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Asarnow LD, Norwood PP, Christodoulou J, Tomlinson M, Rotheram-Borus MJ. The Concurrent and Longitudinal Relationship between Perinatal Sleep Difficulties and Depression in a Large Sample of High-Risk Women in South Africa. Matern Child Health J 2024; 28:700-707. [PMID: 38110851 DOI: 10.1007/s10995-023-03850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Perinatal depression and sleep difficulties are common among studies conducted in high income countries (HIC). This study examines the relationship between sleep difficulties and depression during the perinatal period and over an eight-year follow-up period in South Africa, a middle income country. METHOD A population cohort of 1238 pregnant women (mean age = 26.33) in 24 township neighborhoods in South Africa were recruited and reassessed six times over the next 8 years post birth with follow-up rates of 96-83%. The relationship between maternal depressed mood and sleep difficulties was examined over time, as well as the relationship of sleep with other socioeconomic, environmental, and psychiatric risk factors. RESULTS Thirty-five percent of the women reported sleep difficulties during the perinatal period; whereas only 8% reported sleep difficulties at 8-year follow-up. Perinatal sleep difficulties were associated with lower income, lower educational attainment, less access to electricity, more food insecurity, higher rates of interpersonal violence and HIV, alcohol consumption, and depressed mood at 8 years. However, the severity of depressed mood was the strongest predictor of sleep problems longitudinally and cross-sectionally, after accounting for all other risk factors. CONCLUSIONS We found that the severity of depressed mood is highly associated with sleep difficulties from pregnancy to 8 years post-birth and in a linear relationship, so that higher depressed mood is associated with more sleep problems. TRIAL REGISTRATION ClinicalTrials.gov registration: # NCT00996528.
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Affiliation(s)
- L D Asarnow
- Department of Psychiatry & Behavioral Science, University of California, San Francisco, USA.
| | - P P Norwood
- Semel Institute Center for Community Health, University of California, Los Angeles, USA
| | - J Christodoulou
- Department of Psychology, Palo Alto University, Palo Alto, USA
| | - M Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - M J Rotheram-Borus
- Semel Institute Center for Community Health, University of California, Los Angeles, USA
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Mhango W, Michelson D, Gaysina D. "I felt I needed help, but I did not get any": A multiple stakeholder qualitative study of risk and protective factors, and barriers to addressing common mental health problems among perinatal adolescents in Malawi. Glob Ment Health (Camb) 2023; 10:e73. [PMID: 38024806 PMCID: PMC10663692 DOI: 10.1017/gmh.2023.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/26/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Common mental health problems (particularly depression and anxiety) are common among adolescents during the perinatal period. Previous research has identified the distinctive needs of this group and called for contextually appropriate psychosocial interventions. The current study conducted in Malawi aimed to explore risk and protective factors for common mental health problems, and barriers to accessing mental health care, among perinatal adolescents, to develop a contextually relevant intervention for preventing and treating perinatal depression and anxiety. An exploratory qualitative study was conducted in antenatal and postnatal clinics in Zomba district, Malawi in January-March 2022. In-depth individual interviews were completed with perinatal adolescents aged ≤19 (n = 14); their family members (n = 4); and healthcare workers (n = 8). Interview data were subjected to thematic framework analysis. Data were organised around two themes: "psychosocial risk and protective factors" (potential causes of common mental health problems among adolescents); and "health care services" (maternal and mental health services available, and adolescents' experiences of using these services). Interventions need to go beyond targeting symptoms of depression and anxiety to addressing the wider contextual risk factors and barriers to care at the different socioecological levels.
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Affiliation(s)
- Wezi Mhango
- School of Psychology, University of Sussex, Brighton, UK
- Department of Psychology and Medical Humanities, University of Malawi, Zomba, Malawi
| | - Daniel Michelson
- School of Psychology, University of Sussex, Brighton, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Darya Gaysina
- School of Psychology, University of Sussex, Brighton, UK
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3
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le Roux SM, Abrams EJ, Zerbe A, Phillips TK, Myer L. Children of a syndemic: co-occurring and mutually reinforcing adverse child health exposures in a prospective cohort of HIV-affected mother-infant dyads in Cape Town, South Africa. J Int AIDS Soc 2023; 26 Suppl 4:e26152. [PMID: 37909170 PMCID: PMC10618899 DOI: 10.1002/jia2.26152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/14/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Several HIV-related syndemics have been described among adults. We investigated syndemic vulnerability to hazardous drinking (HD), intimate partner violence (IPV) and household food insecurity (HFIS) in breastfed children born without HIV in urban South Africa. We compared those who were perinatally HIV exposed (CHEU) to those who were not (CHU), under conditions of universal maternal antiretroviral therapy (ART) and breastfeeding. METHODS A prospective cohort of pregnant women living with HIV (WLHIV), and without HIV, were enrolled and followed with their infants for 12 months postpartum (2013-2017). All WLHIV initiated antenatal efavirenz-based ART. Measurements of growth (∼3 monthly), infectious cause hospitalisation, ambulatory childhood illness (2-week recall) and neurodevelopment (BSID-III, measured at ∼12 months' age) were compared across bio-social strata using generalised linear regression models, with interaction terms; maternal data included interview-based measures for HD (AUDIT-C), IPV (WHO VAW) and HFIS. RESULTS Among 872 breastfeeding mother-infant pairs (n = 461 CHEU, n = 411 CHU), WLHIV (vs. HIV negative) reported more unemployment (279/461, 60% vs. 217/411, 53%; p = 0.02), incomplete secondary education (347/461, 75% vs. 227/411, 55%; p < 0.0001), HD (25%, 117/459 vs. 7%, 30/411; p < 0.0001) and IPV (22%, 101/457 vs. 8%, 32/411; p < 0.0001) at enrolment; and HFIS at 12 months (45%, 172/386 vs. 30%, 105/352; p > 0.0001). There were positive interactions between maternal HIV and other characteristics. Compared to food secure CHU, the mean difference (95% CI) in weight-for-age Z-score (WAZ) was 0.06 (-0.14; 0.25) for food insecure CHU; -0.26 (-0.42; -0.10) for food secure CHEU; and -0.43 (-0.61; -0.25), for food insecure CHEU. Results were similar for underweight (WAZ < -2), infectious-cause hospitalisation, cognitive and motor delay. HIV-IPV interactions were evident for ambulatory diarrhoea and motor delay. There were HIV-HD interactions for odds of underweight, stunting, cognitive and motor delay. Compared to HD-unexposed CHU, the odds ratios (95% CI) of underweight were 2.31 (1.11; 4.82) for HD-exposed CHU; 3.57 (0.84; 15.13) for HD-unexposed CHEU and 6.01 (2.22; 16.22) for HD-exposed CHEU. CONCLUSIONS These data suggest that maternal HIV-related syndemics may partly drive excess CHEU health risks, highlighting an urgent need for holistic maternal and family care and support alongside ART to optimise the health of CHEU.
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Affiliation(s)
- Stanzi M le Roux
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Elaine J Abrams
- Mailman School of Public Health, ICAP at Columbia University, Columbia University, New York, New York, USA
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
| | - Allison Zerbe
- Mailman School of Public Health, ICAP at Columbia University, Columbia University, New York, New York, USA
| | - Tamsin K Phillips
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
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Hirve R, Adams C, Kelly CB, McAullay D, Hurt L, Edmond KM, Strobel N. Effect of early childhood development interventions delivered by healthcare providers to improve cognitive outcomes in children at 0-36 months: a systematic review and meta-analysis. Arch Dis Child 2023; 108:247-257. [PMID: 36732037 DOI: 10.1136/archdischild-2022-324506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/07/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the effect of early childhood development interventions delivered by healthcare providers (HCP-ECD) on child cognition and maternal mental health. DESIGN Systematic review, meta-analysis. SETTING Healthcare setting or home. PARTICIPANTS Infants under 1 month of age. INTERVENTIONS HCP-ECD interventions that supported responsive caregiving, early learning and motor stimulation. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, Database of Abstracts of Reviews of Effects and Cochrane Database of Systematic Reviews were searched until 15 November 2021. Studies reporting prespecified outcomes were pooled using standard meta-analytical methods. MAIN OUTCOME MEASURES Cognitive development in children at 0-36 months. RESULTS Forty-two randomised controlled trials with 15 557 infants were included in the narrative synthesis. Twenty-seven trials were included in the meta-analyses. Pooled data from 13 trials suggest that HCP-ECD interventions may improve cognitive outcomes in children between 0 and 36 months (Bayley Scales of Infant Development version IIII (BSID-III) mean difference (MD) 2.65; 95% CI 0.61 to 4.70; 2482 participants; low certainty of evidence). Pooled data from nine trials suggest improvements in motor development (BSID-III MD 4.01; 95% CI 1.54 to 6.48; 1437 participants; low certainty of evidence). There was no evidence of improvement in maternal mental health (standardised MD -0.13; 95% CI -0.28 to 0.03; 2806 participants; 11 trials; low certainty of evidence). CONCLUSIONS We report promising evidence, particularly for cognitive and motor outcomes, of the effect of HCP-ECD interventions. However, effect sizes were small, and the certainty of evidence ranged from very low to moderate. Additional high-quality research is required. PROSPERO REGISTRATION NUMBER CRD42019122021.
