Engaging women and men in the gender-synchronised, community-based Mbereko+Men intervention to improve maternal mental health and perinatal care-seeking in Manicaland, Zimbabwe: A cluster-randomised controlled pragmatic trial

Abstract

Background Maternal mental morbidity and low perinatal health service utilisation in resource-constrained settings contribute substantially to the global burden of poor maternal, newborn, and child health. The community-based Mbereko+Men program in rural Zimbabwe engaged women and men in complementary activities to improve men’s support for women and babies, coparents’ equitable, informed health decision-making, and ultimately, maternal mental health and care-seeking for maternal and newborn health services. The study aimed to test the effectiveness of the Mbereko+Men program on maternal mental health at 0-6 months after childbirth. Methods We conducted a cluster-randomised controlled pragmatic trial using a two-arm parallel design with four clusters per arm. Data was data collected through cross-sectional surveys before and after the implementation of the intervention or standard care. Rural health facility catchments in Mutasa District, Zimbabwe, were randomised using a true random number sequence. Survey participants were women who had given birth within 0-6 months and their male coparents. The primary outcome was women’s mean Edinburgh Postnatal Depression Scale (EPDS) score. Secondary outcomes captured care-seeking, men’s supportive behaviours, and gender dynamics in coparent relationships. Masking was not used. All clusters were included in the analysis. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620001014943) in October 2020. Results Between April 13 and May 20, 2016, 457 women and 242 men participated in the pre-intervention survey; between October 19 and November 30, 2017, 433 women and 273 men participated in the post-intervention survey. Women’s mean EPDS scores declined in both arms. The decline was 34% greater in the intervention arm (adjusted risk ratio = 0.66; 95% confidence interval = 0.48, 0.90, P = 0.008). Improvements in care-seeking, men’s support, and coparents’ relationships were detected. Conclusions A low-intensity gender-synchronised intervention engaged women and men to improve maternal mental health and care-seeking in a setting characterised by gender inequality and demand-side barriers to care.

Non-specialist delivered psycho-social interventions for women with perinatal depression living in rural communities: A systematic review

“…Apart from a solitary study conducted in Israel (n = 1) [ 27 ], the remaining studies were conducted in LMICs including Zimbabwe (n = 1) [ 28 ], South Africa (n = 2) [ 24 , 25 , 29 ], Pakistan (n = 3) [ 26 , 30 – 32 ], and India (n = 2) [ 33 , 34 ].…”

“…Five studies were RCTs [ 26 , 28 , 30 – 32 , 34 ] (four of which were cluster-RCTs) and the remaining were quasi-experimental in design [ 24 , 25 , 27 , 29 , 33 ].…”

Gender Transformative Interventions for Perinatal Mental Health in Low and Middle Income Countries—A Scoping Review

“…Another intervention that was targeted for women, children and men/fathers/coparents in Mutasa district, Zimbabwe, used community-based training and discussion groups that addressed services for mothers, HIV transmissions and engaging in problemsolving therapy. Results indicated that addressing gender inequality improved maternal mental health [46]. The interesting aspect of this program included creating and implementing educational and outreach programs that encouraged "male champions".…”

“…It can further be noted that through participatory interventions, mental health services inclusive of antenatal care, maternity and family planning can be improved through male-involvement. A recent study that contributed towards the current limited literature, was Comrie-Thomson et al's [46] trial on implementing a gender-synchronised intervention. Gendersynchronised interventions are conceptualised as programs that employ multiple strategies to change community norms related to gender as well as engage men to achieve gender equality and improve health [49].…”

Using fatherhood to engage men in HIV services via maternal, neonatal and child health entry points in South Africa

“…Considerable efforts have been made to involve men in MNCH services, however the focus has mainly been on how their involvement can improve MNCH outcomes [ 11 , 22 – 25 ]. Extensive research has been conducted on barriers and facilitators to men’s involvement in MNCH services, and efforts have been made to address some of the barriers, however, men’s involvement in MNCH services remains low [ 26 ].…”