Figure 2 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Source publication
Depression is common among women during perinatal period and is associated with long-term adverse consequences for the mother and infant. In Nigeria, as in many other low- and-middle-income countries (LMIC), perinatal depression usually goes unrecognized and untreated. The aim of EXPONATE is to test the effectiveness and cost-effectiveness of an in...
Similar publications
Background: Depression is common among women in the perinatal period. Although pregnancy and motherhood among adolescents are global public health issues, little is known about how adolescents differ from adults in the occurrence and correlates of perinatal depression.
Methods: Data were derived from a cluster randomized controlled trial of psychos...
Preface
Aim: to provide relevant evidence based practical information and guidelines for all grades of health worker at all levels of care who manage women with postpartum haemorrhage.
This monograph arises from the deliberations of the National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) on how best to minimise maternal death...
Abstract Background and objectives The perinatal period presents a high-risk time for development of mood disorders. Australia-wide universal perinatal care, including depression screening, make this stage amenable to population-level preventative approaches. In a large cohort of women receiving public perinatal care in Sydney, Australia, we examin...
Interprofessional collaboration optimizes maternal-newborn outcomes and satisfaction with care. Since 2002, midwives have provided an increasing proportion of maternity care in British Columbia (BC). Midwives often collaborate with and/or refer to physicians; but no study to date has explored Canadian medical trainees’ exposure to, knowledge of, an...
Citations
... CHVs and other healthcare providers increasingly use mobile phones for health interventions (Winters et al., 2018;Marongwe et al., 2022;Mureithi et al., 2023), and a number of researchers have called for greater exploration of how mobile phones may be used to increase access to mental health care specifically or support the delivery of mental health care (Naslund et al., 2017(Naslund et al., , 2019Hoeft et al., 2018). A growing body of research has examined how mobile technology can support lay mental health providers, including through supporting training (Shields-Zeeman et al., 2017;Naslund et al., 2019), aiding in clinical diagnosis and decision-making (Maulik et al., 2017;Diez-Canseco et al., 2018) and facilitating supervision (Gureje et al., 2015;Rahman et al., 2019;Xu et al., 2019;Triplett et al., 2023). However, to our knowledge, no studies have attempted to train lay providers in mental health interventions entirely through a mobile phone application. ...
This study describes an alternative to face-to-face training method for community health volunteers (CHVs) as used by a collaborative group from the University of Nairobi, University of Washington and the Nairobi Metropolitan Mental Health Team during the COVID-19 lockdown in Kenya. This qualitative study describes the experiences of 17 CHVs enrolled in a training study, required to utilize different digital platforms (Google Meet or Jitsi) as a training forum for the first time. Verbatim extracts of the participants’ daily experiences are extracted from a series of write-ups in the group WhatsApp just before the training. Daily failures and success experiences in joining a Google meet or Jitsi are recorded. Then, 17 participants, 10 women and 7 men, aged between 21 and 51 years (mean = 33), owning a smartphone, were enrolled in the study. None had used Jitsi or Google meet before. Different challenges were reported in login to either and a final decision to use Jitsi, which became the training platform. Training CHVs to deliver a psychosocial intervention using smartphones is possible. However, the trainer must establish appropriate and affordable methods when resources are constrained.
... To detect postnatal depressive symptoms, the Edinburgh Postnatal Depression Scale (EPDS) was used. The EPDS has been widely used in LMICs (26). In sub-Saharan Africa, the EPDS has been validated as a reliable tool for assessing both the severity and the likelihood of depression during the perinatal period in Umuziga et al. 10.3389/fgwh.2023.1113483 ...
Background
Postnatal depression is a significant public health issue that demands attention, and recent evidence indicates that rates are relatively high in low-income countries such as Rwanda. However, lack of social support is recognized as a potential risk factor for postnatal depressive symptoms. This study sought to explore the influence of poor maternal social support on postnatal depressive symptoms in a sample of women in Rwanda.
