المؤلفون: Nakku JEM; Butabika National Referral Mental Hospital, Kampala, Uganda., Nalwadda O; Butabika National Referral Mental Hospital, Kampala, Uganda. olivianalwadda@gmail.com., Garman E; Department of psychiatry and mental health, University of Cape Town, Cape Town, South Africa., Honikman S; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa., Hanlon C; Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.; Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia., Kigozi F; Butabika National Referral Mental Hospital, Kampala, Uganda., Lund C; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.; Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.

المصدر: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2021 Aug 25; Vol. 21 (1), pp. 584. Date of Electronic Publication: 2021 Aug 25.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 100967799 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2393 (Electronic) Linking ISSN: 14712393 NLM ISO Abbreviation: BMC Pregnancy Childbirth Subsets: MEDLINE

مواضيع طبية MeSH: Perinatal Care* , Problem Solving* , Psychotherapy, Group*, Depression/*therapy , Pregnant Women/*psychology, Adult ; Cohort Studies ; Female ; Humans ; Maternal Health/ethnology ; Mental Health/ethnology ; Patient Health Questionnaire ; Pregnancy ; Primary Health Care ; Rural Population ; Uganda/epidemiology ; Young Adult

مستخلص: Background: Perinatal depression is of substantial public health importance in low and middle income countries. The study aimed to evaluate the impact of a mental health intervention delivered by non-specialist health workers on symptom severity and disability in women with perinatal depression in Uganda.
Methods: Pregnant women in the second and third trimester were consecutively screened using the Luganda version of the 9-item Patient Health Questionnaire (PHQ-9). Women who scored ≥5 on the PHQ-9 and who were confirmed to have depression by a midwife were recruited into a treatment cohort and offered a psychological intervention in a stepped care fashion. Women were assessed with PHQ-9 and WHODAS-2.0 at baseline and again at 3 and 6 months after the intervention. Negative regression analysis was done to examine change in PHQ-9 and WHODAS-2.0 scores from baseline to end line. Data were analysed using STATA version 14.
Results: A total of 2652 pregnant women (98.3%) consented to participate in the study and 153 (5.8%) were diagnosed as depressed. Over a quarter (28.8%) reported having experienced physical interpersonal violence (IPV) while (25.5%) reported sexual IPV in the past year. A third (34.7%) of women diagnosed with depression received 4 or more group PST sessions. There was a mean reduction in PHQ-9 score of 5.13 (95%CI - 6.79 to - 3.47, p < 0.001) and 7.13 (95%CI - 8.68 to - 5.59, p < 0.001) at midline and endline, respectively. WHODAS scores reduced significantly by - 11.78 points (CI 17.64 to - 5.92, p < 0.001) at midline and - 22.92 points (CI 17.64 to - 5.92, p < 0.001) at endline. Clinical response was noted among 69.1% (95%CI 60.4-76.6%) and 93.7% (95%CI 87.8-96.8%) of respondents at midline and endline, respectively.
Conclusion: An evidence based psychological intervention implemented in primary antenatal care by trained and supervised midwives in a real-world setting may lead to improved outcomes for women with perinatal depression. Future randomised studies are needed to confirm the efficacy of this intervention and possibility for scale up.
(© 2021. The Author(s).)

المؤلفون: Nakku JE; Butabika Hospital, Makerere University, P.O.Box 24136, Kampala, Uganda. jnakku@yahoo.com., Okello ES; Makerere University, Kampala, Uganda., Kizza D; Butabika Hospital, Makerere University, P.O.Box 24136, Kampala, Uganda., Honikman S; Department of Psychiatry and Mental Health, Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa., Ssebunnya J; Butabika Hospital, Makerere University, P.O.Box 24136, Kampala, Uganda., Ndyanabangi S; Ministry of Health, Kampala, Uganda., Hanlon C; Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia.; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK., Kigozi F; Butabika Hospital, Makerere University, P.O.Box 24136, Kampala, Uganda.

