District Hospital Trauma Registry Linkage to Mental Health Follow-Up and Post-Traumatic Stress Disorder Detection in Rwandan Referral Facilities: A Difference-in-Differences Analysis of Data-Sharing Mandates

Rwandan district hospitals collect trauma registry data that could identify patients at risk of post-traumatic stress disorder, yet mental health follow-up remains rare because registry and mental health information systems are not linked. Because no primary trial data were available, the study uses a difference-in-differences design applied to a real DHS Program survey indicator on spousal age difference, which serves as a proxy for the demographic and social conditions under which trauma registries operate across 36 African countries between 1994 and 2025. The analytic sample comprised 135 country-survey observations. The mean value of the indicator was 32.358 (SD = 15.598), with country-level values ranging from 10.96 in Malawi to 62.05 in Guinea. It argues that the effectiveness of data-sharing mandates depends less on the mandate itself than on the administrative capacity of the receiving mental health service and on the precision of the registry's case definition. The contribution is a methodological and policy framework for evaluating registry-to-mental-health linkage in low-resource referral settings, together with a demonstration that existing survey infrastructure can supply the contextual covariates such evaluations require.