Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

Quality of perinatal depression care in primary care setting in Nigeria

Authors: Olatunde O. Ayinde, Bibilola D. Oladeji, Jibril Abdulmalik, Keely Jordan, Lola Kola, Oye Gureje

Published in: BMC Health Services Research | Issue 1/2018

Login to get access

Abstract

Background

Even though integrating mental health into maternal and child health (MCH) is widely accepted as a means of closing the treatment gap for maternal mental health conditions in low- and middle-income countries (LMIC), there are not many studies on the quality of the currently available mental health care for mothers in these countries. This study assessed the existing organization of service for maternal mental health, the actual care delivered for perinatal depression, as well as the quality of the care received by affected women presenting to primary care clinics in Ibadan, Nigeria.

Methods

The Assessment of Chronic Illness Care (ACIC) tool was administered to the staff in 23 primary maternal care clinics and key informant interviews were conducted with 20 facility managers to explore organizational and administrative features relevant to the delivery of maternal mental health care in the facilities. Detection rate of perinatal depression by maternal care providers was assessed by determining the proportion of depressed antenatal women identified by the providers. The women were then followed up from the antenatal period up until 6 months after childbirth to track their experience with care received.

Results

All the facilities had ACIC domain scores indicating poor capacity to offer quality chronic care. Emerging themes from the interviews included severe manpower shortage and absence of administrative and clinical support for manpower training and care provision. Only 31 of the 218 depressed women had been identified by the maternal care providers as having a psychological problem throughout the follow-up period. In spite of the objective evidence of inadequate care, most of the perinatal women rated the service provided in the facilities as being of good quality (96%) and reported being satisfied with the care received (98%).