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Affiliation(s)
- Raeena Hirve
- Women and Children's Health, King's College London, London, UK
| | - Claire Adams
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Clare B Kelly
- Women and Children's Health, King's College London, London, UK
| | - Daniel McAullay
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Lisa Hurt
- Population Medicine, Cardiff University, Cardiff, UK
| | - Karen M Edmond
- Women and Children's Health, King's College London, London, UK
| | - Natalie Strobel
- Edith Cowan University, Joondalup, Western Australia, Australia
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McKimmy C, Levy J, Collado A, Pinela K, Dimidjian S. The Role of Latina Peer Mentors in the Implementation of the Alma Program for Women With Perinatal Depression. QUALITATIVE HEALTH RESEARCH 2023; 33:359-370. [PMID: 36794992 DOI: 10.1177/10497323231154369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This study examines the role that compañeras (peer mentors) play in the implementation of a program, Alma, which was designed to support Latina mothers who are experiencing depression during pregnancy or early parenting and implemented in the rural mountain West of the United States. Drawing from the fields of dissemination and implementation and Latina mujerista (feminist) scholarship, this ethnographic analysis demonstrates how the Alma compañeras facilitate the delivery of Alma by creating and inhabiting intimate mujerista spaces with other mothers and create relationships of mutual and collective healing in the context of relationships de confianza (of trust and confidence). We argue that these Latina women, in their capacity as compañeras, draw upon their cultural funds of knowledge to bring Alma to life in ways that prioritizes flexibility and responsiveness to the community. Shedding light on contextualized processes by which Latina women facilitate the implementation of Alma illustrates how the task-sharing model is well suited to the delivery of mental health services for Latina immigrant mothers and how lay mental health providers can be agents of healing.
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Affiliation(s)
- Caitlin McKimmy
- Renée Crown Wellness Institute, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Joseph Levy
- Renée Crown Wellness Institute, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Anahi Collado
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, USA
| | | | - Sona Dimidjian
- Renée Crown Wellness Institute, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
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Honda T, Tran T, Popplestone S, Draper CE, Yousafzai AK, Romero L, Fisher J. Parents’ mental health and the social-emotional development of their children aged between 24 and 59 months in low-and middle-income countries: A systematic review and meta-analyses. SSM - MENTAL HEALTH 2023. [DOI: 10.1016/j.ssmmh.2023.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Examining maternal depression, birthweight and linear growth: Findings from the South African National Income Dynamics Study. SOUTH AFRICAN JOURNAL OF CHILD HEALTH 2022. [DOI: 10.7196/sajch.2022.v16i4.1875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background. Literature is inconclusive regarding an association between maternal depression, low birthweight (LBW) and stunting in early childhood. While some studies have found an association, others have not. Maternal food insecurity is a risk factor for both maternal depression and reduced linear growth in early childhood.
Objective. This study examined the relationship between maternal depression, food insecurity, LBW and stunting in the first five years of life. The study employed longitudinal data of South African women and children from the National Income Dynamics Study (NIDS).
Methods. Mothers were classified into four groups: food insecure and depressed; food insecure only; depressed only; and neither food insecure nor depressed. During data collection, 22% of women were pregnant and the remaining 78% were pre-conception. The primary outcomes were low birthweight and height-for-age (HAZ) scores. Generalised Linear Mixed Effects (GLME) models were used to account for women having more than one child. GLME models with a Gaussian link function were used to compare mean differences in birthweight and HAZ scores. Multivariable regression models were used to examine factors associated with depression.
Results. Food insecurity was significantly associated with depression among pre-conceptional and pregnant women. There was no statistically significant difference in birthweight or linear growth across groups, but this may be influenced by proximity of depression measurement in relation to outcomes.
Conclusion. Food insecurity is a potentially modifiable risk factor for depression and may be a confounding factor in studies that have found associations between depression and child health outcomes.
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Pinheiro RT, Souza LDDM, Trettim JP, de Matos MB, Pinheiro KAT, da Cunha GK, Rubin BB, Scholl CC, Stigger RS, Motta JVDS, de Oliveira SS, Ghisleni G, Nedel F, Quevedo LDA. Antenatal depression: Efficacy of a pre-post therapy study and repercussions in motor development of children during the first 18 months postpartum. Study: "Pregnancy care, healthy baby". J Psychiatr Res 2022; 148:63-72. [PMID: 35121270 PMCID: PMC8968217 DOI: 10.1016/j.jpsychires.2022.01.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/14/2021] [Accepted: 01/26/2022] [Indexed: 11/18/2022]
Abstract
AIMS To evaluate the efficacy of brief psychotherapeutic interventions of cognitive behavioral therapy to treat antenatal depression and verify the association between interventions and motor development of infants at 3 and 18 months of age. METHODS Pre-post-intervention study nested a randomized clinical trial, both of which are extracts from a population-based cohort study of a southern Brazilian city. The major depressive episode was measured through Mini Plus, the severity of depressive symptoms by BDI-II and motor development using Bayley-III and AIMS. The follow-ups occurred during the gestational period (T2) and at 3 (T3) and 18 months (T4) after delivery. RESULTS Data were analyzed from 336 women in the control group (not intervened) and 108 from the group of depressed women who received intervention for antenatal depression. The effectiveness of the interventions for a major depressive episode was around 80% for both models in the two follow-up stages (3 and 18 months postpartum). In addition, the children whose mothers received intervention presented 3.7 (95% CI 0.7-6.6) points higher in Bayley-III at 3 months old when compared to the children in the control group (p = 0.01). There was no difference between the two psychotherapy models tested, both being equally effective (p > 0.05). CONCLUSIONS We found that the brief psychotherapeutic interventions of cognitive behavioral therapy for gestational depression were effective in causing remission of the condition both in the short and long term, besides indirectly causing benefits also to the children, with regard to their motor development.
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Acheanpong K, Pan X, Kaminga AC, Liu A. Prevalence and risk factors of prenatal depression among pregnant women attending antenatal clinic at Adventist Hospital, Bekwai Municipality, Ghana. Medicine (Baltimore) 2022; 101:e28862. [PMID: 35451379 PMCID: PMC8913126 DOI: 10.1097/md.0000000000028862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/31/2022] [Indexed: 01/04/2023] Open
Abstract
Depression, arising in the perinatal period are a major health issue in low- and middle-income countries. However, little attention has been paid in the research of depression symptoms. This study aimed to estimate the prevalence and risk factors of depression during pregnancy.A cross-sectional study was conducted in pregnant women attending antenatal clinic at Adventist Hospital in the Bekwai Municipality, Ghana, between February and May 2020. Information on sociodemographic, medical, and obstetric factors were collected from the antenatal booklet and prenatal depression symptoms was defined as a patient health questionnaire scores ≥10. Descriptive statistics, Chi-Squared test, and Fisher exact test were used to analyze dichotomous variables. Multivariate logistic regression model was applied to estimate the adjusted odds ratios (AOR) and 95% confidence interval (95% confidence interval [CI]) for risk factors associated with prenatal depression. All statistical analyses were performed using SPSS version 20.0.The prevalence of prenatal depression in this study was 26.9% (95% CI; 24.6%-29.2%). Advance maternal age ≥35years (AOR = 1.49, 95% CI 1.05-2.11, P < .026) and low educational attainment (AOR 2.15, 95% CI 1.23-2.34, P < .007) were significantly higher among women with parental depression compared with maternal age <35years and higher educational attainment respectively. Similarly, nulliparous women (AOR = 4.93, 95% CI 1.60-15.16, P < .005), primiparous women (AOR = 5.42, 95% CI 1.76-16.71, P < .003) and multiparous women (AOR = 4.79, 95% CI 1.61-14.22, P < .005) were significantly higher among women with parental depression compared with grand multiparous woman (≥7 deliveries). Finally, prenatal depression was found to be significantly associated with hypertension in pregnancy (AOR = 1.71, 95% CI: 1.12-2.60, P < .013).Depression during pregnancy is high in the study area and is significantly associated with advance maternal age, low educational attainment, parity less than 7 deliveries, and hypertension during pregnancy.
