Effect of a lay counselor-delivered integrated maternal mental health and early childhood development group-based intervention in Northern Ghana: a cluster-randomized controlled trial

Abstract

Background Caregiver mental health is linked to early childhood development, yet more robust evidence of community-based interventions to prevent maternal depression and optimize socio-emotional development of young children is needed. Objectives of this cluster-randomized controlled trial (cRCT), based in Northern Ghana, are to assess the impact of the lay counselor-delivered, group-based Integrated Mothers and Babies Course and Early Childhood Development (iMBC/ECD) program on (1) the mental health of mothers of children under age 2; and (2) the socio-emotional development of their children. Methods This cRCT randomized 32 women's groups – 16 received iMBC/ECD content (intervention) and 16 received general health education content (control). Surveys were administered at baseline, immediate post-intervention, and 8-month post-intervention. The primary outcome was maternal depression [Patient Health Questionnaire (PHQ-9)], and the secondary outcome was child's socio-emotional development [Ages and Stages Questionnaire: Social Emotional (ASQ:SE-2)]. Qualitative interviews with 33 stakeholders were also conducted. Results In total, 374 participants were enrolled at baseline while pregnant with the index child, 19% endorsing moderate/severe depression. Of these, 266 (71.1%) completed the 8-month post-intervention survey (~19 months post-baseline). There were no significant effects of iMBC/ECD on PHQ-9 and ASQ:SE-2 scores. However, results favored the intervention arm in most cases. iMBC participants were highly satisfied with the program but qualitative feedback from stakeholders indicated some implementation challenges. Conclusions This real-world evaluation had null findings; however, post-intervention depression levels were very low in both arms (3%). Future research should examine the potential impact of women's groups on postpartum mental health more broadly with varying content.

Effect of a lay counselor delivered integrated maternal mental health and early childhood development group-based intervention in Siaya County, Kenya: A quasi-experimental longitudinal study

“…Sub-group analyses in our study indicated that the iMBC/ECD program, relative to the control group, was associated with lowered depressive symptoms among specific sub-groups of women such as those with low levels of education and those with four or more children. A cluster-randomized controlled trial of iMBC/ECD implemented in Ghana also did not see overall significant effects but did see impacts on certain more vulnerable subgroups ( Baumgartner et al, 2021 ).…”

The impact of a maternal mental health intervention on intimate partner violence in Northern Ghana and the mediating roles of social support and couple communication: secondary analysis of a cluster randomized controlled trial

“…The main trial analysis did not find a significant mental health effect, although the results favored the intervention arm. Overall, there were very low depression means in both the intervention and control groups post-intervention; 1.96, 1.40, respectively [ 40 ]. Another possible explanation is that in contexts with significant gender inequitable norms, where women have less access to resources and economic opportunities, interventions focused on the relationship-level factors might be beneficial, but not sufficient unless structural-level factors are simultaneously addressed [ 56 ], such as the shared drivers of gender inequity and poverty suggested by the syndemics theory.…”

“…The cRCT was not blinded to participants, data collectors, and analysis team. More detailed information on sample size, randomization, and blinding is published elsewhere [ 40 ].…”

“…iMBC/ECD was implemented by lay counselors, who were women from local communities, under the supervision of GHS community health officers and CRS field staff. More detailed information on the intervention and control content and delivery is published elsewhere [ 40 ].…”

Impact of an Early Childhood Development Intervention on the Mental Health of Female Caregivers: Evidence from a Randomized Controlled Trial

“…The overall prevalence of depression among mothers of young children ranges from 13% to 22% worldwide [ 41 , 42 ], and 23–55% of primary caregivers in developing countries have mental health symptoms [ 27 ]. In low- and middle-income countries, the average prevalence of women’s mental disorders is 19.8% postnatally [ 43 , 44 , 45 ], which means one in five women have post-partum depression [ 46 ]. In rural China, 39% of caregivers have at least one type of mental health issue [ 21 ], nearly 32% of caregivers suffer depressive symptoms, 42% suffer anxiety symptoms, and 30% suffer stress symptoms [ 47 ].…”