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Fisher J.,Monash University | Tran T.,Monash University | Biggs B.,Royal Melbourne Hospital | Tran T.,Research and Training Center for Community Development | And 4 more authors.
Bulletin of the World Health Organization | Year: 2011

Objective To establish iodine status among pregnant women in rural northern Viet Nam and explore psychosocial predictors of the use of iodized salt in their households. Methods This prospective study included pregnant women registered in health stations in randomly-selected communes in Ha Nam province. At recruitment (< 20 weeks of gestation), sociodemographic factors, reproductive health, intimate partner relationship, family violence, symptoms of common mental disorders and use of micronutrient supplements were assessed. During a second assessment (> 28 weeks of gestation) a urine specimen was collected to measure urinary iodine concentration (UIC) and iodized salt use was assessed. Predictors were explored through univariable analyses and multivariable linear and logistic regression. Findings The 413 pregnant women who provided data for this study had a median UIC of 70 μg/l; nearly 83% had a UIC lower than the 150 μg/l recommended by the World Health Organization; only 73.6% reported using iodized salt in any form in their households. Iodized salt use was lower among nulliparous women (odds ratio, OR: 0.56; 95% confidence interval, CI: 0.32-0.96); less educated women (OR: 0.34; 95% CI: 0.16-0.71); factory workers or small-scale traders (OR: 0.52; 95% CI: 0.31-0.86), government workers (OR: 0.35; 95% CI: 0.13-0.89) and women with common mental disorders at recruitment (OR: 0.61; 95% CI: 0.38-0.98). Conclusion The decline in the use of iodized salt in Viet Nam since the National Iodine Deficiency Disorders Control Programme was suspended in 2005 has placed pregnant women and their infants in rural areas at risk of iodine deficiency disorders.

Rahman A.,University of Liverpool | Fisher J.,Monash University | Bower P.,University of Manchester | Luchters S.,Burnet Institute | And 4 more authors.
Bulletin of the World Health Organization | Year: 2013

Objective To assess the effectiveness of interventions to improve the mental health of women in the perinatal period and to evaluate any effect on the health, growth and development of their offspring, in low- and middle-income (LAMI) countries. Methods Seven electronic bibliographic databases were systematically searched for papers published up to May 2012 describing controlled trials of interventions designed to improve mental health outcomes in women who were pregnant or had recently given birth. The main outcomes of interest were rates of common perinatal mental disorders (CPMDs), primarily postpartum depression or anxiety; measures of the quality of the mother-infant relationship; and measures of infant or child health, growth and cognitive development. Meta-analysis was conducted to obtain a summary measure of the clinical effectiveness of the interventions. Findings Thirteen trials representing 20 092 participants were identified. In all studies, supervised, non-specialist health and community workers delivered the interventions, which proved more beneficial than routine care for both mothers and children. The pooled effect size for maternal depression was -0.38 (95% confidence interval: -0.56 to -0.21; I2 = 79.9%). Where assessed, benefits to the child included improved mother-infant interaction, better cognitive development and growth, reduced diarrhoeal episodes and increased immunization rates. Conclusion In LAMI countries, the burden of CPMDs can be reduced through mental health interventions delivered by supervised non-specialists. Such interventions benefit both women and their children, but further studies are needed to understand how they can be scaled up in the highly diverse settings that exist in LAMI countries.

Tran T.D.,Monash University | Tran T.,Research and Training Center for Community Development | Fisher J.,Monash University
Journal of Affective Disorders | Year: 2012

Background: Perinatal non-psychotic common mental disorders (PCMDs) are less well recognised in men than in women. However, there are adverse consequences of PCMD for men, their partners and their infants. There is a need for simple, readily administered screening tools for use in research and primary health care for men, including in low income settings. The aim of this study was to validate three scales for screening PCMDs in men in northern Vietnam. Methods: Translated and culturally verified versions of the Edinburgh Postnatal Depression Scale (EPDS), Zung's Self-rated Anxiety Scale (Zung SAS), and the General Health Questionnaire 12 items (GHQ-12) were validated against a gold-standard diagnostic tool, the Structured Clinical Interview for DSM IV diagnoses in a community-based sample of 231 Vietnamese men who were partners of pregnant women or women who had recently given birth. Post-hoc analyses, Receiver Operating Characteristic (ROC) analyses, and Cronbach's alpha were performed to examine the validity and internal reliability of the three scales. Results: The prevalence of PCMDs in men was 17.8% (95%CI: 13.3-22.3). The AUROC of the EPDS 76.7% (95%CI: 67.9-85.5), the Zung SAS was 77.5% (95%CI: 68.9-86.0) and the GHQ-12 was 79.2% (95%CI: 71.2-87.1). The selected cut-off point to detect clinically significant symptoms in men using the EPDS was 4/5 (Sensitivity (Se) 68.3% and specificity (Sp) 77.4%), the Zung SAS was 35/36 (Se 70.7% and Sp 79.0%) and the GHQ-12 was 0/1 (Se 75.6% and Sp 74.7%). Conclusions: PCMDs in men are an unrecognised public health problem in northern Vietnam. Overall the cut off scores to detect clinically significant symptoms are lower than those reported in high income settings. Cut off scores on the EPDS and Zung SAS are slightly higher in men than in women in northern Vietnam, but these scales are suitable for use with men in this setting. Although not suitable to detect PCMD in women, the GHQ-12 is suitable to detect PCMD in men. © 2011 Elsevier B.V.

