Abstract
BackgroundVillage health volunteers (VHVs) are responsible for providing primary care in the communities of Laos. Unlike other districts, in Xepon more than 90% of VHVs are male and therefore experience difficulties interacting with pregnant women. To improve outreach to pregnant women, especially among ethnic minorities, a new project was implemented by local municipalities in 2017: newly selected female VHVs were paired to work with existing male VHVs. The objective of this study was to compare the postnatal depressive symptoms of ethnic minority mothers supported by pair-VHVs and single-VHVs in remote rural areas of Lao People’s Democratic Republic (PDR).MethodsA cross-sectional study was conducted in March 2019. Mothers who had delivered a baby within 1 year preceding the study were recruited from 36 villages. Of the 305 mothers, 227 responded. The questionnaires included (1) demographic characteristics such as age, economic status, and birth experience; (2) self-decision to go to a health center/hospital to receive antenatal care; (3) type of VHVs (pair or single), support, and information from VHVs during pregnancy, support from husband and relationship with husband; (4) the Edinburgh Postnatal Depression Scale (EPDS). A Mann-Whitney U test, chi-square test, and multiple linear regression analysis were performed. Ethical approval was obtained from the University of the Ryukyus and National Ethics Committee for Health Research of Lao PDR.ResultsThe average total EPDS score was 5.5 among mothers supported by pair-VHV and 7.0 among mothers supported by single-VHV. Results of the multiple linear regression analysis showed that the EPDS score was significantly lower among mothers supported by pair-VHV (β=−1.18, p <0.05) even after adjusting for economic and biological factors.ConclusionsMothers supported by pair-VHV had a significantly lower EPDS score than those supported by single-VHVs in this study area, suggesting that the support of male and female VHV pairs contributed to improving mental health status among ethnic minority mothers in remote rural areas of Lao PDR. Expanding the program to train female VHVs working with male VHVs is necessary for improving maternal and child health in a rural district of Lao PDR.
Highlights
Village health volunteers (VHVs) are responsible for providing primary care in the communities of Laos
Mothers supported by pair-VHV had a significantly lower Edinburgh Postnatal Depression Scale (EPDS) score than those supported by singleVHVs in this study area, suggesting that the support of male and female VHV pairs contributed to improving mental health status among ethnic minority mothers in remote rural areas of Lao People’s Democratic Republic (PDR)
Expanding the program to train female VHVs working with male VHVs is necessary for improving maternal and child health in a rural district of Lao PDR
Summary
Village health volunteers (VHVs) are responsible for providing primary care in the communities of Laos. Previous studies show that the prevalence of maternal mental disorders in low- and middle-income countries (LMICs) is higher than that in high-income countries (HICs) [6]. The World Health Organization (WHO) attributes this high prevalence of maternal mental disorders in LMICs to adolescent pregnancy, unsupportive marital relationships, nulliparity, poverty and lack of financial resources, lack of practical support, illiteracy, minimal assistance, poverty, problematic relationships with in-law families, and so on [6]. Previous studies reported that social support has a positive effect on maternal mental health status in both HICs and LMICs [7,8,9]. CHWs may be one of the resources needed to improve maternal mental health status in LMICs
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