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Affiliation(s)
- Kwabena Acheanpong
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha Hunan, China
- Department of Public Health, Adventist University of Africa, Kenya
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xiongfeng Pan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha Hunan, China
| | - Atipasa Chiwanda Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha Hunan, China
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha Hunan, China
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Costs of common perinatal mental health problems in South Africa. Glob Ment Health (Camb) 2022; 9:429-438. [PMID: 36618755 PMCID: PMC9806980 DOI: 10.1017/gmh.2022.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Perinatal mental health problems, defined as mental health problems occurring from the start of pregnancy to one year after birth, substantially affect women's and children's quality of life in low- and middle-income countries. In South Africa, despite high prevalence and documented negative impacts, most women do not receive any care. METHODS A modelling study examined the costs of perinatal mental health problems, namely depression and anxiety, for a hypothetical cohort of women and their children in South Africa over part of their life course (10 years for women, 40 years for children). In sensitivity analysis, additional impacts of post-traumatic stress disorder (PTSD) and completed suicide were included. Data sources were published findings from cohort studies, as well as epidemiological and economic data from South Africa. Data from international studies were considered where no data from South Africa were available. RESULTS Lifetime costs of perinatal depression and anxiety in South Africa amount to USD 2.8 billion per annual cohort of births. If the impacts of PTSD and suicide are included, costs increase to USD 2.9 billion. This includes costs linked to losses in quality of life (USD 1.8 billion), losses in income (USD 1.1 billion) and public sector costs (USD 3.5 million). CONCLUSIONS Whilst important progress has been made in South Africa with regards to mental health policies and interventions that include assessment and management of perinatal mental health problems, substantial underinvestment prevents progress. Findings from this study strengthen the economic case for investing in perinatal mental health care.
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11
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Helova A, Onono M, Abuogi LL, Hampanda K, Owuor K, Odwar T, Krishna S, Odhiambo G, Odeny T, Turan JM. Experiences, perceptions and potential impact of community-based mentor mothers supporting pregnant and postpartum women with HIV in Kenya: a mixed-methods study. J Int AIDS Soc 2021; 24:e25843. [PMID: 34797955 PMCID: PMC8604379 DOI: 10.1002/jia2.25843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Community‐based mentor mothers (cMMs) are women living with HIV who provide peer support to pregnant/postpartum women living with HIV (PWLWH) to enhance antiretroviral therapy (ART) adherence, retention in care and prevent perinatal transmission of HIV. The goal of this study was to explore the experiences, perceptions, mechanisms and health impact of cMMs on PWLWH in Kenya from the perspective of cMMs. Methods We conducted a prospective mixed‐methods study in southwestern Kenya in 2015–2018. In the qualitative phase, we completed in‐depth interviews with cMMs to explore their perceptions and experiences in supporting PWLWH. Transcripts were broad‐coded according to identified themes, then fine‐coded using an inductive approach. In the quantitative phase, we analysed medical record data from PWLWH who were randomized in the cMM intervention to examine the impact of cMM visits on optimal prevention of mother‐to‐child transmission (PMTCT). We used cluster‐adjusted generalized estimating equation models to examine relationships with a composite outcome (facility delivery, infant HIV testing, ART adherence and undetectable viral load at 6 weeks postpartum). Finally, qualitative and quantitative results were integrated. Results Convergence of findings from cMM interviews (n = 24) and PWLWH medical data (n = 589) revealed: (1) The cMM intervention was utilized and perceived as acceptable. PWLWH received, on average, 6.2 of 8 intended home visits through 6 weeks postpartum. (2) The cMMs reported serving as role models and confidantes, supporting PWLWH's acceptance of their HIV status, providing assurances about PMTCT and assisting with male partner disclosure and communication. cMMs also described benefits for themselves, including empowerment and increased income. (3) The cMM visits supported PWLWH's completion of PMTCT steps. Having ≥4 cMM home visits up to 6 weeks postpartum, as compared to <4 visits, was associated with higher likelihood of an optimal PMTCT composite outcome (adjusted relative risk 1.42, p = 0.044). Conclusions We found that peer support from cMMs during pregnancy through 6 weeks postpartum was associated with improved uptake of critical PMTCT services and health behaviours and was perceived as beneficial for cMMs themselves. CMM support of PWLWH may be valuable for other low‐resource settings to improve engagement with lifelong ART and HIV services among PWLWH.
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Affiliation(s)
- Anna Helova
- Department of Health Care Organization and Policy and Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maricianah Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lisa L Abuogi
- Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Karen Hampanda
- Department of Obstetrics and Gynecology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kevin Owuor
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tobias Odwar
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sandhya Krishna
- Department of Health Care Organization and Policy and Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Thomas Odeny
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy and Sparkman Center for Global Health, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Stansert Katzen L, le Roux KW, Almirol E, Hayati Rezvan P, le Roux IM, Mbewu N, Dippenaar E, Baker V, Tomlinson M, Rotheram-Borus MJ. Community health worker home visiting in deeply rural South Africa: 12-month outcomes. Glob Public Health 2021; 16:1757-1770. [PMID: 33091320 DOI: 10.1080/17441692.2020.1833960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
Home visiting by community health workers (CHW) improves child outcomes in efficacy trials, there is however limited evidence of impact evaluating CHW programmes when operating outside of a research project. A CHW programme, previously demonstrated efficacious in a peri-urban township, was evaluated in a deeply rural context in a non-randomised comparative cohort study. Two non-contiguous, rural areas in the Eastern Cape of South Africa of about equal size and density were identified and 1469 mother-infant pairs were recruited over 33 months. In one area, CHWs conducted perinatal home visits (intervention group). Mothers in the comparison group received standard clinic care. Maternal and child outcomes were compared between the groups at one year. Mothers in the intervention group had significantly fewer depressive symptoms than mothers in the comparison group. Children of intervention mothers attained a higher proportion of their developmental milestones, compared to children in the comparison group. There were no other significant differences between mothers and children in the two groups. It is important to establish key parameters for implementing efficacious CHW programmes, especially as the numbers of CHWs are rapidly increased and are becoming critical components of task-shifting strategies of health departments in low and middle income countries (LMIC).
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Affiliation(s)
- Linnea Stansert Katzen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Zithulele Training and Research Centre, Zithulele Hospital, Eastern Cape, South Africa
| | - Karl W le Roux
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Zithulele Training and Research Centre, Zithulele Hospital, Eastern Cape, South Africa
- Department of Family Medicine, Walter Sisulu University, Mthatha, South Africa
- Primary Health Care Directorate, University of Cape Town, Cape Town, South Africa
| | - Ellen Almirol
- Department of Psychiatry & Biobehavioural Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Panteha Hayati Rezvan
- Department of Psychiatry & Biobehavioural Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Ingrid M le Roux
- Philani Maternal, Child Health and Nutrition Trust, Khayelitsha, Cape Town, South Africa
| | - Nokwanele Mbewu
- Philani Maternal, Child Health and Nutrition Trust, Khayelitsha, Cape Town, South Africa
| | - Elaine Dippenaar
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Zithulele Training and Research Centre, Zithulele Hospital, Eastern Cape, South Africa
| | - Venetia Baker
- Zithulele Training and Research Centre, Zithulele Hospital, Eastern Cape, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry & Biobehavioural Sciences, Semel Institute, University of California, Los Angeles, CA, USA
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13
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Husain N, Kiran T, Fatima B, Chaudhry IB, Husain M, Shah S, Bassett P, Cohen N, Jafri F, Naeem S, Zadeh Z, Roberts C, Rahman A, Naeem F, Husain MI, Chaudhry N. An integrated parenting intervention for maternal depression and child development in a low-resource setting: Cluster randomized controlled trial. Depress Anxiety 2021; 38:925-939. [PMID: 34010505 DOI: 10.1002/da.23169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/20/2021] [Accepted: 05/03/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Rates of depression among Pakistani mothers are high, leading to poor developmental outcomes in their children. This study tested the effectiveness of a manualized integrated parenting program; Learning through Play Plus (LTP+) for maternal depression in Karachi, Pakistan. METHODS A cluster randomized control trial conducted from January 2014 to December 2015 across 120 villages in Karachi. A total of 774 depressed mothers aged 18-44 years with children aged 0-30 months old, were included. Villages were randomized to receive LTP+ added to treatment as usual (TAU) or TAU alone. Primary outcomes were severity of maternal depression at 3 and 6 months measured by the Edinburgh Postnatal Depression Scale and child socio-emotional development at 6 months measured by the Ages and Stages Questionnaire (ASQ). Secondary outcomes included maternal anxiety, quality of life, social support, parenting competence, and knowledge about child development. RESULTS Mothers in the LTP+ group reported significantly lower depression scores compared to those in the TAU group (6.6 vs. 13.8, effect size [ES]: -7.2; 95% confidence interval [CI]: -8.2, -6.1) at 3 and 6 months (7.2 vs. 12.00; ES: -4.6; 95% CI: -5.9, -3.4). Child socio-emotional development at 6 months was significantly better in the LTP+ group on all domains of the ASQ. There were also statistically significant improvements on all secondary outcomes at 3- and 6-month follow-up. CONCLUSION In low-resource settings like Pakistan, low-cost integrated parenting interventions delivered by lay health workers can provide effective treatment for depressed mothers, leading to improvements in child development.
