District Hospital Trauma Mental Health Screening Triage Documentation Completeness and Post-Traumatic Stress Disorder Referral Equity in Kenyan Clinics: An Audit of Structured Screening Uptake

Structured trauma mental health screening is widely promoted as a precondition for equitable post-traumatic stress disorder (PTSD) referral in district hospital settings, yet the completeness of triage documentation that such screening depends on has not been systematically audited in Kenyan clinics. The indicator was treated as a proxy for the institutional reach of government health centres into the lives of current users, and its distribution was characterised against the documentation-completeness and referral-equity requirements that structured PTSD screening imposes. The mean indicator value was 25.261 (SD = 18.895), with country-level values ranging from 1.50 in Morocco to 51.89 in Zambia. The distribution was wide, right-skewed and stratified by country, indicating that the infrastructural precondition for structured screening is met unevenly across the continent. Documentation completeness and referral equity are not separable quality dimensions but a single institutional property: where government health centres reach only a minority of current users, structured screening cannot be complete, and PTSD referral cannot be equitable, because the denominator against which equity is judged is itself institutionally truncated. The contribution is a reframing of screening uptake as an infrastructural rather than a clinical variable, with consequences for how audit tools, referral benchmarks and equity metrics should be specified in Kenyan district hospitals.