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

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dc.contributor.authorBaron, Emily C
dc.contributor.authorHanlon, Charlotte
dc.contributor.authorMall, Sumaya
dc.contributor.authorHonikman, Simone
dc.contributor.authorBreuer, Erica
dc.contributor.authorKathree, Tasneem
dc.contributor.authorLuitel, Nagendra P
dc.contributor.authorNakku, Juliet
dc.contributor.authorLund, Crick
dc.contributor.authorMedhin, Girmay
dc.contributor.authorPatel, Vikram
dc.contributor.authorPetersen, Inge
dc.contributor.authorShrivastava, Sanjay
dc.contributor.authorTomlinson, Mark
dc.date.accessioned2016-06-06T11:46:58Z
dc.date.available2016-06-06T11:46:58Z
dc.date.issued2016-02-16
dc.date.updated2016-05-18T15:49:10Z
dc.description.abstractBackground: 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.en_ZA
dc.identifier.apacitationBaron, E. C., Hanlon, C., Mall, S., Honikman, S., Breuer, E., Kathree, T., ... Tomlinson, M. (2016). Maternal mental health in primary care in five low- and middle-income countries: a situational analysis. <i>BMC Health Services Research</i>, http://hdl.handle.net/11427/19926en_ZA
dc.identifier.chicagocitationBaron, Emily C, Charlotte Hanlon, Sumaya Mall, Simone Honikman, Erica Breuer, Tasneem Kathree, Nagendra P Luitel, et al "Maternal mental health in primary care in five low- and middle-income countries: a situational analysis." <i>BMC Health Services Research</i> (2016) http://hdl.handle.net/11427/19926en_ZA
dc.identifier.citationBaron, E. C., Hanlon, C., Mall, S., Honikman, S., Breuer, E., Kathree, T., ... & Patel, V. (2016). Maternal mental health in primary care in five low-and middle-income countries: a situational analysis. BMC health services research, 16(1), 53.en_ZA
dc.identifier.issn1472-6963en_ZA
dc.identifier.ris TY - Journal Article AU - Baron, Emily C AU - Hanlon, Charlotte AU - Mall, Sumaya AU - Honikman, Simone AU - Breuer, Erica AU - Kathree, Tasneem AU - Luitel, Nagendra P AU - Nakku, Juliet AU - Lund, Crick AU - Medhin, Girmay AU - Patel, Vikram AU - Petersen, Inge AU - Shrivastava, Sanjay AU - Tomlinson, Mark AB - 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. DA - 2016-02-16 DB - OpenUCT DO - 10.1186/s12913-016-1291-z DP - University of Cape Town J1 - BMC Health Services Research KW - Maternal mental health KW - Global Mental Health KW - Mental disorders KW - Depression KW - Puerperal psychosis KW - Community mental health services KW - Primary health care KW - Developing countries KW - Sub-Saharan Africa KW - South Asia LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 SM - 1472-6963 T1 - Maternal mental health in primary care in five low- and middle-income countries: a situational analysis TI - Maternal mental health in primary care in five low- and middle-income countries: a situational analysis UR - http://hdl.handle.net/11427/19926 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1186/s12913-016-1291-z
dc.identifier.urihttp://hdl.handle.net/11427/19926
dc.identifier.vancouvercitationBaron EC, Hanlon C, Mall S, Honikman S, Breuer E, Kathree T, et al. Maternal mental health in primary care in five low- and middle-income countries: a situational analysis. BMC Health Services Research. 2016; http://hdl.handle.net/11427/19926.en_ZA
dc.languageengen_ZA
dc.language.rfc3066en
dc.publisherBioMed Centralen_ZA
dc.publisher.departmentCentre for Public Mental Healthen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsCreative Commons Attribution 4.0 International (CC BY 4.0)*
dc.rights.holderBaron et al.
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_ZA
dc.sourceBMC Health Services Researchen_ZA
dc.source.urihttp://bmchealthservres.biomedcentral.com/
dc.subjectMaternal mental health
dc.subjectGlobal Mental Health
dc.subjectMental disorders
dc.subjectDepression
dc.subjectPuerperal psychosis
dc.subjectCommunity mental health services
dc.subjectPrimary health care
dc.subjectDeveloping countries
dc.subjectSub-Saharan Africa
dc.subjectSouth Asia
dc.titleMaternal mental health in primary care in five low- and middle-income countries: a situational analysisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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