Acceptability and feasibility of a screening protocol for antenatal depression (SPADe) in Blantyre District, Malawi

Abstract

Background Depression is one of the most common perinatal mental health problems that affect pregnant women. Antenatal depression can adversely affect the well-being of the pregnant woman and her foetus. Depression is rarely detected by midwives due to the unavailability of relevant screening instruments in Malawi. A Screening Protocol for Antenatal Depression (SPADe) was developed and recommended for possible use to screen for depression in antenatal clinics in the country. The acceptability and feasibility of using the SPADe protocol to screen for depression has not been established. The aim of this study was to assess the acceptability and feasibility of screening for depression by midwives using SPADe in antenatal clinics in Blantyre district. Methods This study used a quantitative survey design to collect data among 60 midwives in three antenatal clinics in primary care settings. All inclusive sampling of all 60 midwives were used. The Structured Assessment of FEasibility and Ottawa Acceptability of Decision Rules Instruments were used to collect the data. Descriptive statistics and Chi square tests were used to analyse the data. Results This study found that it was feasible to implement SPADe and the following enablers for screening depression had the highest ratings: the SPADe is applicable to pregnant women (M = 3.9, sd = 0.4); the intended goal of the SPADe matches the prioritised goals of Malawi Ministry of Health (M = 3.9, sd = 0.5); and the SPADe is likely to be effective (M = 3.8, sd = 0.6). On the other hand, barriers for implementing the SPADe were: the need for specific training to deliver the SPADe (M = 3.7, sd = 0.7); ongoing support and supervision (M = 3.5, sd = 0.8); and additional resources (M = 3.0, sd = 0.9). This study also found that the implementation of the SPADe was acceptable to respondents. The overall mean score for respondents on acceptability of screening antenatal depression using SPADe was found to be high (M = 4.6, sd = 0.6). However the differences in the respondents’ mean scores on acceptability of screening for depression in antenatal clinics using SPADe in relation to their demographic characteristics were not significant (p > .05). Conclusion This study suggests that midwives feel that it is feasible and acceptable for them to implement the SPADe in antenatal clinics with ongoing training, support and clinical supervision.

“I felt I needed help, but I did not get any”: A multiple stakeholder qualitative study of risk and protective factors, and barriers to addressing common mental health problems among perinatal adolescents in Malawi

“…Considering that perinatal adolescents are at high risk of common mental health problems, such as depression and anxiety, integrating screening of common perinatal mental health problems into routine antenatal clinics can help improve detection. Although it may be argued that doing this may increase the workload of the healthcare workers, a recent study (Chorwe-Sungani et al, 2022a) found that it is feasible and acceptable to implement a Screening Protocol for Antenatal Depression (SPADe), delivered by midwives, in routine antenatal clinics in Malawi, especially if the screening tools are brief. In addition, providing information about mental health during routine antenatal clinics may destigmatise perinatal common mental health problems, thereby encouraging help-seeking.…”

Integrating maternal, newborn, child health and non-communicable disease care in the sustainable development goal era

“…Country Example: In Blantyre district, Malawi, it is estimated that 19% of women attending antenatal care services are suffering from antenatal depression ( 26 ). A further investigation demonstrated that introducing antenatal screening by midwives for maternal depression would be feasible to midwives working in this setting ( 27 ). The barrier to introducing screening was lack of a locally relevant screening tool, so the Screening Protocol for Prenatal Depression (SPADe) was developed, which was acceptable to surveyed midwives ( 27 ).…”

“…A further investigation demonstrated that introducing antenatal screening by midwives for maternal depression would be feasible to midwives working in this setting ( 27 ). The barrier to introducing screening was lack of a locally relevant screening tool, so the Screening Protocol for Prenatal Depression (SPADe) was developed, which was acceptable to surveyed midwives ( 27 ). However, mental health services in Malawi are underfunded and with limited or no access from antenatal clinics, so the team felt it was unethical to introduce the screening without effective treatment ( 27 ).…”

“…The barrier to introducing screening was lack of a locally relevant screening tool, so the Screening Protocol for Prenatal Depression (SPADe) was developed, which was acceptable to surveyed midwives ( 27 ). However, mental health services in Malawi are underfunded and with limited or no access from antenatal clinics, so the team felt it was unethical to introduce the screening without effective treatment ( 27 ). This barrier needs to be addressed for effective scale up of this intervention ( 27 ).…”

“…However, mental health services in Malawi are underfunded and with limited or no access from antenatal clinics, so the team felt it was unethical to introduce the screening without effective treatment ( 27 ). This barrier needs to be addressed for effective scale up of this intervention ( 27 ).…”