Systematic review on the prevalence of perinatal depression in Malawi

Chorwe‐Sungani, Genesis; Wella, Kondwani; Mapulanga, Patrick; Nyirongo, Ditress; symbol, Mercy Pindani

doi:10.4102/sajpsychiatry.v28i0.1859

“…In addition to hypertension, opportunities exist within group care to increase screening for other NCDs such as diabetes, anemia, and mental health. Prevalence of postpartum depression among women in Malawi is estimated to be 19.8% (41), highlighting the need for targeted screening and preventive measures to support women experiencing it. Group care provides an opportunity to ll a gap in the care continuum, identify and treat NCDs and other health issues, and assist in the transition from maternity care to primary health care services (36).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of implementation outcomes of an integrated group postpartum and well-child care model at clinics in Malawi

Gresh

¹

,

Mambulasa

²

,

Ngutwa

³

et al. 2023

Preprint

0

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Background Persistently elevated rates of maternal and infant mortality and morbidities in Malawi indicate the need for increased quality of maternal and well-child care services. The first-year postpartum sets the stage for long-term health for the childbearing parent and infant. Integrated group postpartum and well-child care may improve maternal and infant health outcomes. The purpose of this study was to examine implementation outcomes for this model of care. Methods We used mixed methods to examine implementation outcomes of integrated group postpartum and well-child care. We piloted sessions at three clinics in Blantyre District, Malawi. During each session we evaluated fidelity using a structured observation checklist. At the end of each session, we administered three surveys to health care workers and women participants, the Acceptability of Intervention Measure, the Intervention Appropriateness Measure, and the Feasibility of Intervention Measure. Focus groups were conducted to gain greater understanding of people’s experience with and evaluation of the model. Results Forty-one women with their infants participated in group sessions. Nineteen health care workers across the three clinics co-facilitated group sessions, 9 midwives and 10 health surveillance assistants. Each of the 6 sessions was tested once at each clinic for a total of 18 pilot sessions. Both women and health care workers reported group postpartum and well-child care was highly acceptable, appropriate, and feasible across clinics. Fidelity to the group care model was high. During each session as part of structured observation the research team noted common health issues, the most common one among women was high blood pressure and among infants was flu-like symptoms. The most common services received within the group space was family planning and infant vaccinations. Women reported gaining knowledge from health promotion group discussions and activities. There were some challenges implementing group sessions. Conclusion We found that clinics in Blantyre District, Malawi were able to implement group postpartum and well-child care with fidelity and that it was highly acceptable, appropriate, and feasible to women and health care workers. Due to these promising results, we recommend future research examine the effectiveness of the model on maternal and child health outcomes.

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“…Pooled prevalence rates of up to 34% in the antenatal period and 25.8% in the postnatal period were reported in systematic reviews of studies conducted in LMICs [ 3 , 7 ]. A recent systematic review of studies conducted in Malawi reported pooled prevalence of antenatal and postnatal depression of 17.1% and 19.8% respectively with an overall prevalance of perinatal depression of 18.9% [ 8 ]. A mother’s mental and psychological wellbeing is highly significant for her child’s wellbeing especially during the first 3 years when the child is most highly dependent on her care [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Piloting a psychosocial intervention for perinatal depression, the Thinking Healthy Programme–Peer delivered (THPP), in a primary care setting in Lilongwe District, Malawi

Ng’oma,

Atif,

Meltzer-Brody

et al. 2024

PLOS Glob Public Health

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Despite the evidence for the effectiveness of psychosocial interventions for perinatal depression, their uptake is low in Low- and Middle-Income Countries. Reasons for this include the lack of contextually adapted interventions and mental health specialists to deliver them. This study aimed to test the acceptability and feasibility of a psychosocial intervention for perinatal depression, the Thinking Healthy Programme–Peer Delivered, adapted for use in rural Malawi. A multi-method evaluation of feasibility and acceptability of the intervention was conducted using a one-group pretest-posttest quasi-experimental design and an exploratory qualitative study. Pre-post intervention change in depression scores (paired t-test) and recruitment, retention and session adherence rates were calculated. Qualitative data were collected through 29 in-depth interviews (22 mothers and 7 peer volunteers) and 1 Focus Group Discussion (18 mothers). Thematic analysis approach was used to analyse qualitative data. Seven (7) out of 8 peer volunteers were successfully trained to deliver the intervention. A total of 31 pregnant women with Edinburgh Postnatal Depression Scale (EPDS) score ≥12 were offered intervention, of whom 24 were enrolled (recruitment rate 77.4%). Out of these 24 women, 22 completed the intervention (retention rate 91.6%). Mean difference between pre- and post-test EPDS scores one week after 8th session was 7.59 (95% CI 4.98 to 10.19), p<0.001. Qualitative evaluation showed that the intervention was acceptable despite some challenges including stigma and issues around incentivization of peer volunteers. The Thinking Healthy Programme–Peer Delivered, adapted for use in Malawi, was feasible to deliver and acceptable to its target population. The intervention may be useful in management of perinatal depression in primary care settings in Malawi. However, definitive trials are needed to evaluate its effectiveness.

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Evaluation of implementation outcomes of an integrated group postpartum and well-child care model at clinics in Malawi

Gresh

¹

,

Mambulasa

²

,

Ngutwa

³

et al. 2023

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background Persistently elevated rates of maternal and infant mortality and morbidities in Malawi indicate the need for increased quality of maternal and well-child care services. The first-year postpartum sets the stage for long-term health for the childbearing parent and infant. Integrated group postpartum and well-child care may improve maternal and infant health outcomes. The purpose of this study was to examine implementation outcomes for this model of care. Methods We used mixed methods to examine implementation outcomes of integrated group postpartum and well-child care. We piloted sessions at three clinics in Blantyre District, Malawi. During each session we evaluated fidelity using a structured observation checklist. At the end of each session, we administered three surveys to health care workers and women participants, the Acceptability of Intervention Measure, the Intervention Appropriateness Measure, and the Feasibility of Intervention Measure. Focus groups were conducted to gain greater understanding of people’s experience with and evaluation of the model. Results Forty-one women with their infants participated in group sessions. Nineteen health care workers across the three clinics co-facilitated group sessions, 9 midwives and 10 health surveillance assistants. Each of the 6 sessions was tested once at each clinic for a total of 18 pilot sessions. Both women and health care workers reported group postpartum and well-child care was highly acceptable, appropriate, and feasible across clinics. Fidelity to the group care model was high. During each session as part of structured observation the research team noted common health issues, the most common one among women was high blood pressure and among infants was flu-like symptoms. The most common services received within the group space was family planning and infant vaccinations. Women reported gaining knowledge from health promotion group discussions and activities. There were some challenges implementing group sessions. Conclusion We found that clinics in Blantyre District, Malawi were able to implement group postpartum and well-child care with fidelity and that it was highly acceptable, appropriate, and feasible to women and health care workers. Due to these promising results, we recommend future research examine the effectiveness of the model on maternal and child health outcomes.

show abstract

Systematic review on the prevalence of perinatal depression in Malawi

Cited by 4 publications

References 47 publications

Evaluation of implementation outcomes of an integrated group postpartum and well-child care model at clinics in Malawi

Evaluation of implementation outcomes of an integrated group postpartum and well-child care model at clinics in Malawi

Piloting a psychosocial intervention for perinatal depression, the Thinking Healthy Programme–Peer delivered (THPP), in a primary care setting in Lilongwe District, Malawi

Evaluation of implementation outcomes of an integrated group postpartum and well-child care model at clinics in Malawi

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