Impact of maternal mental health interventions on child-related outcomes in low- and middle-income countries: a systematic review and meta-analysis

Abstract

Aims Observational studies have shown a relationship between maternal mental health (MMH) and child development, but few studies have evaluated whether MMH interventions improve child-related outcomes, particularly in low- and middle-income countries. The objective of this review is to synthesise findings on the effectiveness of MMH interventions to improve child-related outcomes in low- and middle-income countries (LMICs). Methods We searched for randomised controlled trials conducted in LMICs evaluating interventions with a MMH component and reporting children's outcomes. Meta-analysis was performed on outcomes included in at least two trials. Results We identified 21 trials with 28 284 mother–child dyads. Most trials were conducted in middle-income countries, evaluating home visiting interventions delivered by general health workers, starting in the third trimester of pregnancy. Only ten trials described acceptable methods for blinding outcome assessors. Four trials showed high risk of bias in at least two of the seven domains assessed in this review. Narrative synthesis showed promising but inconclusive findings for child-related outcomes. Meta-analysis identified a sizeable impact of interventions on exclusive breastfeeding (risk ratio = 1.39, 95% confidence interval (CI): 1.13–1.71, ten trials, N = 4749 mother–child dyads, I2 = 61%) and a small effect on child height-for-age at 6-months (std. mean difference = 0.13, 95% CI: 0.02–0.24, three trials, N = 1388, I2 = 0%). Meta-analyses did not identify intervention benefits for child cognitive and other growth outcomes; however, few trials measured these outcomes. Conclusions These findings support the importance of MMH to improve child-related outcomes in LMICs, particularly exclusive breastfeeding. Given, the small number of trials and methodological limitations, more rigorous trials should be conducted.

Task-sharing psychosocial interventions for the prevention of common mental disorders in the perinatal period in low- and middle-income countries: A systematic review and meta-analysis

“…Notably, maternal mental health interventions can also improve child-related outcomes. As synthetised by a recent systematic review and meta-analysis by Tol et al (2020), maternal mental health interventions along the continuum ill-health (promotion, prevention, treatment) for women living in LMICs have shown promising results for the improvement of child health, nutrition and development outcomes (e.g. exclusive breastfeeding).…”

“…Despite this, maternal mental health is still a globally neglected issue. Evidence-based mental health and psychosocial support interventions (MHPSS) for preventing and treating common mental disorders in the perinatal period exist (Tol et al, 2020), nevertheless their access remains a challenge in LMICs. There persists a severe gap between individuals in need of mental health support and those who actually receive it (WHO, 2018a), mainly because of the paucity of resources in terms of skilled staff and inequitable access to mental health services (WHO, 2020).…”

“…A growing body of evidence on MHPSS interventions delivered through task-sharing approaches in the perinatal period has emerged in the past few years, but most studies focused on treatment rather than prevention (Clarke et al, 2013; Rahman et al, 2013; Tol et al, 2020). Prevention aims at reducing the likelihood of future mental disorders with the general population or with people who are identified as being at risk of disorder (e.g.…”

A Systematic Review of Interventions That Integrate Perinatal Mental Health Care Into Routine Maternal Care in Low- and Middle-Income Countries

“…This is in part a reflection of limited research conducted in LMICs, with three times more mental health research output from high-income countries than low-income countries ( 36 ). Previous systematic assessments of interventions focused on perinatal mental health care in LMICs have examined non-mental health professional task-sharing for care delivery and psychological and psychosocial interventions ( 50 – 56 ). However, no systematic review to this point has examined the effectiveness of interventions that integrate perinatal mental health care into routine maternal care in LMICs.…”

What works to protect, promote and support breastfeeding on a large scale: A review of reviews

“…Home visits were a highly effective mode of delivering pre-and postnatal education and lactation support with both trained health workers and CHW, across different settings (Tiruneh et al, 2019;Tol et al, 2020;Yonemoto et al, 2017). Prenatal visits that incorporate maternal mental health components improved exclusive breastfeeding (Tol et al, 2020) Postnatal home visits were associated with higher exclusive breastfeeding and longer breastfeeding duration (Tiruneh et al, 2019;Yonemoto et al, 2017), although further research is needed to determine the specific aspects of the most effective package (e.g., the frequency, timing and duration of the visits) (Yonemoto et al, 2017). Importantly, CHW bridged healthcare as well as community and family settings (Lassi et al, 2019), including in home visits (Tiruneh et al, 2019).…”