1. Introduction

1.1. Background information

Schizophrenia is a severe mental disorder that affects approximately 1% of the world's population. It is a chronic condition that can have a debilitating impact on an individual's quality of life, relationships, and ability to function in society thus cause a significant range of cognitive, behavioral, and emotional dysfunctions(1). Schizophrenia is characterized by symptoms such as hallucinations, delusions, disorganized thinking, and abnormal behavior(2).
With the wide range of availability of treatments for schizophrenia, such as antipsychotic medication and psychotherapy, rehospitalization among patients with previous admissions and those with severe symptoms is quite common(3). Rehospitalization due to schizophrenia may either be newly onset of the disease or more of a relapse of the disease and one of the main reason for hospitalization is due to safety issues which may arise from this condition. A relapse can be defined as the worsening of a clinical condition that had previously improved. The risk of relapse varies depending on factors such as the severity of the illness, the presence of comorbidities, medication adherence, and environmental stressors(4). Studies have shown that the risk of relapse and rehospitalization is highest during the first few years after the onset of symptoms. On a global survey the relapse rate for people with schizophrenia ranges between 50 to 92% with an estimated 3.5% per month in those who are on depot medication(5). In Tanzania there was approximately 10% of people with schizophrenia that were rehospitalized due to relapse at Muhimbili National Hospital (MNH) Dar-es-salaam Tanzania in 2012(6). Research has shown that individuals who have experienced multiple episodes of schizophrenia are more likely to be rehospitilized compared to those with fewer episodes having close to 80% chance within 12 months compared to those with single episodes. Furthermore, individuals who have a history of poor medication adherence or substance abuse are at a higher risk of about 62% within 12 months(7). Thus relapse of schizophrenia can have severe consequences, including hospitalization, loss of employment, and a decreased quality of life(8). Therefore, understanding the factors that contribute to relapse and developing effective strategies to prevent or manage relapse is crucial while also further understanding of the protective factors can help proper utilization of these techniques so as to prevent a rather fatal outcome. There are various approaches to implemented in preventing relapse in schizophrenia, including psychosocial interventions, medication management, and early intervention programs. Psychosocial interventions, such as cognitive-behavioral therapy and family therapy, have been shown to improve treatment adherence and reduce the risk of relapse(9). Medication management, including long-acting injectable antipsychotic medication, can also improve medication adherence and reduce the risk of relapse. Early intervention programs, which aim to identify and treat symptoms early on so as to prevent fully manifestation of the disease, can also reduce the risk of relapse and improve outcomes for individuals with schizophrenia(3). In conclusion, relapse of schizophrenia as the main reason for rehospitalization of schizophrenic patients remains a significant challenge for individuals with this condition, their families, and healthcare providers. While various approaches to prevent relapse exist, more research is needed to assess the factors contributing to relapse among individuals with schizophrenia so as to develop a more effective intervention and improve outcome for individuals with schizophrenia.

1.2. Problem statement

Schizophrenia is a chronic and severe mental illness that affects millions of people worldwide (approximately 24 million people)(10) and despite the advancement in treatment with the availability of antipsychotic medications and various psychological interventions, relapse remains a significant challenge for patients and their caregivers(11). Relapse is associated with negative outcomes, including recurrent hospitalization of the individual, increased morbidity, increased symptom severity compared to previous episodes, functional impairment, and decreased quality of life for patients and their families(8). While some research has been conducted on factors that may contribute to relapse in schizophrenia, there is still much to be understood about the contributing factors for relapse and their roles each in their contribution to exacerbate the relapse and potential interventions that could prevent or minimize relapse in this population. Therefore, this research proposal aims to identify risk factors and protective factors associated with rehospitalization among patients with schizophrenia and explore potential targeted interventions for prevents and dealing with relapse that could improve outcomes for patients with this disorder.

1.3. Rationale of study

The study will provide useful information regarding risk factors and protective factors associated with rehospitalization among patients with schizophrenia in Bugando Medical Centre psychiatric ward, identification of various factors that are largely associated with rehospitalization these patients in our settings and recommended suggestions to overcome them. This will be useful in efforts to reduce the relapse of this disorder as it will profoundly expose the causes in our setting and urge for further exploitation of the protective factors so as to help the patients and their family in improving the quality of life.

1.4. Research question

What are the associated risk factors and protective factors associated with rehospitalization among patients with schizophrenia in Bugando Medical Centre?

1.5. Research Objectives

1.5.1. Broad objective

• To determine the risk and protective factors associated with rehospitalization among patients with schizophrenia in Bugando Medical Centre

1.5.2. Specific objectives

1. To determine the risk factors associated with rehospitalization among patients with schizophrenia in Bugando Medical Centre.
2. To determine the protective factors against relapse and rehospitalization among patients with schizophrenia in Bugando Medical Centre.