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Psychological interventions delivered by non-specialist health workers are effective for the treatment of perinatal depression in low- and middle-income countries. In this systematic review, we describe the content and delivery of such interventions. Nine studies were identified. The interventions shared a number of key features, such as delivery provided within the context of routine maternal and child health care beginning in the antenatal period and extending postnatally; focus of the intervention beyond the mother to include the child and involving other family members; and attention to social problems and a focus on empowerment of women. All the interventions were adapted for contextual and cultural relevance; for example, in domains of language, metaphors and content. Although the competence and quality of non-specialist health workers delivered interventions was expected to be achieved through structured training and ongoing supervision, empirical evaluations of these were scarce. Scalability of these interventions also remains a challenge and needs further attention.

Biofloc is a conglomeric aggregation of microbial communities such as phytoplankton, bacteria, and living and dead particulate organic matter. Biofloc technology involves manipulation of C/N ratio to convert toxic nitrogenous wastes into the useful microbial protein and helps in improving water quality under a zero water exchange system. It may act as a complete source of nutrition for aquatic organisms, along with some bioactive compounds that will enhance growth, survival, and defense mechanisms, and acts as a novel approach for health management in aquaculture by stimulating innate immune system of animals. Nutritionally, the floc biomass provides a complete source of nutrition as well as various bioactive compounds that are useful for improving the overall welfare indicators of aquatic organisms. Beneficial microbial bacterial floc and its derivative compounds such as organic acids, polyhydroxy acetate and polyhydroxy butyrate, could resist the growth of other pathogens, thus serves as a natural probiotic and immunostimulant. The technology is useful in maintaining optimum water quality parameters under a zero water exchange system, thus prevents eutrophication and effluent discharge into the surrounding environment. Moreover, the technology will be useful to ensure biosecurity, as there is no water exchange except sludge removal. The technology is economically viable, environmentally sustainable, and socially acceptable.

BackgroundPerinatal depression is highly prevalent in South Asia. Although effective and culturally feasible interventions exist, a key bottleneck for scaled-up delivery is lack of trained human resource. The aim of this study was to adapt an evidence-based intervention so that local women from the community (peers) could be trained to deliver it, and to test the adapted intervention for feasibility in India and Pakistan.MethodsThe study was conducted in Rawalpindi, Pakistan and Goa, India. To inform the adaptation process, qualitative data was collected through 7 focus groups (four in Pakistan and three in India) and 61 in-depth interviews (India only). Following adaptation, the intervention was delivered to depressed mothers (20 in Pakistan and 24 in India) for six months through 8 peers in Pakistan and nine in India. Post intervention data was collected from depressed mothers and peers through 41 in-depth interviews (29 in Pakistan and 12 in India) and eight focus groups (one in Pakistan and seven in India). Data was analysed using Framework Analysis approach.ResultsMost mothers perceived the intervention to be acceptable, useful, and viewed the peers as effective delivery-agents. The simple format using vignettes, pictures and everyday terms to describe distress made the intervention easy to understand and deliver. The peers were able to use techniques for behavioural activation with relative ease. Both the mothers and peers found that shared life-experiences and personal characteristics greatly facilitated the intervention-delivery. A minority of mothers had concerns about confidentiality and stigma related to their condition, and some peers felt the role was emotionally challenging.ConclusionsThe study demonstrates the feasibility of using peers to provide interventions for perinatal depression in two South Asian settings. Peers can be a potential resource to deliver evidence-based psychosocial interventions.Trial registrationPakistan Trial: ClinicalTrials.gov Identifier: NCT02111915 (9 April 2014), India Trial: ClinicalTrials.gov Identifier: NCT02104232 (1 April 2014).

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