0.34)	12.08 (0.15)
	2013–2014	2.34 (0.59)	0.30 (0.01)	0.13 (0.17)	3.04 (0.14)	1.58 (0.42)	3.53 (0.06)	3.12 (1.62)	14.04 (1.20)
	2015–2016	3.19 (0.38)	1.27 (0.19)	0.10 (0.04)	4.57 (0.71)	3.30 (0.42)	6.31 (0.61)	2.66 (1.32)	21.40 (1.02)
	2017–2018	3.79 (0.51)	1.47 (1.12)	0.27 (0.04)	5.45 (2.25)	3.98 (0.83)	7.45 (2.27)	0.00 (0.00)	22.40 (5.37)
Rwanda (6)	2009–2010	1.34 (1.07)	0.02 (0.02)	0.16 (0.02)	0.59 (0.47)	0.37 (0.04)	0.42 (0.26)	0.42 (0.33)	3.32 (2.22)
	2011–2012	1.26 (0.83)	0.002 (0.002)	0.02 (0.02)	0.79 (0.66)	0.46 (0.52)	0.07 (0.04)	0.50 (0.47)	3.11 (2.50)
	2013–2014	1.80 (0.85)	0.03 (0.02)	0.05 (0.05)	1.11 (0.85)	0.09 (0.07)	0.33 (0.17)	0.40 (0.30)	3.80 (2.19)
	2015–2016	2.15 (0.49)	0.03 (0.02)	0.05 (0.04)	0.84 (0.42)	0.34 (0.23)	0.42 (0.44)	0.37 (0.24)	4.21 (1.18)
	2017–2018	2.83 (0.78)	0.05 (0.05)	0.11 (0.10)	1.03 (0.26)	0.34 (0.11)	0.20 (0.09)	0.53 (0.39)	5.08 (0.80)
South Sudan (13)	2011–2012	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)
	2013–2014	0.002 (0.003)	0.00 (0.00)	0.00 (0.00)	0.001 (0.002)	0.0002 (0.001)	0.00 (0.00)	0.03 (0.05)	0.03 (0.05)
	2015–2016	0.38 (0.67)	0.01 (0.01)	0.004 (0.01)	0.12 (0.24)	0.01 (0.03)	0.01 (0.02)	0.04 (0.08)	0.56 (1.02)
	2017–2018	0.54 (0.78)	0.02 (0.04)	0.004 (0.01)	0.11 (0.22)	0.03 (0.05)	0.03 (0.07)	0.11 (0.22)	0.84 (1.30)
Sudan (7)	2009–2010	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)
	2011–2012	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)
	2013–2014	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)
	2015–2016	0.03 (0.08)	0.00 (0.00)	0.01 (0.02)	0.08 (0.23)	0.001 (0.004)	0.00 (0.00)	0.01 (0.01)	0.12 (0.34)
	2017–2018	1.30 (1.02)	0.01 (0.02)	0.09 (0.11)	0.78 (0.70)	0.29 (0.25)	0.02 (0.02)	0.18 (0.19)	2.67 (1.85)
Tanzania (3)	2009–2010	6.12	0.01	0.09	1.27	0.53	0.05	0.03	8.10
	2011–2012	6.54	0.002	0.17	1.58	1.08	0.05	0.02	9.43
	2013–2014	3.99	0.00	0.04	0.98	0.54	0.01	0.01	5.56
	2015–2016	3.13 (1.28)	0.09 (0.19)	0.10 (0.15)	0.91 (0.16)	0.51 (0.22)	0.29 (0.57)	0.08 (0.11)	5.11 (0.55)
	2017–2018	1.59 (0.96)	0.15 (0.16)	0.12 (0.12)	0.71 (0.39)	0.56 (0.28)	0.73 (0.66)	1.37 (1.51)	5.23 (2.16)
Thailand (9)	2009–2010	1.09 (0.73)	0.03 (0.05)	0.01 (0.01)	0.79 (0.41)	0.06 (0.09)	0.06 (0.11)	0.15 (0.15)	2.19 (0.87)
	2011–2012	1.22 (0.55)	0.04 (0.08)	0.12 (0.28)	1.28 (0.88)	0.07 (0.13)	0.13 (0.19)	0.22 (0.35)	3.09 (1.32)
	2013–2014	1.21 (0.48)	0.03 (0.04)	0.06 (0.23)	1.44 (1.04)	0.08 (0.13)	0.18 (0.18)	0.53 (1.08)	3.53 (1.56)
	2015–2016	1.56 (0.53)	0.14 (0.13)	0.07 (0.12)	1.74 (0.91)	0.13 (0.14)	0.19 (0.19)	0.81 (1.27)	4.65 (1.72)
