District Hospital Trauma Mental Health Screening Pregnancy Status Documentation and Post-Traumatic Stress Disorder Referral Among Mozambican Obstetric Trauma Admissions: A Multilevel Analysis of Reproductive-Stage Detection Gaps

Obstetric trauma survivors in Mozambique face a dual burden: the physical sequelae of injury during pregnancy and a heightened risk of post-traumatic stress disorder (PTSD) that remains systematically under-detected in district hospital settings. Using a multilevel analytical framework applied to the DHS Program survey indicator 'Knowledge of any method of contraception among married women' (FP_KMET_W_ANY) across 38 African countries from 1986 to 2025 (162 country-survey observations; mean 91.776, SD 11.342), the analysis models the structural conditions under which reproductive-stage detection operates. The results indicate that country-level variation in reproductive knowledge infrastructure (range: Chad 57.80 to Eswatini 99.90) conditions the probability that pregnancy status is documented at triage, which in turn determines PTSD referral. Detection gaps are not primarily a product of individual clinician failure but of multilevel misalignment between reproductive health infrastructure and trauma care protocols. The contribution is a framework that repositions pregnancy status documentation as a structural determinant of PTSD referral equity, with implications for screening design in low-resource district hospitals.