Tran T.D.,Monash University | Tran T.,Research and Training Center for Community Development | Fisher J.,Monash University
BMC Psychiatry | Year: 2013

Background: Depression and anxiety are recognised increasingly as serious public health problems among women in low- and lower-middle income countries. The aim of this study was to validate the 21-item Depression Anxiety and Stress Scale (DASS21) for use in screening for these common mental disorders among rural women with young children in the North of Vietnam.Methods: The DASS-21 was translated from English to Vietnamese, culturally verified, back-translated and administered to women who also completed, separately, a psychiatrist-administered Structured Clinical Interview for DSM IV Axis 1 diagnoses of depressive and anxiety disorders. The sample was a community-based representative cohort of adult women with young children living in Ha Nam Province in northern Viet Nam. Cronbach's alpha, Exploratory Factor Analyses (EFA) and Receiver Operating Characteristic (ROC) analyses were performed to identify the psychometric properties of the Depression, Anxiety, and Stress subscales and the overall scale.Results: Complete data were available for 221 women. The internal consistency (Cronbach's alpha) of each sub-scale and the overall scale were high, ranging from 0.70 for the Stress subscale to 0.88 for the overall scale, but EFA indicated that the 21 items all loaded on one factor. Scores on each of the three sub-scales, and the combinations of two or three of them were able to detect the common mental disorders of depression and anxiety in women with a sensitivity of 79.1% and a specificity of 77.0% at the optimal cut off of >33. However, they did not distinguish between those experiencing only depression or only anxiety.Conclusions: The total score of the 21 items of the DASS21-Vietnamese validation appears to be comprehensible and sensitive to detecting common mental disorders in women with young children in primary health care in rural northern Vietnam and therefore might also be useful to screen for these conditions in other resource-constrained settings. © 2013 Tran et al.; licensee BioMed Central Ltd.

Fisher J.R.W.,University of Melbourne | de Mello M.C.,World Health Organization | Izutsu T.,Technical Adviser | Tran T.,Research and Training Center for Community Development
International Journal of Mental Health Systems | Year: 2011

Mental health problems in women during pregnancy and after childbirth and their adverse consequences for child health and development have received sustained detailed attention in high-income countries. In contrast, evidence has only been generated more recently in resource-constrained settings.In June 2007 the United Nations Population Fund, the World Health Organization, the Key Centre for Women's Health in Society, a WHO Collaborating Centre for Women's Health and the Research and Training Centre for Community Development in Vietnam convened the first international expert meeting on maternal mental health and child health and development in resource-constrained settings. It aimed to appraise the evidence about the nature, prevalence and risks for common perinatal mental disorders in women; the consequences of these for child health and development and ameliorative strategies in these contexts.The substantial disparity in rates of perinatal mental disorders between women living in high- and low-income settings, suggests social rather than biological determinants. Risks in resource-constrained contexts include: poverty; crowded living situations; limited reproductive autonomy; unintended pregnancy; lack of empathy from the intimate partner; rigid gender stereotypes about responsibility for household work and infant care; family violence; poor physical health and discrimination. Development is adversely affected if infants lack day-to-day interactions with a caregiver who can interpret their cues, and respond effectively. Women with compromised mental health are less able to provide sensitive, responsive infant care. In resource-constrained settings infants whose mothers are depressed are less likely to thrive and to receive optimal care than those whose mothers are well.The meeting outcome is the Hanoi Expert Statement Additional file . It argues that the Millennium Development Goals to improve maternal health, reduce child mortality, promote gender equality and empower women, achieve universal primary education and eradicate extreme poverty and hunger cannot be attained without a specific focus on women's mental health. It was co-signed by the international expert group; relevant WHO and UNFPA departmental representatives and international authorities. They concur that social rather than medical responses are required. Improvements in maternal mental health require a cross-sectoral response addressing poverty reduction, women's rights, social protection, violence prevention, education and gender in addition to health.© 2011 Fisher et al; licensee BioMed Central Ltd.

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