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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

Maternal mental health in primary care in five low- and middle-income countries: a situational analysis

Authors: Emily C. Baron, Charlotte Hanlon, Sumaya Mall, Simone Honikman, Erica Breuer, Tasneem Kathree, Nagendra P. Luitel, Juliet Nakku, Crick Lund, Girmay Medhin, Vikram Patel, Inge Petersen, Sanjay Shrivastava, Mark Tomlinson

Published in: BMC Health Services Research | Issue 1/2016

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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.
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Metadata
Title
Maternal mental health in primary care in five low- and middle-income countries: a situational analysis
Authors
Emily C. Baron
Charlotte Hanlon
Sumaya Mall
Simone Honikman
Erica Breuer
Tasneem Kathree
Nagendra P. Luitel
Juliet Nakku
Crick Lund
Girmay Medhin
Vikram Patel
Inge Petersen
Sanjay Shrivastava
Mark Tomlinson
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1291-z

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