Opportunities and obstacles to screening for perinatal depression among women in Zimbabwe: A narrative review of literature

Abstract

BackgroundThe perinatal period provides an opportune time for health care providers to screen for and proffer interventions for women suffering from depression. However, routine screening for depression is not done in primary care settings in Zimbabwe.AimThis narrative review discusses opportunities and obstacles surrounding screening for perinatal depression in primary care settings in Zimbabwe, with a view to stress the importance of routine screening to policy-makers.MethodsBoth electronic and manual searches were done on PubMed, PubMed Central, African Journals Online, Google Scholar and the University of Zimbabwe Institutional Repository (UZIR) using the following key terms: ‘women and antenatal depression’, ‘prenatal depression’, ‘postnatal depression’, ‘postpartum depression’, ‘depressive disorder’, or ‘common mental disorder’ and ‘screening and Zimbabwe’.ResultsAlthough opportunities for depression screening are possible because of the high antenatal and postnatal service coverage, the potential for universal screening is fraught with human and financial resource constraints, lack of training in mental health care among primary health care providers and lack of locally validated screening tools for depression.ConclusionThere is a need to channel resources into the training of midwives and other primary health care providers on mental health issues affecting women perinatally.

“Passing through difficult times”: Perceptions of perinatal depression and treatment needs in Malawi - A qualitative study to inform the development of a culturally sensitive intervention

“…This was compounded by a lack of availability of health workers due to their workload and negative attitudes. While shortage of health workers and negative attitudes has been found to be the greatest barrier to accessing services in health facilities in LMIC [31,50], lack of knowledge on the condition was also identified by key informants as contributing greatly to their inability to provide necessary help to women in this study. This issue is likely due to the fact that the mental health training course is a smaller component in pre service training courses for most health related programmes in Malawi, and with lack of practice and exposure most health workers completely lose the competency for diagnosing and treating mental illness.…”

“…Low staffing level and inadequate training is a big problem in health care systems in LMIC [50–52]. This affects universal health coverage and the quality of care provided.…”

“We do not know how to screen and provide treatment”: A qualitative study of barriers and enablers of implementing perinatal depression health services in Ethiopia

“…Staff workloads and lack of time with health professionals for health service linkage were reported to be barriers to screening and referral for perinatal depression in high-income countries (66)(67)(68). Furthermore, lack of training in mental health care, resources, and locally validated screening tools, together with health professionals' negative attitudes towards screening were reported as barriers in systematic reviews of qualitative studies (69)(70)(71)(72). Insu cient or lack of training, unexplained long waiting times, inconsistent screening practices, and not knowing the scope of practice were mentioned as common barriers for identi cation and treatment of perinatal mental disorders in other systematic reviews (73,74).…”

“We do not know how to screen and provide treatment”: a qualitative study of barriers and enablers of implementing perinatal depression health services in Ethiopia

“…Staff workloads and lack of time with health professionals for health service linkage were reported to be barriers to screening and referral for perinatal depression in high-income countries [ 66 – 68 ]. Furthermore, lack of training in mental health care, resources, and locally validated screening tools, together with health professionals’ negative attitudes towards screening were reported as barriers in systematic reviews of qualitative studies [ 69 – 72 ]. Insufficient or lack of training, unexplained long waiting times, inconsistent screening practices, and not knowing the scope of practice were mentioned as common barriers for identification and treatment of perinatal mental disorders in other systematic reviews [ 73 , 74 ].…”