Method
A prospective cohort research design was conducted with women recruited from four different health centers in Rwanda's Southern Province. A sample of 396 pregnant women accessing antenatal care services was recruited at the baseline from their late second term or later, then followed up after giving birth. The dropout rate was 21.46%; thus, the data of 311 women were analyzed. The outcome variable was the presence of depressive symptoms (Edinburgh Postnatal Depression Scale (EPDS) (≥12 cut-off score), while predictor variables included maternal social support measured using a modified Maternal Social Support Scale (MSSS), perceived health status, socio-demographic information (marital status, wealth class, age, education, occupation), negative life events, gestational and obstetric information (parity, pregnancy intention, age at birth, children given birth, and mode of delivery). Univariate and multivariate analyses were performed.
Results
From a sample of 311 participants, over a quarter (20.9%) had elevated postnatal depressive symptoms (EPDS ≥ 12 scores). Elevated scores were predicted by poor perceived health status; respondents reporting neither poor nor good (AOR = 0 .28, CI = 0.11; 0.72, p = 0.007) or good health (AOR = 0 .14, CI = 0.05; 0.37, p = 0.001) were less likely to be affected. Poor maternal social support was also linked with postnatal depressive symptoms; poor partner support (AOR = 4 .22; CI = 1.44; 12.34; p = 0.009) was associated with high risk, while good friend support (AOR = 0 .47, CI = 0.23; 0.98, p = 0.04) was a significant protector. Additionally, violence or negative life events were also independent predictors of postnatal depressive symptoms (AOR: 2.94, CI: 1.37–6.29, p = 0.005).
Conclusion
Postnatal depressive symptoms were found to affect one in five Rwandan women. However, good maternal social support can be a strong protector. Early interventions targeting mothers in the postnatal period and strengthened social support networks for women at risk should be developed.
... However, no study has systematically reviewed the prevalence, associated factors, policies and interventions of adolescent pregnancy in Nigeria, either in the form of a scoping or a systematic review. It is essential to review these variables by pooling all available evidence to develop effective interventions and policies to address the risks associated with adolescent pregnancy, in line with achieving SDG2, SDG3, SDG6, and SDG7 [21,31,39]. Nigeria's empirical data to guide national planning for adolescent and mental health are limited [38,39], and evidence based on empirical studies is crucial to leverage consensus on investing in adolescent health and development for the success of the post-2015 developmental agenda [67]. ...
... It is essential to review these variables by pooling all available evidence to develop effective interventions and policies to address the risks associated with adolescent pregnancy, in line with achieving SDG2, SDG3, SDG6, and SDG7 [21,31,39]. Nigeria's empirical data to guide national planning for adolescent and mental health are limited [38,39], and evidence based on empirical studies is crucial to leverage consensus on investing in adolescent health and development for the success of the post-2015 developmental agenda [67]. ...
Background: Adolescent pregnancy is a global public health and social problem that affects both developed and developing countries. Reducing adolescent pregnancy is central to achieving sustainable development goals. In 2021 Nigeria’s Adolescent pregnancy was 106 per 1000 and showed an increasing rate. This study, therefore, aims to explore the literature to map the risk factors and interventions against adolescent pregnancy in Nigeria.
Method: A scoping review of studies published between January 2007 and December 2022 using PubMed, Web of Science and Africa Journals Online were searched using the keywords' adolescent pregnancy' AND 'Nigeria'. Studies were screened using the eligibility criteria.
Results: A total of 241 articles, of which 229 were identified through the databases and 12 were identified through hand search. After the full-text review, 28 studies met the inclusion criteria and were included in the final review. In Nigeria, the prevalence of adolescent pregnancy is between 7.5 and 49.5%. Associated factors for adolescent pregnancy in Nigeria are multifactorial, including individual, community, societal, school, family, and peer factors. Policies on adolescent sexual and reproductive health exist in Nigeria. Still, the policies need more sponsorship, implementation, and monitoring, while only some interventions on adolescent pregnancy majorly based on contraceptives and education of health providers are available in Nigeria.
Conclusion: Associated factors for adolescent Pregnancy in Nigeria are multidimensional, with educational attainment and wealth index being the highest associated factor. Intervention strategies aimed at the educational level have been identified as a critical factor in curbing adolescent pregnancy. Thus, policies on sexual, reproductive, and mental health development specifically targeting adolescents to reduce the cycle of societal dependence by empowering this group economically and educationally are justifiably warranted.