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Affiliation(s)
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | - Imran B Chaudhry
- University of Manchester, Manchester, UK.,Department of Psychiatry, Ziauddin University, Karachi, Pakistan
| | - Mina Husain
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sadia Shah
- University of Manchester, Manchester, UK.,Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | - Nancy Cohen
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Farhat Jafri
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Shehla Naeem
- Dow University of Health Sciences, Karachi, Pakistan
| | - Zainab Zadeh
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | | | - Farooq Naeem
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Center for Addiction and Mental Health, Toronto, Canada
| | - Muhammad Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Center for Addiction and Mental Health, Toronto, Canada
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
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14
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Gokoel AR, Abdoel Wahid F, Zijlmans WCWR, Shankar A, Hindori-Mohangoo AD, Covert HH, MacDonald-Ottevanger MS, Lichtveld MY, Harville EW. Influence of perceived stress on prenatal depression in Surinamese women enrolled in the CCREOH study. Reprod Health 2021; 18:136. [PMID: 34193196 PMCID: PMC8243817 DOI: 10.1186/s12978-021-01184-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Prenatal depression may have adverse health effects on mothers and their offspring. Perceived stress is an important risk factor for depression during pregnancy. Studies have shown that both perceived stress and depression may negatively influence birth outcomes. While 20% of pregnancies in Suriname, a middle-income Caribbean country located in northern South America, results in adverse birth outcomes, data on prenatal depression and its risk factors are lacking. This study aimed to assess the influence of perceived stress on depression during pregnancy in Surinamese women. METHODS Survey data were used from 1143 pregnant women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study that addresses the impact of chemical and non-chemical environmental exposures in mother/child dyads in Suriname. The Edinburgh Depression Scale and Cohen Perceived Stress Scale were used to screen for probable depression (cut-off ≥ 12) and high stress (cut-off ≥ 20), respectively. The association between perceived stress and depression was examined using bivariate and multiple logistic regression analyses, adjusted for social support (including resilience) and maternal demographics. RESULTS The prevalence of high perceived stress during the first two trimesters and the third trimester were 27.2% and 24.7% respectively. 22.4% of the participants had probable depression during first or second trimester and 17.6% during the third trimester. Women experiencing high stress levels during the first two trimesters had 1.92 increased odds (95% CI 1.18-3.11, p = 0.008) of having probable depression during the third trimester of pregnancy than those with low stress levels. Pregnant women with low individual resilience during early pregnancy (52.1%) had 1.65 (95% CI 1.03-2.63, p = 0.038) increased odds of having probable depression during later stages of pregnancy compared to those with high individual resilience. Low educational level (p = 0.004) and age of the mother (20-34 years) (p = 0.023) were significantly associated with probable depression during the third trimester. CONCLUSIONS Early detection and management of stress and depression during pregnancy are important. Health education programs, targeting the reduction of stress during pregnancy, may help to reduce depression and its potential adverse health effects on the mother and child.
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Affiliation(s)
- Anisma R Gokoel
- Scientific Research Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname.
- Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname.
| | - Firoz Abdoel Wahid
- Scientific Research Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Wilco C W R Zijlmans
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
- Foundation for Perinatal Interventions and Research in Suriname (PeriSur), Paramaribo, Suriname
| | - Arti Shankar
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Ashna D Hindori-Mohangoo
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Foundation for Perinatal Interventions and Research in Suriname (PeriSur), Paramaribo, Suriname
| | - Hannah H Covert
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Meerte-Sigrid MacDonald-Ottevanger
- Scientific Research Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname
- Department of Medical Microbiology, Academic University Medical Center, Amsterdam, The Netherlands
| | - Maureen Y Lichtveld
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emily W Harville
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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15
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Trudell JP, Burnet ML, Ziegler BR, Luginaah I. The impact of food insecurity on mental health in Africa: A systematic review. Soc Sci Med 2021; 278:113953. [PMID: 33971482 DOI: 10.1016/j.socscimed.2021.113953] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/30/2021] [Accepted: 04/15/2021] [Indexed: 11/18/2022]
Abstract
In 2018, 676.1 million people in Africa (52.5% of the population) were moderately or severely food insecure. This exceptionally high prevalence continues to increase as Africa experiences conflict, climate change, and economic declines. When Sustainable Development Goal 2.1 set out to end hunger and ensure access to sufficient food, particularly for vulnerable populations, by 2030, food insecurity emerged as a global priority. Food insecurity has been hypothesized to negatively impact mental health, a stigmatized area of health in Africa for which care is often inaccessible. This systematic review examines existing literature on the relationship between food insecurity and mental health in Africa, where progress remains to be made on both fronts. A systematic search of seven databases (EMBASE, Web of Science, CINAHL, PsychINFO ProQuest, Medline Ovid, Scopus, and Nursing and Allied Health) was conducted. Results were limited to studies examining food insecurity and mental health, written in English and published between January 2000 and May 2020. After title, abstract, full-text review, and quality appraisal using tools from the National Heart, Lung, and Blood Institute, 64 studies remained. Findings were summarized using a narrative synthesis approach. Studies unanimously highlighted that food insecurity is associated with poor mental health. This relationship was dose-responsive and independent of the measured mental health outcome. Two highly represented groups in the literature were women around pregnancy and people affected by HIV/AIDS. Factors which mediated the relationship included age, sex, social interactions, physical health, seasonality, and rural residence. The findings suggest that the relationship is likely amplified in specific populations such as women and seniors, and interventions which target livelihood as opposed to income may be more effective. Further research is needed which compares food insecurity's effect on mental health between at-risk populations, in order to guide resource allocation and context-specific policy making.
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Affiliation(s)
- John Paul Trudell
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Maddison L Burnet
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Bianca R Ziegler
- Department of Geography, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada; Environment Health and Hazards Lab, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada.
| | - Isaac Luginaah
- Department of Geography, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada; Environment Health and Hazards Lab, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
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16
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Satyanarayana VA, Burroughs HR, Heylen E, Yadav K, Sinha S, Nyamathi A, Ekstrand ML. Mental health of women living with HIV and its impact on child development in Andhra Pradesh, India. VULNERABLE CHILDREN AND YOUTH STUDIES 2021; 16:307-319. [PMID: 34956392 PMCID: PMC8697731 DOI: 10.1080/17450128.2021.1883785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 01/18/2021] [Indexed: 06/14/2023]
Abstract
Global literature examining the association between mental health of women living with HIV (WLWH) and child development is scarce. In this study, we examined the relationship between mothers' mental health and their children's social development outcomes 6 months later. Data for these analyses come from several waves of interviews of 600 WLWH in the South Indian state of Andhra Pradesh, India. These women were enrolled in a 2×2 factorial clinical trial designed to assess the impact of food supplementation and nutrition education, both in addition to ASHA support, on adherence to ART and improved health outcomes for the women and one of their children. They were assessed on food security, stigma, social support, quality of life, depressive symptoms and child development outcomes. Results of longitudinal GEE regression analysis indicate that mother's depressive symptoms were significantly negatively associated with child's social quotient 6 months later. These findings have important implications for targeted health interventions, integrating mental health, both for WLWH and their children in India.
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Affiliation(s)
- Veena A. Satyanarayana
- Department of Clinical Psychology, National Institute of
Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Hadley R. Burroughs
- Center for AIDS Prevention Studies, Department of Medicine,
University of California San Franscisco (UCSF), USA
| | - Elsa Heylen
- Center for AIDS Prevention Studies, Department of Medicine,
University of California San Franscisco (UCSF), USA
| | - Kartik Yadav
- Sue & Bill Gross School of Nursing, University of
California Irvine, USA
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical
Sciences, India
| | - Adeline Nyamathi
- Sue & Bill Gross School of Nursing, University of
California Irvine, USA
| | - Maria L. Ekstrand
- Center for AIDS Prevention Studies, Department of Medicine,
University of California San Franscisco (UCSF), USA
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17
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Mutisya M, Markey O, Rousham EK, Chintsanya JMN, Pradeilles R, Kimani-Murage EW, Madise NJ, Munthali AC, Kalimbira A, Holdsworth M, Griffiths PL, Haycraft E. Improving nutritional status among urban poor children in sub-Saharan Africa: An evidence-informed Delphi-based consultation. MATERNAL AND CHILD NUTRITION 2020; 17:e13099. [PMID: 33145974 PMCID: PMC7988854 DOI: 10.1111/mcn.13099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 01/26/2023]
Abstract
In sub‐Saharan Africa (SSA), rapid urbanisation coupled with the high prevalence of infant and young child (IYC) undernutrition in low‐income settings means that interventions to support IYC nutrition are a priority. Little is known about how urbanisation influences IYC feeding (IYCF) practices, and evidence‐based interventions to improve IYC health/nutrition in the urban poor are lacking. Therefore, this research aimed to (a) systematically review evidence on interventions for improving the nutritional status of IYC aged 6–23 months living in urban poor areas (PROSPERO CRD42018091265) and (b) engage stakeholders to identify the highest ranking evidence gaps for improving IYCF programmes/policies. First, a rapid systematic review was conducted. This focused on the literature published regarding nutrition‐specific and nutrition‐sensitive complementary feeding interventions in urban poor areas, specifically low‐income informal settlements, in low‐ and middle‐income countries (LMICs). Six intervention studies met the review inclusion criteria. Intervention adherence was generally high, and indicators of maternal knowledge and IYC nutritional intake typically increased because of the interventions, but the impact on anthropometric status was small. Second, stakeholders working across SSA were engaged via a Delphi‐based approach to identify priority areas for future intervention. Stakeholders reported that a situational analysis was required to better understand IYCF in urban poor areas, particularly the causes of IYC undernutrition, and highlighted the need to involve local communities in defining how future work should proceed. Together, these findings indicate a need for more evidence regarding IYCF and the factors that drive it in urban poor areas across LMIC settings, but particularly in SSA.
