Abstract
BackgroundEven though integrating mental health into maternal and child health (MCH) is widely accepted as a means of closing the treatment gap for maternal mental health conditions in low- and middle-income countries (LMIC), there are not many studies on the quality of the currently available mental health care for mothers in these countries. This study assessed the existing organization of service for maternal mental health, the actual care delivered for perinatal depression, as well as the quality of the care received by affected women presenting to primary care clinics in Ibadan, Nigeria.MethodsThe Assessment of Chronic Illness Care (ACIC) tool was administered to the staff in 23 primary maternal care clinics and key informant interviews were conducted with 20 facility managers to explore organizational and administrative features relevant to the delivery of maternal mental health care in the facilities. Detection rate of perinatal depression by maternal care providers was assessed by determining the proportion of depressed antenatal women identified by the providers. The women were then followed up from the antenatal period up until 6 months after childbirth to track their experience with care received.ResultsAll the facilities had ACIC domain scores indicating poor capacity to offer quality chronic care. Emerging themes from the interviews included severe manpower shortage and absence of administrative and clinical support for manpower training and care provision. Only 31 of the 218 depressed women had been identified by the maternal care providers as having a psychological problem throughout the follow-up period. In spite of the objective evidence of inadequate care, most of the perinatal women rated the service provided in the facilities as being of good quality (96%) and reported being satisfied with the care received (98%).ConclusionThere are major inadequacies in the organisational and administrative profile of these primary maternal care facilities that militate against the provision of quality chronic care. These inadequacies translate to a large treatment gap for women with perinatal depression. Lack of awareness by service users of what constitutes good quality care, indicative of low service expectation, may hamper user-driven demand for quality improvement.
Highlights
Even though integrating mental health into maternal and child health (MCH) is widely accepted as a means of closing the treatment gap for maternal mental health conditions in low- and middle-income countries (LMIC), there are not many studies on the quality of the currently available mental health care for mothers in these countries
Ayinde et al BMC Health Services Research 879(201): There is evidence for the intergenerational transmission of the socio-economic disadvantages associated with perinatal depression, such that its effects continue to echo in the lives of offspring of affected persons up to 18 years after birth [12]
In order to understand the capacity of maternal primary care clinics in Nigeria to deliver care to those in need of service, this study aims to examine the existing organisational structures of the selected facilities as well as the current level of care provided to women with perinatal depression living in poor social and economic circumstances
Summary
Even though integrating mental health into maternal and child health (MCH) is widely accepted as a means of closing the treatment gap for maternal mental health conditions in low- and middle-income countries (LMIC), there are not many studies on the quality of the currently available mental health care for mothers in these countries. This study assessed the existing organization of service for maternal mental health, the actual care delivered for perinatal depression, as well as the quality of the care received by affected women presenting to primary care clinics in Ibadan, Nigeria. Perinatal depression affects up to 25% of women in LMIC in the antenatal period and 19% in the postnatal period, rates that are significantly higher than reported for high-income countries [2]. Ayinde et al BMC Health Services Research 879(201): There is evidence for the intergenerational transmission of the socio-economic disadvantages associated with perinatal depression, such that its effects continue to echo in the lives of offspring of affected persons up to 18 years after birth [12]. There is evidence suggesting that a focus on coverage alone without due attention to quality of care provided might have hampered the achievement of both the development goals and the protection of human rights of mothers and children in LMIC during the Millennium Development Goals (MDG) era [13]
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