Maternal mental health in primary care in five low- and middle-income countries : a situational analysis
Date
2016-02-16
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
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.
Description
CITATION: Baron, E. C., et al. 2016. Maternal mental health in primary care in five low- and middle-income countries : a situational analysis. BMC Health Services Research, 16:53, doi:10.1186/s12913-016-1291-z.
The original publication is available at http://bmchealthservres.biomedcentral.com
The original publication is available at http://bmchealthservres.biomedcentral.com
Keywords
Maternal mental health, Mental illness, Primary health care -- Developing countries, Puerperal psychoses, Community mental health services
Citation
Baron, E. C., et al. 2016. Maternal mental health in primary care in five low- and middle-income countries : a situational analysis. BMC Health Services Research, 16:53, doi:10.1186/s12913-016-1291-z