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Atif N.,Human Development Research Foundation | Lovell K.,University of Manchester | Rahman A.,University of Liverpool
Seminars in Perinatology | Year: 2015

While the physical health of women and children is emphasized, the mental aspects of their health are often ignored by maternal and child health programs, especially in low- and middle-income countries. We review the evidence of the magnitude, impact, and interventions for common maternal mental health problems with a focus on depression, the condition with the greatest public health impact. The mean prevalence of maternal depression ranges between 15.6% in the prenatal and 19.8% in the postnatal period. It is associated with preterm birth, low birth weight, and poor infant growth and cognitive development. There is emerging evidence for the effectiveness of interventions, especially those that can be delivered by non-specialists, including community health workers, in low-income settings. Strategies for integrating maternal mental health in the maternal and child health agenda are suggested. © 2015 Elsevier Inc. Source

Fuhr D.C.,London School of Hygiene and Tropical Medicine | Salisbury T.T.,London School of Hygiene and Tropical Medicine | Salisbury T.T.,Kings College London | De Silva M.J.,London School of Hygiene and Tropical Medicine | And 4 more authors.
Social Psychiatry and Psychiatric Epidemiology | Year: 2014

Purpose: To evaluate the effectiveness of peer-delivered interventions in improving clinical and psychosocial outcomes among individuals with severe mental illness (SMI) or depression.Methods: Systematic review and meta-analysis of randomised controlled trials comparing a peer-delivered intervention to treatment as usual or treatment delivered by a health professional. Random effect meta-analyses were performed separately for SMI and depression interventions.Results: Fourteen studies (10 SMI studies, 4 depression studies), all from high-income countries, met the inclusion criteria. For SMI, evidence from three high-quality superiority trials showed small positive effects favouring peer-delivered interventions for quality of life (SMD 0.24, 95 % CI 0.08–0.40, p = 0.003, I2= 0 %, n = 639) and hope (SMD 0.24, 95 % CI 0.02–0.46, p = 0.03, I2 = 65 %, n = 967). Results of two SMI equivalence trials indicated that peers may be equivalent to health professionals in improving clinical symptoms (SMD −0.14, 95 % CI −0.57 to 0.29, p = 0.51, I2= 0 %, n = 84) and quality of life (SMD −0.11, 95 % CI −0.42 to 0.20, p = 0.56, I2= 0 %, n = 164). No effect of peer-delivered interventions for depression was observed on any outcome.Conclusions: The limited evidence base suggests that peers may have a small additional impact on patient’s outcomes, in comparison to standard psychiatric care in high-income settings. Future research should explore the use and applicability of peer-delivered interventions in resource poor settings where standard care is likely to be of lower quality and coverage. The positive findings of equivalence trials demand further research in this area to consolidate the relative value of peer-delivered vs. professional-delivered interventions. © 2014, Springer-Verlag Berlin Heidelberg. Source

Fuhr D.C.,London School of Hygiene and Tropical Medicine | Calvert C.,London School of Hygiene and Tropical Medicine | Ronsmans C.,London School of Hygiene and Tropical Medicine | Chandra P.S.,National Institute of Mental Health and Neuro Sciences | And 4 more authors.
The Lancet Psychiatry | Year: 2014

Although suicide is one of the leading causes of deaths in young women in low-income and middle-income countries, the contribution of suicide and injuries to pregnancy-related mortality remains unknown. Methods: We did a systematic review to identify studies reporting the proportion of pregnancy-related deaths attributable to suicide or injuries, or both, in low-income and middle-income countries. We used a random-effects meta-analysis to calculate the pooled prevalence of pregnancy-related deaths attributable to suicide, stratified by WHO region. To account for the possible misclassification of suicide deaths as injuries, we calculated the pooled prevalence of deaths attributable to injuries, and undertook a sensitivity analysis reclassifying the leading methods of suicides among women in low-income and middle-income countries (burns, poisoning, falling, or drowning) as suicide. Findings: We identified 36 studies from 21 countries. The pooled total prevalence across the regions was 1·00% for suicide (95% CI 0·54-1·57) and 5·06% for injuries (3·72-6·58). Reclassifying the leading suicide methods from injuries to suicide increased the pooled prevalence of pregnancy-related deaths attributed to suicide to 1·68% (1·09-2·37). Americas (3·03%, 1·20-5·49), the eastern Mediterranean region (3·55%, 0·37-9·37), and the southeast Asia region (2·19%, 1·04-3·68) had the highest prevalence for suicide, with the western Pacific (1·16%, 0·00-4·67) and Africa (0·65%, 0·45-0·88) regions having the lowest. Interpretation: The available data suggest a modest contribution of injuries and suicide to pregnancy-related mortality in low-income and middle-income countries with wide regional variations. However, this study might have underestimated suicide deaths because of the absence of recognition and inclusion of these causes in eligible studies. We recommend that injury-related and other co-incidental causes of death are included in the WHO definition of maternal mortality to promote measurement and effective intervention for reduction of maternal mortality in low-income and middle-income countries. Funding: National Institute of Mental Health. © 2014 Elsevier Ltd. Source

Rahman A.,University of Liverpool | Sikander S.,Human Development Research Foundation | Malik A.,Human Development Research Foundation | Malik A.,University of Sheffield | And 3 more authors.
British Journal of Psychiatry | Year: 2012

Background: Poverty may moderate the effect of treatment of depression in low-income countries. Aims: To assess poverty and lack of empowerment as moderators of a cognitive-behavioural therapy (CBT)-based intervention for perinatal depression in rural Pakistan. Method: Using secondary analysis of data from a randomised controlled trial (trial registration: ISRCTN65316374) we identified predictors of depression at 1-year follow-up and moderators of the intervention (n = 791). Results: Predictors of follow-up depression included household debt, the participant not being empowered to manage household finance and the interaction terms for these variables with the trial arm. Effect sizes for women with and without household debt were 0.80 and 0.55 respectively. The effect size for women in debt and not empowered financially was 0.94 compared with 0.50 for women with neither of these factors. Conclusions: Our findings demonstrate the importance of household debt and lack of financial empowerment of women as important maintaining factors of depression in low-income countries and our locally developed intervention tackled these problems successfully. Source

Rahman A.,University of Liverpool | Haq Z.,Human Development Research Foundation | Sikander S.,Human Development Research Foundation | Ahmad I.,Human Development Research Foundation | And 2 more authors.
Maternal and Child Nutrition | Year: 2012

Despite being an important component of Pakistan's primary health care programme, the rates of exclusive breastfeeding at 6 months remain among the lowest in the world. Low levels of literacy in women and deeply held cultural beliefs and practices have been found to contribute to the ineffectiveness of routine counselling delivered universally by community health workers in Pakistan. We aimed to address this by incorporating techniques of cognitive-behavioural therapy (CBT) into the routine counselling process. We conducted qualitative studies of stakeholders' opinions (mothers, community health workers, their trainers and programme managers) and used this data to develop a psycho-educational approach that combined education with techniques of CBT that could be integrated into the health workers' routine work. The workers were trained to use this approach and feedback was obtained after implementation. The new intervention was successfully integrated into the community health worker programme and found to be culturally acceptable, feasible and useful. Incorporating techniques of CBT into routine counselling may be useful to promote health behaviours in traditional societies with low literacy rates. © 2011 Blackwell Publishing Ltd. Source

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