... Specifically, these authors investigated the user experience with a mobile app for the well-being of pregnant women, during one week, aiming to bring awareness to their affective states, besides also teaching them strategies to cope with anxiety and stress. We also found studies, like the one conducted by Gureje et al. (2015), 38 which were extendedinitially beginning with eight weekly sessions but including additional sessions during pregnancy on demand as well as an intervention six weeks after the birth of the child, depending on the levels of depressive symptoms notice in the mother during postpartum. In this case, specifically, the support and the clinical supervision were delivered mainly via mobile phone by doctors and psychiatrists. ...
... Specifically, these authors investigated the user experience with a mobile app for the well-being of pregnant women, during one week, aiming to bring awareness to their affective states, besides also teaching them strategies to cope with anxiety and stress. We also found studies, like the one conducted by Gureje et al. (2015), 38 which were extendedinitially beginning with eight weekly sessions but including additional sessions during pregnancy on demand as well as an intervention six weeks after the birth of the child, depending on the levels of depressive symptoms notice in the mother during postpartum. In this case, specifically, the support and the clinical supervision were delivered mainly via mobile phone by doctors and psychiatrists. ...
Objective: This article aims to review the literature regarding the use of technologies to promote mental health for pregnant women. We seek to: understand the strategies that pregnant women use for mental health care. Also, we investigate the existence of scientific evidence that validates such practices.
Methods: This study follows the PRISMA guidelines for systematic reviews. We analyze 27 studies published between 2012 and 2019. We include publications in Portuguese, English, and Spanish.
Results: The results revealed several different possibilities to use technology, including the use of text messages and mobile applications on smartphones. Mobile applications are the most commonly used approaches (22.5%). Regarding the strategies used, cognitive-behavioral approaches, including mood checks, relaxation exercises, and psychoeducation comprised 44.12% of the content.
Conclusion: There is a need for further investigation and research and development efforts in this field to better understand the possibilities of intervention in mental health in the digital age.
... Recent years have seen the emergence of projects that support NSHWs in treating and preventing common mental disorders in primary care or community-based settings, responding to perinatal depression, and supporting care for people with schizophrenia (Gureje O & Oladeji BD, 2015;Shields-Zeeman.Let al2017;). These projects use digital interventions like text messaging, voice calls, web applications, and smartphones.In these instances, digital technologies were primarily used to strengthen the role of NSHWs by facilitating patient support, facilitating access to training and continuing education opportunities, supporting data collection and care coordination, and facilitating connections with more specialised providers for supervision and clinical support . ...
A call is being made for psychologists globally to "think beyond the box". This paper emphasises that, especially in low-and middle-income countries, there is now a concrete data basis supporting the effectiveness of task sharing in mental health care provided by Non-Specialist Health Workers NSHWs. The actual implementation of such services in a sustained, sensible way that is balanced across provider cadres, collaborative, simple enough to be implemented yet with safety and quality ensured through sufficient training and supervision. Therefore, non-specialist providers and health workers are well positioned to deliver interventions for mental disorders, and a variety of delivery approaches can support, facilitate, and sustain this innovation. These approaches should be used and evaluated to increase access to mental health services and prevent armchair psychology risks.
... Our study methodology has been described previously (Adeponle et al., 2017). In brief, the current study is based on qualitative interview data from the formative study of the Expanding Care of Perinatal Women with Depression (EXPONATE), a mixed-methods study to assess the effectiveness of a stepped-care intervention program for perinatal depression in Nigeria (Gureje et al., 2015a). The formative study was conducted prior to the start of EXPONATE, and no recruitment to EXPONATE had taken place at the time. ...
... Recent years have seen the emergence of projects that support NSHWs in treating and preventing common mental disorders in primary care or community-based settings, responding to perinatal depression, and supporting care for people with schizophrenia (Gureje O & Oladeji BD, 2015;Shields-Zeeman.Let al2017;). These projects use digital interventions like text messaging, voice calls, web applications, and smartphones.In these instances, digital technologies were primarily used to strengthen the role of NSHWs by facilitating patient support, facilitating access to training and continuing education opportunities, supporting data collection and care coordination, and facilitating connections with more specialised providers for supervision and clinical support . ...