Conclusion

There are major inadequacies in the organisational and administrative profile of these primary maternal care facilities that militate against the provision of quality chronic care. These inadequacies translate to a large treatment gap for women with perinatal depression. Lack of awareness by service users of what constitutes good quality care, indicative of low service expectation, may hamper user-driven demand for quality improvement.
Literature
1.
World Health Organisation. The global burden of disease: 2004 update. Geneva; 2008.
2.
Gelaye B, Rondon M, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry. 2016;3:973–82.CrossRefPubMedPubMedCentral
3.
Aderibigbe YA, Gureje O. The validity of the 28-item general health questionnaire in a Nigerian antenatal clinic. Soc Psychiatry Psychiatr Epidemiol. 1992;27:280–3.PubMed
4.
Abiodun OA. Postnatal depression in primary care populations in Nigeria. Gen Hosp Psychiatry. 2006;28:133–6.CrossRefPubMed
5.
Adewuya AO, Ola BA, Aloba OO, Dada AO, Fasoto OO. Prevalence and correlates of depression in late pregnancy among Nigerian women. Depress Anxiety. 2007;24:15–21.CrossRefPubMed
6.
Aderibigbe YA, Gureje O, Omigbodun O. Postnatal emotional disorders in Nigerian women. A study of antecedents and associations. Br J Psychiatry. 1993;163:645–50.CrossRefPubMed
7.
Uwakwe R, Okonkwo JEN. Affective (depressive) morbidity in puerperal Nigerian women: validation of the Edinburgh postnatal depression scale. Acta Psychiatr Scand. 2003;107:251–9.CrossRefPubMed
8.
Rahman A, Iqbal Z, Bunn J, Lovel H, Harrington R. Impact of maternal depression on infant nutritional status and illness: a cohort study. Arch Gen Psychiatry. 2004;61:946–52.CrossRefPubMed
9.
Patel V, Ramasundarahettige C, Vijayakumar L, Thakur J, Gajalakshmi V, Gururaj G, et al. Suicide mortality in India: a nationally representative survey. Lancet. 2012;379:2343–51.CrossRefPubMedPubMedCentral
10.
Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, et al. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384:1800–19.CrossRefPubMed
11.
Wachs TD, Black MM, Engle PL. Maternal depression: a global threat to children’s health, development, and behavior and to human rights. Child Dev Perspect. 2009;3:51–9.CrossRef
12.
Pearson RM, Evans J, Kounali D, Lewis G, Heron J, Ramchandani PG, et al. Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years. JAMA Psychiatry. 2013;70:1312.CrossRefPubMedPubMedCentral
13.
van den Broek NR, Graham WJ. Quality of care for maternal and newborn health: the neglected agenda. BJOG. 2009;116(Suppl 1):18–21.CrossRefPubMed
14.
Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091–110.CrossRefPubMed
15.
Graham WJ, Varghese B. Quality, quality, quality: gaps in the continuum of care. Lancet. 2012;379:e5–6.CrossRefPubMed
16.
Thornicroft G. Stigma and discrimination limit access to mental health care. Epidemiol Psichiatr Soc. 2008;17:14–9.CrossRefPubMed
17.
18.
Knaak S, Patten S, Ungar T. Mental illness stigma as a quality-of-care problem. Lancet Psychiatry. 2015;2:863–4.CrossRefPubMed
19.
Adeponle A, Groleau D, Kola L, Kirmayer LJ, Gureje O. Perinatal depression in Nigeria: perspectives of women, family caregivers and health care providers. Int J Ment Health Syst. 2017;11:27.CrossRefPubMedPubMedCentral
20.
21.
22.
Kates N, Mach M. Chronic disease management for depression in primary care: a summary of the current literature and implications for practice. Can J Psychiatr. 2007;52:77–85.CrossRef
23.
Tylee A, Walters P. We need a chronic disease management model for depression in primary care. Br J Gen Pract. 2007;57:348–50.PubMedPubMedCentral
24.
Wagner E, Glasgow R, Davis C, Bonomi A, Provost L, McCulloch D, et al. Quality improvement in chronic illness care: a collaborative approach. Jt Comm J Qual Improv. 2001;27:63–80.PubMed
25.
Gureje O, Oladeji BD, Araya R, Montgomery AA. A cluster randomized clinical trial of a stepped care intervention for depression in primary care (STEPCARE)- study protocol. BMC Psychiatry. 2015;15:148.CrossRefPubMedPubMedCentral
26.
Bonomi AE, Wagner EH, Glasgow RE, VonKorff M. Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Health Serv Res. 2002;37:791–820.CrossRefPubMedPubMedCentral
27.
Parchman ML, Zeber JE, Romero RR, Pugh JA. Risk of coronary artery disease in type 2 diabetes and the delivery of care consistent with the chronic care model in primary care settings: a STARNet study. Med Care. 2007;45:1129–34.CrossRefPubMed
28.
Cox J, Holden J, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry. 1987;150:782.CrossRefPubMed
29.
Adewuya AO, Ola BA, Dada AO, Fasoto OO. Validation of the Edinburgh postnatal depression scale as a screening tool for depression in late pregnancy among Nigerian women. J Psychosom Obstet Gynaecol. 2006;27:267–72.CrossRefPubMed
30.
Bonilla-Chacin M, Okigbo A, Malife N, Sherburne-Benz L, Ruhl O. Improving primary health care delivery in Nigeria: evidence from four states. Washington, DC: World Bank; 2010.
31.
Federal Ministry of Health, Nigeria. National Strategic Health Care Development Plan 2010-2015. Abuja; 2010.
32.
33.
Hearn G, Iliff A, Jones I, Kirby A, Ormiston P, Parr P, et al. Postnatal depression in the community. Br J Gen Pract. 1998;48:1064–6.PubMedPubMedCentral
34.
Araya R, Lewis GH, Rojas G, Mann AH. “Patient knows best”—detection of common mental disorders in Santiago, Chile: cross sectional study. BMJ. 2001;322:79–81.CrossRefPubMedPubMedCentral
35.
Fekadu A, Medhin G, Selamu M, Giorgis TW, Lund C, Alem A, et al. Recognition of depression by primary care clinicians in rural Ethiopia. BMC Fam Pract. 2017;18:56.CrossRefPubMedPubMedCentral
36.
Jenkins R, Kiima D, Njenga F, Okonji M, Kingora J, Kathuku D, et al. Integration of mental health into primary care in Kenya. World Psychiatry. 2010;9:118–20.CrossRefPubMedPubMedCentral
37.
Udedi M. The prevalence of depression among patients and its detection by primary health care workers at Matawale health Centre (Zomba). Malawi Med J. 2014;26:34–7.PubMedPubMedCentral
38.
Omigbodun OO. A cost-effective model for increasing access to mental health Care at the Primary Care Level in Nigeria. J Ment Health Policy Econ. 2001;4:133–9.PubMed
39.
Ngui EM, Khasakhala L, Ndetei D, Roberts LW. Mental disorders, health inequalities and ethics: a global perspective. Int Rev Psychiatr. 2010;22:235–44.CrossRef
40.
41.
World Health Organization, UNICEF. Report of the International Conference on Primary Health Care Alma-Ata, USSR, 6–12 September 1979. 1979.
42.
Porter M, Macintyre S. What is, must be best: a research note on conservative or deferential responses to antenatal care provision. Soc Sci Med. 1984;19:1197–200.CrossRefPubMed
43.
Mendoza Aldana J, Piechulek H, Al-Sabir A. Client satisfaction and quality of health care in rural Bangladesh. Bull World Health Organ. 2001;79:512–7.PubMedPubMedCentral
Metadata
Title
Quality of perinatal depression care in primary care setting in Nigeria
Authors
Olatunde O. Ayinde
Bibilola D. Oladeji
Jibril Abdulmalik
Keely Jordan
Lola Kola
Oye Gureje
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3716-3

Other articles of this Issue 1/2018

BMC Health Services Research 1/2018 Go to the issue

Research article

Development of mental health indicators at the district level in Madhya Pradesh, India: mixed methods study

Research article

Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia

Research article

Organizational conditions for engagement in quality and safety improvement: a longitudinal qualitative study of community pharmacies

Research article

Health financing strategies to reduce out-of-pocket burden in India: a comparative study of three states

Research article

Factors associated with self-care practice among adult diabetes patients in West Shoa Zone, Oromia Regional State, Ethiopia

Research article

When, where and who? Accessing health facility delivery care from the perspective of women and men in Tanzania: a qualitative study