"I would not have kept the baby": fight depression during pregnancy

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About 450 million people worldwide currently suffer from mental disorders, making it one of the leading causes of ill health. Could it be that other members of their community hold the key to help solve this problem?

People in high-income countries often face a lack of mental health services, but in low- and middle-income countries, the scale of the problem can be much worse.

Millions of people suffering from depression, anxiety and schizophrenia are struggling to get treatment because of lack of resources and stigma of mental health issues.

Pregnant women are particularly at risk.

In Kenya, for example, symptoms of depression such as fatigue and sleep problems are sometimes considered as purely pregnancy-related or even as witchcraft-related symptoms.

This lack of medical attention, combined with high rates of domestic violence, contributed to a maternal mortality rate of 0.5% in 2015, one of the highest in the world.

Depression during pregnancy is also associated with low birth weight, maltreatment and breastfeeding problems.

Legend

In rural Kenya, many pregnant women use the services of a midwife

One million people without a psychiatrist

Kenya has only two mental health professionals per 100,000 population and is concentrated in urban areas. This means that some rural counties have a population of millions, but no psychiatrists.

It is estimated that 75% of people with mental health problems in the poorest countries do not have access to medical care. This means that many are turning to traditional non-specialist healers, religious healers and community health workers.

We found that training these groups in mental health screening could significantly reduce the number of people who do not have access to treatment.

Based on these findings, traditional birth attendants were trained to screen for depression in more than 1,700 pregnant women as part of a pilot study conducted by the Mental Health Research and Training Foundation. in Africa..

The study took place in Makueni County, an essentially rural part of southeastern Kenya. One of the poorest counties in the country, there are no resident psychologists.

Legend

Makueni is an essentially rural part of southeastern Kenya, with a population of almost one million inhabitants

Who are traditional birth attendants?

Midwives are often the first point of contact for pregnant women in rural Africa
Although not having medical training, they play a role similar to that of midwives
By learning through learning, they usually receive money or in-kind payments from the woman's family.
In addition to giving birth, birth attendants reassure women and help them prepare to become mothers, while trying to reduce family conflict.
Midwives used the Edinburgh Questionnaire for Postnatal Depression and then a WHO Intervention Guide for Mental Health, both designed for use outside clinics and hospitals.

Domestic violence

The results of the projection were striking.

A quarter of the mothers in the study had mild to moderate depression. Three-quarters were victims of spousal, physical, sexual or psychological violence, or of dominant behavior. Half are victims of at least two forms of this violence.

Nearly 60% of mothers with depression received treatment from their birth attendant on the basis of a World Health Organization program designed to be used by lay people.

Legend

One of the birth attendants is to explain the problems that a pregnant woman might encounter.

The mothers were on average 26 years old and almost half were between 12 and 24 years old.

Ndanu *, a young mother participating in the study, was diagnosed with depression.

She said: "Without this program and the help of a midwife, I would not have kept this baby until eventually and I might not have gone through all of it. prenatal visits.

"The midwife advised me, encouraged me to keep the baby telling me that it was not my fault and that the children were a blessing and that I had to go to the antenatal care health center. promised to watch me and opened his house for me to talk to him when I wanted "

Legend

Training in mental health was based on a WHO program for non-specialists.

Midwives intervened by discussing problems, involving family members, and reporting any signs of abuse.

They encouraged depressed mothers to exercise and maintain a regular sleep pattern, to rebuild their social networks and to resume the activities they had previously enjoyed. Mothers also had the opportunity to participate in community activities and join support groups.

Mueni *, a midwife participating in the study, said: "A pregnant mother opens up to us and we try to understand the reasons for her depression, we solve the problems by guidance and counseling.If the problem is rooted in his parents or spouse, we engage them and we reach an agreement. "

Mothers who received treatment saw their depressive symptoms fall by 55% after three months, compared to 26% of those who did not receive a specific intervention.

Discrete mental health services

These initial findings suggest that the training of midwives in mental health care could improve the well-being of mothers and their children, not only in Kenya, but in all countries where similar community health workers operate.

Midwives are generally accessible and maintain good relationships with their patients, which means they are well placed to offer low-cost, low-cost mental health services.

Training more psychiatrists would be helpful, but it takes a lot of time and funding.

TBAs could bridge the gap by providing an accessible and acceptable level of basic mental health care in disadvantaged areas, while maintaining a link between health professionals and pregnant women.

* The names have been changed

About this piece

This analysis article was commissioned by the BBC to an expert working for an outside organization.

Dr. Christine Musyimi is Head of the Ethics Department of Research and Scientific Publications of the Foundation for Research and Training in Mental Health in Africa.

The midwifery study was funded by Grand Challenges Africa, an initiative funded in part by the African Academy of Sciences (AAS).

AAS describes itself as an apolitical, non-profit organization dedicated to transforming lives on the African continent through science.

Published by Eleanor Lawrie

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One million people without a psychiatrist

Who are traditional birth attendants?

Domestic violence

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Discrete mental health services