... The study is part of the formative phase of the project titled Responding to the challenge of adolescent perinatal depression (RAPID). In an earlier clinical trial (EXPONATE study) [24], we found that even though the intervention proved effective in treating perinatal depression, the results from the study showed that adolescents mothers were less likely to attend treatment session, they had a higher rate of undernourished infants compared to adult mothers and had poorer parenting skills (this is despite the fact that the intervention had built in it, a component on parenting skills). An ensuing process evaluation of the study suggested a combination of age-related and structural factors such as shame of being pregnant at a young age, low social support, experiences of stigma from clinic staff and perceptions of being judged by healthcare workers as exacerbating feelings of ostracisation in adolescent mothers which limit their use of available services. ...
... We identified seventeen (17) mothers who, as adolescents, participated in the intervention arm of the EXPONATE trial [24], conducted in primary care between 2014 to 2016 in Ibadan, Nigeria, and twenty-five (25) maternal care providers from the same study. The Focus Group Discussions presently reported, were conducted between 6th March and 29th April 2018. ...
Purpose
This paper describes the design of a theory-informed pragmatic intervention for adolescent perinatal depression in primary care in Nigeria.
Methods
We conducted Focus Group Discussions (FGDs) among 17 adolescent mothers and 25 maternal health care providers with experience in the receipt and provision of care for perinatal depression. The Consolidated Framework for Implementation Research (CFIR) was used to systematically examine the barriers and facilitators affecting adolescent mothers' use of an existing intervention package for depression. The Theoretical Domain Framework (TDF) and the Capability, Opportunity, Motivation, Behaviour (COM-B) model were used to analyze the results of the data across the five CFIR domains.
Results
FGD analysis revealed that care providers lacked knowledge on approaches to engage young mothers in treatment. Young mothers had poor treatment engagement, low social support, and little interest in parenting. A main characteristic of the newly designed intervention is the inclusion of age-appropriate psychoeducation supported with weekly mobile phone calls, to address treatment engagement and parenting behaviours of young mothers. Also in the outer setting, low social support from relatives was addressed with education, “as need arises” phone calls, and the involvement of "neighborhood mothers”. In the inner settings, care providers’ behaviour is addressed with training to increase their capacity to engage young mothers in treatment.
Conclusion
A theory-based approach helped develop an age-appropriate intervention package targeting depression and parenting skills deficit among perinatal adolescents in primary maternal care and in which a pragmatic use of mobile phone was key.
... Psychology and global mental health researchers have called for studies evaluating the potential of digital health tools to improve mental health services [20][21][22]. In LMICs specifically, an emerging body of literature has examined the use of digital health tools to support lay counselors, including facilitating training [23,24], providing tools for diagnosis [25,26], and supporting supervision [19,[27][28][29]. However, although this work may use digital health solutions, it has not explicitly discussed the various ways in which mobile phones are used to support service provision, nor has it focused on the support needed to facilitate digital health solutions. ...
... Lay counselors and supervisors generated unique solutions to improve the acceptability and feasibility of mobile phone supervision that are currently being explored in a pilot trial [38]. Mobile phones are already often used to support health care providers in LMICs, and other mental health projects have examined how mobile phones can be used as a tool to support supervision [27][28][29]. However, our study is among the first to gather lay counselor perspectives and explicitly examine how use of mobile phones can be optimized as a low-technology digital health tool to support lay counselors and supervisors in supervision-a key solution to increasing access to mental health care and improving mental health equity worldwide. ...
Background:
Task shifting is an effective model for increasing access to mental health treatment via lay counselors with less specialized training that deliver care under supervision. Mobile phones may present a low-technology opportunity to replace or decrease reliance on in-person supervision in task shifting, but important technical and contextual limitations must be examined and considered.
Objective:
Guided by human-centered design methods, we aimed to understand how mobile phones are currently used when supervising lay counselors, determine the acceptability and feasibility of mobile phone supervision, and generate solutions to improve mobile phone supervision.
Methods:
Participants were recruited from a large hybrid effectiveness implementation study in western Kenya wherein teachers and community health volunteers were trained to provide trauma-focused cognitive behavioral therapy. Lay counselors (n=24) and supervisors (n=3) participated in semistructured interviews in the language of the participants' choosing (ie, English or Kiswahili). Lay counselor participants were stratified by supervisor-rated frequency of mobile phone use such that interviews included high-frequency, average-frequency, and low-frequency phone users in equal parts. Supervisors rated lay counselors on frequency of phone contact (ie, calls and SMS text messages) relative to their peers. The interviews were transcribed, translated when needed, and analyzed using thematic analysis.