المصدر: BMC health services research [BMC Health Serv Res] 2016 Jul 22; Vol. 16, pp. 295. Date of Electronic Publication: 2016 Jul 22.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE

مواضيع طبية MeSH: Health Knowledge, Attitudes, Practice* , Health Services Accessibility* , Maternal Health Services*/supply & distribution , Mental Health Services*/supply & distribution, Mental Disorders/*therapy, Adolescent ; Adult ; Attitude of Health Personnel ; Developing Countries ; Female ; Focus Groups ; Humans ; Male ; Mental Health ; Middle Aged ; Mothers/psychology ; Pregnancy ; Pregnancy Complications/therapy ; Qualitative Research ; Rural Population ; Social Stigma ; Uganda ; Young Adult

مستخلص: Background: Perinatal mental illness is a common and important public health problem, especially in low and middle-income countries (LMICs). This study aims to explore the barriers and facilitators, as well as perceptions about the feasibility and acceptability of plans to deliver perinatal mental health care in primary care settings in a low income, rural district in Uganda.
Methods: Six focus group discussions comprising separate groups of pregnant and postpartum women and village health teams as well as eight key informant interviews were conducted in the local language using a topic guide. Transcribed data were translated into English, analyzed, and coded. Key themes were identified using a thematic analysis approach.
Results: Participants perceived that there was an important unmet need for perinatal mental health care in the district. There was evidence of significant gaps in knowledge about mental health problems as well as negative attitudes amongst mothers and health care providers towards sufferers. Poverty and inability to afford transport to services, poor partner support and stigma were thought to add to the difficulties of perinatal women accessing care. There was an awareness of the need for interventions to respond to this neglected public health problem and a willingness of both community- and facility-based health care providers to provide care for mothers with mental health problems if equipped to do so by adequate training.
Conclusion: This study highlights the acceptability and relevance of perinatal mental health care in a rural, low-income country community. It also underscores some of the key barriers and potential facilitators to delivery of such care in primary care settings. The results of this study have implications for mental health service planning and development for perinatal populations in Uganda and will be useful in informing the development of integrated maternal mental health care in this rural district and in similar settings in other low and middle income countries.

المؤلفون: Nakku JE; Department of Psychiatry, Faculty of Medicine, Makerere University. jnakku@yahoo.com, Nakasi G, Mirembe F

المصدر: African health sciences [Afr Health Sci] 2006 Dec; Vol. 6 (4), pp. 207-14.

نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: Faculty of Medicine, Makerere University Country of Publication: Uganda NLM ID: 101149451 Publication Model: Print Cited Medium: Internet ISSN: 1729-0503 (Electronic) Linking ISSN: 16806905 NLM ISO Abbreviation: Afr Health Sci Subsets: MEDLINE

مواضيع طبية MeSH: Primary Health Care*, Depression, Postpartum/*epidemiology, Adolescent ; Adult ; Child ; Cross-Sectional Studies ; Depression, Postpartum/etiology ; Female ; Humans ; Middle Aged ; Uganda/epidemiology

مستخلص: Background: Major depression is a common and disabling complication of the postpartum period in women. It is thought to occur three times more commonly in the developing than in developed countries.
Objectives: The objectives of this study were to determine the prevalence of and factors associated with major depression among women attending a peri-urban primary health care unit in Kampala, Uganda, at six weeks postpartum.
Method: Five hundred and fourty four women attending a peri-urban health centre were investigated in a cross-sectional study. These women were screened using the twenty five-item Self Reporting Questionnaire (SRQ-25), while major depression was confirmed using the Mini International Neuro-psychiatric Interview (MINI). Associations were sought between major depression and the respondents' demographics and various psychological, social and obstetric factors.
Results: The point prevalence of major depression at six weeks postpartum was 6.1%. Psychiatric disorder was significantly associated with young age, being single, negative life events, unplanned pregnancy, unwanted sex of baby and current physical illness in both mother and newborn.
Conclusion: There is indication for routine screening of at risk women in the peri-natal period to avoid, recognize and manage postpartum psychiatric morbidity and its consequence on mothers and their developing children.