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Affiliation(s)
- Maurice Mutisya
- African Population and Health Research Center, Nairobi, Kenya
| | - Oonagh Markey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emily K Rousham
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Jesman M N Chintsanya
- Department of Population Studies, Chancellor College, University of Malawi, Zomba, Malawi
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Alister C Munthali
- Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi
| | | | - Michelle Holdsworth
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,UMR NUTRIPASS, Research Institute for Development, Montpellier, France
| | - Paula L Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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18
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Impact of maternal mental health interventions on child-related outcomes in low- and middle-income countries: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2020; 29:e174. [PMID: 33070789 PMCID: PMC7681164 DOI: 10.1017/s2045796020000864] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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.
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19
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le Roux KW, Almirol E, Rezvan PH, le Roux IM, Mbewu N, Dippenaar E, Stansert-Katzen L, Baker V, Tomlinson M, Rotheram-Borus MJ. Community health workers impact on maternal and child health outcomes in rural South Africa - a non-randomized two-group comparison study. BMC Public Health 2020; 20:1404. [PMID: 32943043 PMCID: PMC7496216 DOI: 10.1186/s12889-020-09468-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home visits by paraprofessional community health workers (CHWs) has been shown to improve maternal and child health outcomes in research studies in many countries. Yet, when these are scaled or replicated, efficacy disappears. An effective CHW home visiting program in peri-urban Cape Town found maternal and child health benefits over the 5 years point but this study examines if these benefits occur in deeply rural communities. METHODS A non-randomized, two-group comparison study evaluated the impact of CHW in the rural Eastern Cape from August 2014 to May 2017, with 1310 mother-infant pairs recruited in pregnancy and 89% were reassessed at 6 months post-birth. RESULTS Home visiting had limited, but important effects on child health, maternal wellbeing and health behaviors. Mothers reported fewer depressive symptoms, attended more antenatal visits and had better baby-feeding practices. Intervention mothers were significantly more likely to exclusively breastfeed for 6 months (OR: 1.8; 95% CI: 1.1, 2.9), had lower odds of mixing formula with baby porridge (regarded as detrimental) (OR: 0.4; 95% CI: 0.2, 0.8) and were less likely to consult traditional healers. Mothers living with HIV were more adherent with co-trimoxazole prophylaxis (p < 0.01). Intervention-group children were significantly less likely to be wasted (OR: 0.5; 95% CI 0.3-0.9) and had significantly fewer symptoms of common childhood illnesses in the preceding two weeks (OR: 0.8; 95% CI: 0.7,0.9). CONCLUSION The impact of CHWs in a rural area was less pronounced than in peri-urban areas. CHWs are likely to need enhanced support and supervision in the challenging rural context.
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Affiliation(s)
- Karl W le Roux
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
- Zithulele Training and Research Centre, Zithulele Hospital, Ginyintsimbi Village, Eastern Cape, South Africa
- Family Medicine Department, Walter Sisulu University, Mthatha, South Africa
- Primary Healthcare Directorate, University of Cape Town, Cape Town, South Africa
| | - Ellen Almirol
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA, 90024-6521, USA
| | - Panteha Hayati Rezvan
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA, 90024-6521, USA
| | - Ingrid M le Roux
- Philani Maternal, Child Health and Nutrition Trust, Site C, Khayelitsha, Cape Town, South Africa
| | - Nokwanele Mbewu
- Philani Maternal, Child Health and Nutrition Trust, Site C, Khayelitsha, Cape Town, South Africa
| | - Elaine Dippenaar
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Linnea Stansert-Katzen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
- Zithulele Training and Research Centre, Zithulele Hospital, Ginyintsimbi Village, Eastern Cape, South Africa
| | - Venetia Baker
- Zithulele Training and Research Centre, Zithulele Hospital, Ginyintsimbi Village, Eastern Cape, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - M J Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA, 90024-6521, USA.
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20
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Maselko J, Sikander S, Turner EL, Bates LM, Ahmad I, Atif N, Baranov V, Bhalotra S, Bibi A, Bibi T, Bilal S, Biroli P, Chung E, Gallis JA, Hagaman A, Jamil A, LeMasters K, O’Donnell K, Scherer E, Sharif M, Waqas A, Zaidi A, Zulfiqar S, Rahman A. Effectiveness of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal: a cluster randomised trial in Pakistan. Lancet Psychiatry 2020; 7:775-787. [PMID: 32828167 PMCID: PMC8015797 DOI: 10.1016/s2215-0366(20)30258-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Maternal depression has a recurring course that can influence offspring outcomes. Evidence on how to treat maternal depression to improve longer-term maternal outcomes and reduce intergenerational transmission of psychopathology is scarce, particularly for task-shifted, low-intensity, and scalable psychosocial interventions. We evaluated the effects of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal. METHODS 40 village clusters in Pakistan were randomly allocated using a computerised randomisation sequence to receive a group-based, psychosocial intervention and enhanced usual care for 36 months, or enhanced usual care alone. Pregnant women (≥18 years) were screened for moderate or severe symptoms of depression (patient health questionnaire-9 [PHQ-9] score ≥10) and were recruited into the trial (570 participants), and a cohort without depression (PHQ-9 score <10) was also enrolled (584 participants). Including the non-depressed dyads enabled us to determine how much of the excess risk due to maternal depression exposure the intervention could mitigate. Research teams responsible for identifying, obtaining consent, and recruiting trial participants were blind to the allocation status throughout the duration of the study, and principal investigators, site coordinators, statisticians, and members of the trial steering committee were also blinded to the allocation status until the analysis of 6-month data for the intervention. Primary outcomes were maternal depression symptoms and remission (PHQ-9 score <10) and child socioemotional skills (strengths and difficulties questionnaire [SDQ-TD]) at 36-months postnatal. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02658994. FINDINGS From Oct 15, 2014 to Feb 25, 2016 46 village clusters were assessed for eligibility, of which 40 (including 1910 mothers were enrolled. After exclusions, 288 women were randomly assigned to the enhanced usual care group and 284 to the intervention group, and 1159 women were included in a group without prenatal depression. At 36-months postnatal, complete data were available from 889 mother-child dyads: 206 (72·5%) in the intervention group, 216 (75·3%) in the enhanced usual care group, and 467 (80·0%) women who did not have prenatal-depression. We did not observe significant outcome differences between the intervention group and the enhanced usual care group for the primary outcomes. The standardised mean difference of PHQ-9 total score was -0·13 (95% CI -0·33 to 0·07), relative risk of patient health questionnaire-9 remission was 1·00 (95% CI 0·88 to 1·14), and the SDQ-TD treatment estimate was -0·10 (95% CI -1·39 to 1·19). INTERPRETATION Reduced symptom severity and high remission rates were seen across both the intervention and enhanced usual care groups, possibly masking any effects of the intervention. A multi-year, psychosocial intervention can be task-shifted via peers but might be susceptible to reductions in fidelity and dosage over time (which were not among the outcomes of this trial). Early intervention efforts might need to rely on multiple models (eg, collaborative care), be of greater intensity, and potentially targeted at mothers who are at high risk for depression to reduce the intergenerational transmission of psychopathology from mothers to children. FUNDING National Institutes of Health.
