Abstract
BackgroundLimited knowledge exists to inform the selection and introduction of locally relevant, feasible, and effective mental health interventions in diverse socio-cultural contexts and health systems. We examined stakeholders’ perspectives on mental health-related priorities, help-seeking behaviors, and existing resources to guide the development of a maternal mental health component for integration into non-specialized care in Soroti, eastern Uganda.MethodsWe employed rapid ethnographic methods (free listing and ranking; semi-structured interviews; key informant interviews and pile sorting) with community health workers (n = 24), primary health workers (n = 26), perinatal women (n = 24), traditional and religious healers (n = 10), and mental health specialists (n = 9). Interviews were conducted by trained Ateso-speaking interviewers. Two independent teams conducted analyses of interview transcripts following an inductive and thematic approach. Smith’s Salience Index was used for analysis of free listing data.ResultsWhen asked about common reasons for visiting health clinics, the most salient responses were malaria, general postnatal care, and husbands being absent. Amongst the free listed items that were identified as mental health problems, the three highest ranked concerns were adeka na aomisio (sickness of thoughts); ipum (epilepsy), and emalaria (malaria). The terms epilepsy and malaria were used in ways that reflected both biomedical and cultural concepts of distress. Sickness of thoughts appeared to overlap substantially with major depression as described in international classification, and was perceived to be caused by unsupportive husbands, intimate partner violence, chronic poverty, and physical illnesses. Reported help-seeking for sickness of thoughts included turning to family and community members for support and consultation, followed by traditional or religious healers and health centers if the problem persisted.ConclusionOur findings add to existing literature that describes ‘thinking too much’ idioms as cultural concepts of distress with roots in social adversity. In addition to making feasible and effective treatment available, our findings indicate the importance of prevention strategies that address the social determinants of psychological distress for perinatal women in post-conflict low-resource contexts.
Highlights
Limited knowledge exists to inform the selection and introduction of locally relevant, feasible, and effective mental health interventions in diverse socio-cultural contexts and health systems
Our research was framed around two key objectives: (1) given the existence of limited resources and the potential for diverse maternal mental health needs in conflict-affected settings, we aimed to examine the perspectives of stakeholders regarding prioritization of maternal mental health problems; and (2) to build upon local resources and develop an acceptable intervention strategy, we sought to understand current help-seeking patterns for prioritized maternal mental health problems and perceptions of both available resources and gaps in support for women with these problems
At the village or Health Center I level (HC I), community health workers are organized into Village Health Teams
Summary
Limited knowledge exists to inform the selection and introduction of locally relevant, feasible, and effective mental health interventions in diverse socio-cultural contexts and health systems. Armed conflicts, which predominantly affect LMIC, are associated with an increased burden of mental ill health. In these settings, women have been found to have higher odds of poor outcomes than men [3]. A crucial health concern in its own right, is associated with multiple poor child outcomes including: preterm birth and low birth weight [5]; suboptimal breastfeeding and immunization coverage [6]; being underweight or stunted [7]; higher rates of diarrhea and febrile illness [6, 8]; and, negative impacts on child development [6]
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