	2017–2018	1.51 (0.57)	0.46 (0.45)	0.16 (0.43)	1.89 (1.08)	0.39 (0.56)	0.37 (0.52)	1.25 (4.59)	6.02 (6.16)
Uganda (14)	2009–2010	0.25 (0.40)	0.02 (0.05)	0.02 (0.03)	0.06 (0.08)	0.09 (0.06)	0.27 (0.16)	0.16 (0.07)	0.87 (0.62)
	2011–2012	0.97 (1.09)	0.03 (0.05)	0.04 (0.06)	0.46 (0.83)	0.26 (0.29)	0.59 (0.29)	0.19 (0.27)	2.54 (2.51)
	2013–2014	0.65 (0.80)	0.03 (0.08)	0.06 (0.10)	0.28 (0.66)	0.21 (0.27)	0.14 (0.25)	0.19 (0.29)	1.57 (2.18)
	2015–2016	0.56 (0.58)	0.06 (0.05)	0.08 (0.08)	0.27 (0.55)	0.25 (0.34)	0.18 (0.23)	0.19 (0.20)	1.59 (1.85)
	2017–2018	0.86 (0.48)	0.06 (0.04)	0.08 (0.08)	0.22 (0.35)	0.24 (0.31)	0.16 (0.30)	0.25 (0.32)	1.87 (1.45)
Yemen (3)	2009–2010	0.67 (0.48)	0.01 (0.01)	0.10 (0.05)	0.92 (0.45)	1.21 (0.66)	0.56 (0.57)	1.45 (1.84)	4.91 (3.29)
	2011–2012	0.74 (0.31)	0.04 (0.03)	0.07 (0.02)	0.82 (0.27)	1.61 (0.57)	0.47 (0.34)	0.63 (0.31)	4.37 (1.67)
	2013–2014	0.67 (0.18)	0.01 (0.01)	0.08 (0.02)	0.92 (0.13)	1.91 (0.42)	0.53 (0.06)	0.22 (0.06)	4.35 (0.58)
	2015–2016	0.91 (0.92)	0.01 (0.01)	0.13 (0.18)	1.01 (0.42)	2.73 (2.68)	0.55 (0.08)	0.48 (0.42)	5.83 (4.38)
	2017–2018	1.67 (2.97)	0.01 (0.02)	0.33 (0.69)	1.58 (1.40)	4.30 (6.80)	0.78 (0.54)	1.22 (1.71)	9.89 (13.86)
Zambia (2)	2009–2010	0.04 (0.03)	0.05 (0.04)	0.005 (0.004)	0.04 (0.04)	0.002 (0.002)	0.03 (0.02)	0.002 (0.003)	0.16 (0.01)
	2011–2012	0.28 (0.24)	0.01 (0.01)	0.00 (0.00)	0.08 (0.05)	0.00 (0.00)	0.01 (0.005)	0.01 (0.01)	0.38 (0.19)
	2013–2014	0.01 (0.01)	0.01 (0.01)	0.00 (0.00)	0.05 (0.04)	0.00 (0.00)	0.00 (0.00)	0.00 (0.00)	0.07 (0.02)
	2015–2016	0.003 (0.003)	0.003 (0.003)	0.00 (0.00)	0.22 (0.20)	0.00 (0.00)	0.02 (0.02)	0.00 (0.00)	0.24 (0.21)

^aRates were first calculated at the camp level. For each camp, the numerator of the rate was the total number of visits in each MNS category within a given 2-year period. The denominator was the total number of person-time contributed by the camp in the same period, which reflected the camp’s monthly population during the months that the HIS was active. The resulting rate was multiplied by 1000. For each country, weighted mean rates and standard deviations were calculated from the camp-level rates within that country. Weights were calculated as the ratio of a camp’s contributed person-time to all camp’s contributed person-time within a country. Therefore, the weights summed to 1. MNS, mental, neurological, and substance use; HIS, health information system

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