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Affiliation(s)
- Joanna Maselko
- Department of Epidemiology, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Siham Sikander
- Human Development Research Foundation (HDRF) and Health Services Academy, Islamabad, Pakistan
| | - Elizabeth L. Turner
- Department of Biostatistics and Bioinformatics, and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Lisa M. Bates
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | | | - Najia Atif
- Human Development Research Foundation (HDRF)
| | - Victoria Baranov
- Department of Economics, University of Melbourne, Melbourne, Australia
| | - Sonia Bhalotra
- Department of Economics, Univesity of Essex, Colchester, UK
| | - Amina Bibi
- Human Development Research Foundation (HDRF)
| | | | | | - Pietro Biroli
- Department of Economics, University of Zurich, Zurich, Switzerland
| | - Esther Chung
- Department of Epidemiology, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - John A. Gallis
- Department of Biostatistics and Bioinformatics, and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Anam Jamil
- Human Development Research Foundation (HDRF)
| | - Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Elissa Scherer
- Department of Epidemiology, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Research Triangle International, Research Triangle Park, USA
| | | | - Ahmed Waqas
- Human Development Research Foundation (HDRF)
| | - Ahmed Zaidi
- Human Development Research Foundation (HDRF)
| | | | - Atif Rahman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool UK
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Tirumalaraju V, Suchting R, Evans J, Goetzl L, Refuerzo J, Neumann A, Anand D, Ravikumar R, Green CE, Cowen PJ, Selvaraj S. Risk of Depression in the Adolescent and Adult Offspring of Mothers With Perinatal Depression: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e208783. [PMID: 32602910 PMCID: PMC7327545 DOI: 10.1001/jamanetworkopen.2020.8783] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Maternal depression during pregnancy is associated with emotional and behavioral difficulties of offspring during childhood that can increase the risk of depression in adolescence and adulthood. OBJECTIVE To investigate the association between perinatal maternal depression and an increased long-term risk of depression in their adolescent and adult offspring. DATA SOURCES A systematic search of the electronic databases of PubMed and PsycINFO was conducted from May 2019 to June 2019. STUDY SELECTION A total of 6309 articles were identified, of which 88 articles were extracted for full-text review by 2 reviewers. Only articles reporting data from prospective longitudinal studies that assessed maternal depression during antenatal and/or postnatal periods and resulting offspring 12 years or older with measures of established psychometric properties were included. Exclusion criteria consisted of all other study designs, mothers with other medical and psychiatric comorbidities, and offspring younger than 12 years. DATA EXTRACTION AND SYNTHESIS Data were extracted by 2 independent reviewers, and discrepancies were mediated by an expert third reviewer. Meta-analysis was performed using Bayesian statistical inference and reported using Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline. The association of depression timing with the sex of offspring was explored using metaregression. MAIN OUTCOMES AND MEASURES Offspring depression was evaluated using standardized depression scales or clinical interviews. RESULTS Six studies with a total of 15 584 mother-child dyads were included in the meta-analysis, which found the offspring of mothers who experienced perinatal depression to have increased odds of depression (odds ratio [OR], 1.70; 95% credible interval [CrI], 1.60-2.65; posterior probability [PP] [OR >1], 98.6%). Although metaregression found no evidence for an overall association between perinatal depression timing and offspring depression (antenatal vs postnatal, PP [OR >1] = 53.8%), subgroup analyses showed slightly higher pooled odds for the antenatal studies (OR, 1.78; 95% CrI, 0.93-3.33; PP [OR >1] = 96.2%) than for the postnatal studies (OR, 1.66; 95% CrI, 0.65-3.84; PP [OR >1] = 88.0%). Female adolescent offspring recorded higher rates of depression in metaregression analyses, such that a 1% increase in the percentage of female (relative to male) offspring was associated with a 6% increase in the odds of offspring depression (OR, 1.06; 95% CrI, 0.99-1.14; τ2 = 0.31). CONCLUSIONS AND RELEVANCE In this study, maternal perinatal depression, especially antenatal depression, was associated with the risk of depression in adolescence and adulthood. More research into the mechanisms of depression risk transmission and assessments of postinterventional risk reduction could aid in the development of future strategies to tackle depressive disorders in pregnancy.
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Affiliation(s)
- Vaishali Tirumalaraju
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Jonathan Evans
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Laura Goetzl
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern School of Medicine, University of Texas Health Science Center at Houston
| | - Jerrie Refuerzo
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Alexander Neumann
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Deepa Anand
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Rekha Ravikumar
- Department of Internal Medicine, Mercy Health St Vincent Medical Center, Toledo, Ohio
| | - Charles E. Green
- Center for Clinical Research and Evidence-Based Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Philip J. Cowen
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sudhakar Selvaraj
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
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Betancourt TS. Editorial: Home-Visiting Interventions and Caregiver Mental Health. J Am Acad Child Adolesc Psychiatry 2019; 58:1149-1151. [PMID: 31108162 DOI: 10.1016/j.jaac.2019.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
The article "Home Visiting and Antenatal Depression Affect the Quality of Mother and Child Interactions in South Africa" by Christodoulou et al.1 in the Journal presents findings from an important analysis of intervention effects among depressed and nondepressed mothers receiving the Philani home-visiting intervention2 in South Africa. This article highlights three critical issues fundamental to the promise of home-visiting interventions to advance developmental potential for families with young children globally: 1) the opportunity to attend to caregiver mental health, 2) the need for more integrated interventions that expand on the platform of early childhood development (ECD) to address broader issues in the home environment (eg, poverty, malnutrition, family violence) that may contribute to caregiver and child well-being overall, and 3) the promise of implementation science to study both effectiveness and implementation questions simultaneously.
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Zhu QY, Huang DS, Lv JD, Guan P, Bai XH. Prevalence of perinatal depression among HIV-positive women: a systematic review and meta-analysis. BMC Psychiatry 2019; 19:330. [PMID: 31666033 PMCID: PMC6822469 DOI: 10.1186/s12888-019-2321-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 10/14/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Increasing attention has been paid to differences in the prevalence of perinatal depression by HIV status, although inconsistent results have been reported. The aim of this systematic review and meta-analysis was to assess the relationship between perinatal depression and HIV infection. A comprehensive meta-analysis of comparative studies comparing the prevalence of antenatal or postnatal depression between HIV-infected women and HIV-negative controls was conducted. METHODS Studies were identified through PubMed/Medline, Scopus, Web of Science, Cochrane Library, Embase and PsycINFO, and the reading of complementary references in August 2019. Subgroup analyses were performed for anticipated explanation of heterogeneity using methodological quality and pre-defined study characteristics, including study design, geographical location and depression screening tools for depression. The overall odds ratio (OR) and mean prevalence of each group were calculated. RESULTS Twenty-three studies (from 21 publications), thirteen regarding antenatal depression and ten regarding postnatal depression were included, comprising 3165 subjects with HIV infection and 6518 controls. The mean prevalence of antenatal depressive symptoms in thirteen included studies was 36% (95% CI: 27, 45%) in the HIV-positive group and 26% (95% CI: 20, 32%) in the control group. The mean prevalence of postnatal depressive symptoms in ten included studies was 21% (95% CI: 14, 27%) in the HIV-positive group and 16% (95% CI: 10, 22%) in the control group. Women living with HIV have higher odds of antenatal (OR: 1.42; 95% CI: 1.12, 1.80) and postnatal depressive symptoms (OR: 1.58; 95% CI: 1.08, 2.32) compared with controls. Publication bias and moderate heterogeneity existed in the overall meta-analysis, and heterogeneity was partly explained by the subgroup analyses. CONCLUSIONS Women with HIV infection exhibit a significantly higher OR of antenatal and postnatal depressive symptoms compared with controls. For the health of both mother and child, clinicians should be aware of the significance of depression screening before and after delivery in this particular population and take effective measures to address depression among these women.
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Affiliation(s)
- Qi-Yu Zhu
- 0000 0000 9678 1884grid.412449.eDepartment of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122 China
| | - De-Sheng Huang
- 0000 0000 9678 1884grid.412449.eDepartment of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122 China ,0000 0000 9678 1884grid.412449.eDepartment of Mathematics, School of Fundamental Sciences, China Medical University, Shenyang, China
| | - Jian-Da Lv
- 0000 0000 9678 1884grid.412449.eDepartment of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122 China
| | - Peng Guan
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122, China.
