Quality of perinatal depression care in primary care setting in Nigeria

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.

Under detection of depression in primary care settings in low and middle-income countries: A systematic review and meta-analysis

“…Clinician diagnosis of depression was recorded in a clinician consultation or encounter form 19 20 28 or patients’ records were reviewed and diagnosis status extracted 21 22 26 27 . Three reports did not indicate the methods they used to specify clinicians’ diagnosis 23–25 .…”

“…The remaining studies relied on a single assessment--the 9-item Patient Health Questionnaire (PHQ-9) 20 21 24 or the Beck Depression Inventory (BDI-II) 25 and the Edinburgh Postnatal Depression Scale 26 --for the diagnosis of probable depression. For the PHQ, varied cutoff scores were used as threshold for detection: a cutoff of threshold score of 10 20 and score of 5 21 24 and both scores of 5 and 10 28 .…”

“…The study among men adult clinic attendees reported detection of 69.0% with just two physician assessors 27 . The study carried out among pregnant women who were joining ANC follow up reported a detection of 1.4% (n=3/218) 26 .…”

“…Regarding the setting, 12 reports were based in primary care clinics [19][20][21][22][23] , four studies in general hospitals where patients had direct access from the community 19 24 and one primary care clinic for patients with diabetes 25 and one primary maternal care clinic 26 . One study recruited men only participants 27 .…”

“…40.8 % (95% CI: 35.4%, 46.5%) among people with Diabetics 25 , 7.3% among pregnant women who were on ANC follow-up 26 and 22% among male only participants 27 .…”