Results:
Participants described a range of mobile phone uses, including providing clinical updates, scheduling and coordinating supervision and clinical groups, and supporting research procedures. Participants liked how mobile phones decreased burden, facilitated access to clinical and personal support, and enabled greater independence of lay counselors. Participants disliked how mobile phones limited information transmission and relationship building between supervisors and lay counselors. Mobile phone supervision was facilitated by access to working smartphones, ease and convenience of mobile phone supervision, mobile phone literacy, and positive supervisor-counselor relationships. Limited resources, technical difficulties, communication challenges, and limitations on which activities can be effectively performed via mobile phone were barriers to mobile phone supervision. Lay counselors and supervisors generated 27 distinct solutions to increase the acceptability and feasibility of mobile phone supervision. Strategies ranged in terms of the resources required and included providing phones and airtime to support supervision, identifying quiet and private places to hold mobile phone supervision, and delineating processes for requesting in-person support.
Conclusions:
Lay counselors and supervisors use mobile phones in a variety of ways; however, there are distinct challenges to their use that must be addressed to optimize acceptability, feasibility, and usability. Researchers should consider limitations to implementing digital health tools and design solutions alongside end users to optimize the use of these tools.
International registered report identifier (irrid):
RR2-10.1186/s43058-020-00102-9.
... There is a growing evidence that antenatal depression also leads to postnatal depression, and has influence on offspring's cognitive development, emotions and behaviors in childhood [4,7]. However, the magnitude and risk factors of maternal depression during pregnancy in developing countries are currently poorly understood [8], and antenatal depression is often overlooked in routine screening [9]. ...
... The prevalence estimates of antenatal depression can vary across regions globally [9]. However, the burden of antenatal depression is generally higher in low-and middle-income countries (LMICs). ...
... The EPDS has been validated as a screening tool for antenatal depression in the previous studies in Rwanda [18,26] and was reported to be reliable tool for screening antenatal depressive symptoms in two other studies with Cronbach's Alpha values over 0.80 [12,18]. We followed the recommendation of Gureje and colleagues [9] to use a score of 12 or higher to define case level depressive symptoms (hereafter referred to as 'depression'). The EPDS was also found to be reliable in this study, with a Cronbach's Alpha value of 0.894. ...
Background
Prevalence of perinatal depression is high in Rwanda and has been found to be associated with the quality of relationship with partner. This study extends this work to examine the relationship between antenatal depressive symptoms and social support across several relationships among women attending antenatal care services.
Methods
Structured survey interviews were conducted with 396 women attending antenatal care services in 4 health centres in the Southern Province of Rwanda. The Edinburgh Postnatal Depression Scale (EPDS) and Maternity Social Support Scale (MSSS) were used to assess antenatal depressive symptoms and the level of support respectively. Socio-demographic and gestational information, pregnancy intentions, perceived general health status, and experience of violence were also collected. Univariate, bivariate analyses and a multivariate logistic regression model were performed to determine the relationship between social support and risk factors for antenatal depressive symptoms.
Results
More than half of respondents were married (55.1%) or living with a partner in a common-law relationship (28.5%). About a third (35.9%) were in their 6th month of pregnancy; the rest were in their third term. The prevalence of antenatal depressive symptoms was 26.6% (EPDS ≥ 12). Bivariate analyses suggested that partner and friend support negatively predict depression level symptoms. Adjusting for confounding variables such as unwanted pregnancy (AOR: 0.415, CI: 0.221- 0.778), parity (AOR: 0.336, CI: 0.113–1.000) and exposure to extremely stressful life events (AOR: 2.300, CI: 1.263- 4.189), partner support (AOR: 4.458, CI: 1.833- 10.842) was strongly significantly associated with antenatal depressive symptoms; women reporting good support were less likely to report depressive symptoms than those reporting poor support or those with no partner. Friend support was no longer significant.
Conclusion
The study revealed that social support may be a strong protector against antenatal depressive symptoms but only support from the partner. This suggests that strengthening support to pregnant women may be a successful strategy for reducing the incidence or severity of maternal mental health problems, but more work is required to assess whether support from the broader social network can compensate for absent or unsupportive partners.