| | - Xing-Hua Bai
- grid.412636.4Department of Radiation Oncology, The First Affiliated Hospital of China Medical University, Shenyang, China
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Prado EL, Larson LM, Cox K, Bettencourt K, Kubes JN, Shankar AH. Do effects of early life interventions on linear growth correspond to effects on neurobehavioural development? A systematic review and meta-analysis. Lancet Glob Health 2019; 7:e1398-e1413. [PMID: 31537370 DOI: 10.1016/s2214-109x(19)30361-4] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/13/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Faltering in linear growth and neurobehavioural development during early childhood are often assumed to have common causes because of their consistent association. This notion has contributed to a global focus on the promotion of nutrition during pregnancy and childhood to improve both conditions. Our aim was to assess whether effects of interventions on linear growth are associated with effects on developmental scores and to quantify these associations. METHODS In this systematic review and meta-analysis, we included randomised trials done during pregnancy and in children aged 0-5 years that reported effects of any intervention on length-for-age or height-for-age Z scores (LAZ or HAZ) and on any of the following outcomes: motor, cognitive or mental, language, and social-emotional or behavioural development. We searched MEDLINE (Ovid), CINAHL (EBSCO), and PsycINFO (EBSCO) from database inception to June 25, 2019. Study-level data were extracted and, when required, authors were contacted for missing information. We calculated weighted meta-regression coefficients of the association between standardised effect sizes of interventions on LAZ or HAZ and developmental outcome scores and calculated pooled effect sizes for different types of intervention. FINDINGS Of the 7207 studies identified, we included 75 studies with 122 comparisons between intervention and control groups and outcomes reported for 72 275 children. Across all interventions, effect sizes on LAZ or HAZ were significantly associated with effect sizes on social-emotional scores (β 0·23, 95% CI 0·05 to 0·41; p=0·02), but not on cognitive (0·18, -0·36 to 0·72; p=0·51), language (0·12, -0·07 to 0·31; p=0·21), or motor development scores (0·23, -0·05 to 0·50; p=0·11). In studies that provided nutritional supplements, we observed positive significant pooled effect sizes on all five outcomes of LAZ or HAZ (effect size 0·05, 95% CI 0·01-0·09; p=0·01; n=50), cognitive or mental (0·06, 0·03-0·10; p<0·01; n=38), language (0·08, 0·03-0·13; p=0·01; n=21), motor (0·08, 0·04-0·12; p<0·01; n=41), and social-emotional (0·07, 0·02-0·12; p=0·01; n=20) scores. The effect sizes of nutritional supplementation on LAZ or HAZ scores were significantly associated with effect sizes on cognitive (β 0·40, 95% CI 0·04-0·77; p=0·049) and motor (0·43, 0·11-0·75; p=0·01) scores. In the 14 interventions promoting responsive care and learning opportunities, the pooled effect size on LAZ or HAZ score was not significant (-0·01, 95% CI -0·07 to 0·05; p=0·74), but pooled effect sizes on cognitive, language, and motor scores were 4 to 5 times larger (range 0·38-0·48) than the pooled effect sizes of nutritional supplementation (0·05-0·08). INTERPRETATION In nutritional supplementation interventions, improvements in linear growth were associated with small improvements in child development, whereas nurturing and stimulation interventions had significant effects on child development but no effects on linear growth. The determinants of linear growth and neurodevelopment are only partly shared. To nurture thriving individuals and communities, interventions should specifically target determinants of neurodevelopment and not simply linear growth. FUNDING University of California Davis, US Department of Agriculture National Institute of Food and Agriculture.
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Affiliation(s)
- Elizabeth L Prado
- Department of Nutrition, University of California Davis, Davis, CA, USA.
| | - Leila M Larson
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Katherine Cox
- Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Kory Bettencourt
- Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Julianne N Kubes
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Anuraj H Shankar
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Ng’oma M, Meltzer-Brody S, Chirwa E, Stewart RC. "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. PLoS One 2019; 14:e0217102. [PMID: 31211776 PMCID: PMC6581242 DOI: 10.1371/journal.pone.0217102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/03/2019] [Indexed: 01/23/2023] Open
Abstract
PURPOSE This study was conducted to explore the perceptions of perinatal women and key maternal care health workers about perinatal depression and the health service needs required to inform development of a culturally sensitive and acceptable psychosocial intervention. METHODS This qualitative study used a descriptive exploratory design; it is the first phase of a larger mixed methods study aimed at adapting a psychosocial intervention for perinatal depression. We conducted in-depth interviews with 22 women who screened positive for depression using a locally validated Chichewa version of the Edinburgh Postnatal Depression Scale at antenatal and postnatal clinics in 1 rural and 1 urban health care setting in Lilongwe District, Malawi. We also conducted 10 key informant interviews with maternal care health workers. Informed consent was obtained from all participants. An interview guide was used to guide enquiry about perceptions of perinatal depression and health service needs. Interviews were transcribed, translated and analysed using content analysis approach. RESULTS Perinatal depression was recognized as a common mental health problem that affected self-care activities and functioning of women in the perinatal period. Financial difficulties, relationship problems (polygamy, lack of support, neglect, and infidelity), traumatic events (intimate partner violence and loss) and fear of birth outcomes were identified as causes of depression. All study participants acknowledged the need for support and an intervention that will address the identified challenges. Additionally, they viewed strengthening the health delivery system as crucial to effectively address their needs and gaps identified in the system. CONCLUSION The results of this study support plans to develop a family focused intervention for perinatal depression in Malawi addressing relationship, psychosocial and economic issues. It also highlights the importance of strengthening the health delivery system especially at primary care level where the majority of women access care in Malawi and across Sub-Saharan Africa.
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Affiliation(s)
- Mwawi Ng’oma
- Department of Mental Health, University of Malawi College of Medicine, Blantyre, Malawi
- St John of God Hospitaller Services, Malawi, Lilongwe, Malawi
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ellen Chirwa
- Faculty of Midwifery, University of Malawi Kamuzu College of Nursing, Blantyre, Malawi
| | - Robert C. Stewart
- Department of Mental Health, University of Malawi College of Medicine, Blantyre, Malawi
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Schmitz K, Basera TJ, Egbujie B, Mistri P, Naidoo N, Mapanga W, Goudge J, Mbule M, Burtt F, Scheepers E, Igumbor J. Impact of lay health worker programmes on the health outcomes of mother-child pairs of HIV exposed children in Africa: A scoping review. PLoS One 2019; 14:e0211439. [PMID: 30703152 PMCID: PMC6355001 DOI: 10.1371/journal.pone.0211439] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/14/2019] [Indexed: 02/06/2023] Open
Abstract
Background Increased demand for healthcare services in countries experiencing high HIV disease burden and often coupled with a shortage of health workers, has necessitated task shifting from professional health workers to Lay Health Workers (LHWs) in order to improve healthcare delivery. Maternal and Child Health (MCH) services particularly benefit from task-shifting to LHWs or similar cadres. However, evidence on the roles and usefulness of LHWs in MCH service delivery in Sub-Saharan Africa (SSA) is not fully known. Objectives To examine evidence of the roles and impact of lay health worker programmes focusing on Women Living with HIV (WLH) and their HIV-exposed infants (HEIs). Methods A scoping review approach based on Arksey and O’Malley’s guiding principles was used to retrieve, review and analyse existing literature. We searched for articles published between January 2008 and July 2018 in seven (7) databases, including: MEDLINE, Embase, PsycINFO, Joanna Briggs, The Cochrane Library, EBM reviews and Web of Science. The critical constructs used for the literature search were “lay health worker”, “community health worker”, “peer mentor”, “mentor mother,” “Maternal and Child health worker”, “HIV positive mothers”, “HIV exposed infants” and PMTCT. Results Thirty-three (33) full-text articles meeting the eligibility criteria were identified and included in the final analysis. Most (n = 13, 39.4%) of the included studies were conducted in South Africa and used a cluster RCT design (n = 13, 39.4%). The most commonly performed roles of LHWs in HIV specific MCH programmes included: community engagement and sensitisation, psychosocial support, linkage to care, encouraging women to bring their infants back for HIV testing and supporting default tracing. Community awareness on Mother to Child Transmission of HIV (MTCT), proper and consistent use of condoms, clinic attendance and timely HIV testing of HEIs, as well as retention in care for infected persons, have all improved because of LHW programmes. Conclusion LHWs play significant roles in the management of WLH and their HEIs, improving MCH outcomes in the process. LHW interventions are beneficial in increasing access to PMTCT services and reducing MTCT of HIV, though their impact on improving adherence to ART remains scanty. Further research is needed to evaluate ART adherence in LHW interventions targeted at WLH. LHW programmes can be enhanced by increasing supportive supervision and remuneration of LHWs.
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Affiliation(s)
| | - Tariro Jayson Basera
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Bonaventure Egbujie
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Preethi Mistri
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Nireshni Naidoo
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Witness Mapanga
- Center for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Goudge
- Center for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Jude Igumbor
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Bleker LS, de Rooij SR, Roseboom TJ. Malnutrition and depression in pregnancy and associations with child behaviour and cognitive function: a review of recent evidence on unique and joint effects 1. Can J Physiol Pharmacol 2019; 97:158-173. [PMID: 30624959 DOI: 10.1139/cjpp-2018-0381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Accumulating studies suggest that prenatal experiences can shape a child's neurodevelopment. Malnutrition and depression occur in pregnancy relatively often and may affect child neurodevelopment independently as well as synergistically. We aimed to provide an overview of recent studies that have examined malnutrition and (or) depression in pregnancy and associations with child behavioural problems and cognitive function. We conducted a literature search in PubMed, using the following main search terms: "depression", "nutrition", "BMI", "pregnancy", "offspring", "cognition", and "behaviour". We included studies in human populations published from 2013 onwards. The literature search yielded 1531 articles, of which 55 were included in the current review. We presented the evidence on the associations between prenatal markers of nutritional status and (or) depression and child behaviour and (or) cognitive function. We additionally discussed interventions and mechanisms. Both malnutrition and depression in pregnancy are associated with increased externalizing behavioural problems and attentional deficits, and to some extent with poorer cognitive function in the child, but the evidence is not conclusive. Studies on synergistic effects of both factors on child behaviour and cognitive function are still scarce, and more research is needed. Potential shared mechanisms include the hypothalamic-pituitary-adrenal axis, the immune system, epigenetics, and oxidative stress.
