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BMC Health Serv Res. 2016 Feb 16;16:53. doi: 10.1186/s12913-016-1291-z.

Maternal mental health in primary care in five low- and middle-income countries: a situational analysis.

Author information

  • 1Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa. emily.baron@uct.ac.za.
  • 2Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia. charlotte.hanlon@kcl.ac.uk.
  • 3King's College London, Institute of Psychiatry, Centre for Global Mental Health, London, UK. charlotte.hanlon@kcl.ac.uk.
  • 4Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa. sumaya.mall@gmail.com.
  • 5Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. simone.honikman@uct.ac.za.
  • 6Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa. erica.breuer@uct.ac.za.
  • 7University of KwaZulu-Natal, Durban, South Africa. Kathree@ukzn.ac.za.
  • 8Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal. luitelnp@gmail.com.
  • 9Butabika National Mental Hospital, Kampala, Uganda. jnakku@yahoo.com.
  • 10Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa. crick.lund@uct.ac.za.
  • 11King's College London, Institute of Psychiatry, Centre for Global Mental Health, London, UK. crick.lund@uct.ac.za.
  • 12Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia. gtmedhin@yahoo.com.
  • 13London School of Hygiene and Tropical Medicine, London, UK. vikram.patel@lshtm.ac.uk.
  • 14Public Health Foundation of India, New Delhi, India. vikram.patel@lshtm.ac.uk.
  • 15Sangath, Goa, India. vikram.patel@lshtm.ac.uk.
  • 16University of KwaZulu-Natal, Durban, South Africa. peterseni@ukzn.ac.za.
  • 17Sangath, Goa, India. sanjay.shrivastava@sangath.in.
  • 18Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa. markt@sun.ac.za.
  • 19Alan J Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa. markt@sun.ac.za.

Abstract

BACKGROUND:

The integration of maternal mental health into primary health care has been advocated to reduce the mental health treatment gap in low- and middle-income countries (LMICs). This study reports findings of a cross-country situation analysis on maternal mental health and services available in five LMICs, to inform the development of integrated maternal mental health services integrated into primary health care.

METHODS:

The situation analysis was conducted in five districts in Ethiopia, India, Nepal, South Africa and Uganda, as part of the Programme for Improving Mental Health Care (PRIME). The analysis reports secondary data on the prevalence and impact of priority maternal mental disorders (perinatal depression, alcohol use disorders during pregnancy and puerperal psychosis), existing policies, plans and services for maternal mental health, and other relevant contextual factors, such as explanatory models for mental illness.

RESULTS:

Limited data were available at the district level, although generalizable data from other sites was identified in most cases. Community and facility-based prevalences ranged widely across PRIME countries for perinatal depression (3-50 %) and alcohol consumption during pregnancy (5-51 %). Maternal mental health was included in mental health policies in South Africa, India and Ethiopia, and a mental health care plan was in the process of being implemented in South Africa. No district reported dedicated maternal mental health services, but referrals to specialised care in psychiatric units or general hospitals were possible. No information was available on coverage for maternal mental health care. Challenges to the provision of maternal mental health care included; limited evidence on feasible detection and treatment strategies for maternal mental disorders, lack of mental health specialists in the public health sector, lack of prescribing guidelines for pregnant and breastfeeding women, and stigmatising attitudes among primary health care staff and the community.

CONCLUSIONS:

It is difficult to anticipate demand for mental health care at district level in the five countries, given the lack of evidence on the prevalence and treatment coverage of women with maternal mental disorders. Limited evidence on effective psychosocial interventions was also noted, and must be addressed for mental health programmes, such as PRIME, to implement feasible and effective services.

PMID:
26880075
PMCID:
PMC4754802
DOI:
10.1186/s12913-016-1291-z
[PubMed - indexed for MEDLINE]
Free PMC Article
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