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Table 4 Relevant context

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

  Ethiopia India Nepal South Africa Uganda
Availability of health sector personnel to deliver psychosocial interventions No No No No A few (insufficient) psychiatric nurses available in health centres
PHC staff attitudes towards delivering mental health care General positive attitude; interest in delivering mental health care, greater with higher level of general health training. Need for more training; Poor knowledge of causes of mental disorders [76]a Lack of training on mental health and awareness [133] Lack of training on mental health and awareness [134]c Nurses think they offer good service to mentally ill patients; doctors feel psychiatric nurses are essential for good mental health care; negative attitudes and stigma towards patients with mental illness, and managers are not supportive [77]d [80]b General negative attitude; health workers stigmatize patients with mental disorders and health workers taking care of them [81]b
Community explanatory models of maternal mental disorders Common perinatal mental disorders attributed to poverty, marital problems or other interpersonal difficulties [82]a; psychosis and severe mental illness attributed to supernatural causes [86]a Depression attributed to economic and marital difficulties [83, 84]a Distress perceived as ‘tension’, linked to limited autonomy and perceived duty towards family; women with symptoms of distress also sometimes labelled as ‘witch’ [32]b Poverty, food and financial insecurity, partner rejection, infidelity and general lack of support; medical intervention is not considered appropriate [85]b Attributed to witchcraft & spirits; psychosis can only be treated by traditional African healers [87]b; in Ganda culture, puerperal psychosis blamed on supernatural spirits due to promiscuity of the woman during pregnancy [88]b
Known cultural practices for pregnant and postnatal women Cultural taboos on leaving the home following childbirth – confinement for 40 days (for girls) and 80 days (for boys). Health care access dependent on husband’s approval and financial support [82]a Pressure to remain in house during pregnancy and during post-natal period; access to health care services dependent on will of husband and mother in law; dietary restrictions during pregnancy and postnatal period [90]b Childbirth seen as natural event needing no medical assistance; in remote areas pregnancy associated with “shame” and not readily exposed in front of others [135]b; role of husband to make financial and transport arrangements for delivery [89]b In some rural areas, confinement (4–6 weeks), not allowed to participate in household activities and duties, sometimes sent home to be under the care of own mothers and family members. Confinement also useful to protect the mother from evil spirits [91]b Own mother or mother-in-law moves in to support the new mother during the first month after giving birth
Illicit substance use during pregnancy Khat: 12.9 % (weekly) [14]a Unknown Unknown Methamphetamine: 8.1 % [63]b Unknown
Prevalence of HIV among pregnant women 6.4 % (urban) [137]e; 9–12 % (urban) and <2 % (rural) [94]a 0.32 % [96]d 0.07 % [95]c 36.0 % [137] 6.5 % [138]c
Prevalence of intimate partner violence against women Lifetime: 71 %; past year: 54 % [92]a Lifetime: 38 %; past year: 42.5 % [139]d Lifetime: 33.6 %; past year: 17 % [75]c Past year: 31 % [140]c Past year: 29 % [141]b
Validated screening tools for antenatal depression Yes, but positive predictive value very lowe EPDS & K10 in rural setting [104]a No K10/K6 [103]b;EPDS [142]b
3-item tool [105]b
CES-D [44]b
Validated screening tools for postnatal depression SRQ in rural setting [33]a; K10/K6 and EPDS in urban setting [100]b SRQ [102]a
EPDS and BDI [42] a
EPDS [39]a
SRQ [102]a
EPDS [101]b
SRQ [102]b
None
Validated screening tool for AUDs No AUDIT [97]a AUDIT [98]a AUDIT [99]b AUDIT-C [143]b
Screening tools used in clinical practice for perinatal depression or AUD No No No No No
Evidence for a culturally relevant psychosocial intervention for depression in perinatal women None Maternal self-help groups [108]a None Counselling as part of stepped care [23]b; parenting support and guidance [107]b None
Evidence for culturally relevant psychosocial intervention for AUD None None None None None
  1. aData from a different district, but same region as PRIME district; bData from a different region in the PRIME country; cNational data; dRegional data; ePersonal communication with F Girma (2014)