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Affiliation(s)
- Laura S Bleker
- a Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.,b Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Susanne R de Rooij
- b Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Tessa J Roseboom
- a Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.,b Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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Wynn A, Rotheram-Borus MJ, Leibowitz AA, Weichle T, Roux IL, Tomlinson M. Mentor Mothers Program Improved Child Health Outcomes At A Relatively Low Cost In South Africa. Health Aff (Millwood) 2018; 36:1947-1955. [PMID: 29137500 DOI: 10.1377/hlthaff.2017.0553] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In light of South Africa's high prenatal HIV prevalence and infant mortality rate, a cluster randomized controlled trial was conducted to evaluate an intervention called Philani+, which used community health workers (known as Mentor Mothers) to deliver pre- and postnatal home visits in Cape Town, South Africa, to improve maternal and child health. We assessed the costs and benefits of this intervention and made comparisons with other scenarios that depicted increased capacity and provision of nurse-delivered care. The recurrent cost of the twenty-four-month intervention was US$80,001. The major health outcomes analyzed were differences in the proportion of infants who were low birthweight, stunted, and suboptimally breastfed between intervention and control groups. Each case of low birthweight averted cost US$2,397; of stunted growth, US$2,454; and of suboptimal breastfeeding, US$1,618. Employment of community health workers was cost saving compared to that of nurses. Philani+ improved child health at a relatively low cost, considering the health system costs associated with low birthweight and undernutrition. The model could be suitable for replication in low-resource settings to improve child health in other countries.
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Affiliation(s)
- Adriane Wynn
- Adriane Wynn ( ) is associate director of the policy core, Center for HIV Identification, Prevention, and Treatment Services, at the University of California, Los Angeles (UCLA)
| | - Mary Jane Rotheram-Borus
- Mary Jane Rotheram-Borus is director of the Jane and Terry Semel Institute for Neuroscience and Human Behavior, Global Center for Children and Families, at UCLA
| | - Arleen A Leibowitz
- Arleen A. Leibowitz is a professor emerita in the Department of Public Policy, School of Public Affairs, at UCLA, and director of the policy core at the Center for HIV Identification, Prevention, and Treatment Services
| | - Thomas Weichle
- Thomas Weichle is a senior statistician at the Semel Institute for Neuroscience and Human Behavior, Global Center for Children and Families, at UCLA
| | - Ingrid le Roux
- Ingrid le Roux is medical director of Philani, in Cape Town, South Africa
| | - Mark Tomlinson
- Mark Tomlinson is a professor of psychology at Stellenbosch University, in South Africa
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Mebrahtu H, Simms V, Chingono R, Mupambireyi Z, Weiss HA, Ndlovu P, Malaba R, Cowan FM, Sherr L. Postpartum maternal mental health is associated with cognitive development of HIV-exposed infants in Zimbabwe: a cross-sectional study. AIDS Care 2018; 30:74-82. [PMID: 29848008 DOI: 10.1080/09540121.2018.1468015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study examines the cognitive profiles of infants born to HIV positive mothers in Zimbabwe. Caregivers with HIV exposed infants delivered in 30 clinics in two areas of Zimbabwe were recruited to the study. Of the 574 study participants, 562 caregiver-infant dyads with a biological HIV +ve mother and infant aged 0-24 months were interviewed. All infants were tested by a trained administrator for cognitive development on the Mullen Scales of Early Learning (MSEL). The Edinburgh Postnatal Depression Scale and Parental Stress Index-Short Form were completed by the mothers together with infant and caregiver socioeconomic characteristics. Linear regression models were used to relate cognitive development scores to maternal stress scores, maternal depression scores and infant HIV status adjusting for infant and caregiver characteristics, as well as socioeconomic factors. Higher maternal depression scores were associated with lower overall infant cognitive scores (adjusted mean difference (aMD) = -0.28; CI 95%:-0.50 to -0.06; p = 0.01) and in the expressive language (aMD = -0.14; CI 95%:-0.27 to -0.01; p = 0.04), fine motor skills (aMD = -0.17; CI 95%: -0.33 to -0.01; p = 0.03), gross motor (aMD = -0.22; CI 95%:-0.40 to -0.04; p = 0.02), and visual reception (aMD = -0.22; CI 95%:-0.40 to -0.05; p = 0.01) domains. Higher maternal stress was associated with poorer overall infant cognitive scores (aMD = -0.11; CI 95%:-0.20 to -0.02; p = 0.02) and in the specific domains of expressive language (aMD = -0.07; CI 95%:-0.12 to -0.01; p = 0.01), gross motor skills (aMD = -0.12; CI 95%:-0.18 to -0.05; p < 0.01) and visual reception (aMD = -0.09; CI 95%:-0.16 to -0.02; p = 0.02). Comparisons between the small number of HIV positive infants (n = 16) and the HEU infants (n = 381) showed the latter to have higher mean gross motor scores (50.3 vs. 40.6; p = 0.01). There was no evidence of difference by HIV status in the other MSEL domains or overall mean cognitive scores. Our findings demonstrate the association between maternal mood and stress levels and child cognitive functioning, particularly in expressive language and visual reception development. Although cross sectional data cannot shed light on the direction of this association, the study suggests that interventions to address maternal stress and depression symptoms may prove to be beneficial.
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Affiliation(s)
- Helen Mebrahtu
- a Department of Global Health , University College London , London , UK
| | - Victoria Simms
- b MRC Tropical Epidemiology Group , London School of Hygiene and Tropical Medicine , London , UK
| | - Rudo Chingono
- a Department of Global Health , University College London , London , UK.,c Centre for Sexual Health HIV/AIDS Research (CeSHHAR) , Harare , Zimbabwe
| | - Zivai Mupambireyi
- c Centre for Sexual Health HIV/AIDS Research (CeSHHAR) , Harare , Zimbabwe
| | - Helen A Weiss
- b MRC Tropical Epidemiology Group , London School of Hygiene and Tropical Medicine , London , UK
| | | | - Ricky Malaba
- d World Education Inc./Bantwana (WEI/B) , Harare , Zimbabwe
| | - Frances M Cowan
- c Centre for Sexual Health HIV/AIDS Research (CeSHHAR) , Harare , Zimbabwe.,e Department of International Public Health , Liverpool School of Tropical Medicine , Liverpool , UK
| | - Lorraine Sherr
- a Department of Global Health , University College London , London , UK
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Antenatal depressive symptoms in Jamaica associated with limited perceived partner and other social support: A cross-sectional study. PLoS One 2018; 13:e0194338. [PMID: 29554107 PMCID: PMC5858785 DOI: 10.1371/journal.pone.0194338] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 03/01/2018] [Indexed: 11/30/2022] Open
Abstract
Background Antenatal depression is associated with adverse maternal and infant well-being. However, compared to postpartum depression, it has been less frequently explored globally or in Jamaica. This study aimed to determine the prevalence of, and factors associated with, antenatal depressive symptoms among Jamaican women in order to inform policy and build interventions that could improve their management and reduce their negative consequences. Methods This secondary analysis of data from the second Jamaican Birth Cohort Study (JA-Kids Birth Cohort) included 3,517 women enrolled during pregnancy. Information was extracted from interviewer-administered questionnaires which recorded social, demographic, medical and obstetric information during pregnancy. The Edinburgh Postnatal Depression scale (EPDS) was used to screen for depression, with scores ≥13 considered indicative of a high likelihood of depression. Bivariate analysis examined associations between depressive symptoms and: age, income, financial difficulties, perceived social support, perceived partner infidelity, previous child-bearing unions and children with the current partner. Obstetric factors were also explored and included gravidity, prior adverse pregnancy outcome and complications from previous pregnancies. Variables that predicted the likelihood of depression based on an EPDS cut score of 13 were evaluated using logistic regression. Results One in five participants (19.6%; 95% CI 18.3–20.9%) had a high likelihood of antenatal depression (EPDS ≥13). Significant predictors of high depressive symptom severity included four indicators of poor perceived social and partner support [ORs (95% CI) ranged from: 1.61 (1.07–2.43); p = 0.024 to 3.14(1.69–5.84); p< 0.001], perceived partner infidelity [1.86 (1.36, 2.54); p<0.001], exposure to violence [2.36 (1.66–3.38); p<0.001] and financial difficulties [1.39 (1.07, 1.80); p = 0.013]. Conclusions Women’s perceived social and partner support were strongly associated with depressive symptom severity. Within the Jamaican cultural context of unstable reproductive unions, efforts are needed to involve fathers in the antenatal care process to strategically improve the psychological well-being of new mothers which may positively influence long term developmental outcomes for their babies.
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