Molly E Lasater1, Sarah M Murray1, Mariam Keita2, Fatoumata Souko2, Pamela J Surkan1,3, Nicole E Warren4, Peter J Winch3, Aissata Ba2, Seydou Doumbia5,6, Judith K Bass1. 1. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 2. Department of Public Health, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali. 3. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 4. Department of Community Public Health Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland. 5. Faculty of Medicine and Odontostomatology, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali. 6. University Clinical Research Center/ICER-Mali, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali.
Abstract
INTRODUCTION: Common perinatal mental disorders are prevalent in low- and middle-income countries. The gap between the need for and availability of mental health services, also known as the mental health treatment gap, is particularly acute for women during the perinatal period in rural Mali. This qualitative study aimed to identify a feasible and acceptable integrated care approach for the provision of maternal mental health care in rural Mali to help narrow the treatment gap and increase access to care. METHODS: From April to June 2016, qualitative data were collected in the Sélingué health district and Bamako, Mali. In-depth interviews were conducted among women, community health workers, midwives, and mental health specialists. Focus group participants included community health workers, midwives, and an obstetric nurse. All data were inductively coded and analyzed using a thematic analysis approach. RESULTS: Women described several coping strategies to manage their distress, including visiting their parents; confiding in a friend, relative, or community health worker; and participating in women's association groups. Mental health-related stigma was described as being widespread in the community and among health providers. In response to the lack of mental health services, midwives and community health workers supported the feasibility and acceptability of the integration of mental health services into maternal health services. Midwives were discussed as being key providers to conduct mental health screenings and provide initial psychosocial care for women. DISCUSSION: Integrated maternal and mental health interventions are needed to narrow the gap between the need for and availability of mental health services in rural Mali. Findings from this study underscore the great need for mental health services for women in the perinatal period who reside in rural Mali and that it is both feasible and acceptable to integrate mental health screening and low-level psychosocial care into antenatal care, delivered by midwives.
INTRODUCTION: Common perinatal mental disorders are prevalent in low- and middle-income countries. The gap between the need for and availability of mental health services, also known as the mental health treatment gap, is particularly acute for women during the perinatal period in rural Mali. This qualitative study aimed to identify a feasible and acceptable integrated care approach for the provision of maternal mental health care in rural Mali to help narrow the treatment gap and increase access to care. METHODS: From April to June 2016, qualitative data were collected in the Sélingué health district and Bamako, Mali. In-depth interviews were conducted among women, community health workers, midwives, and mental health specialists. Focus group participants included community health workers, midwives, and an obstetric nurse. All data were inductively coded and analyzed using a thematic analysis approach. RESULTS:Women described several coping strategies to manage their distress, including visiting their parents; confiding in a friend, relative, or community health worker; and participating in women's association groups. Mental health-related stigma was described as being widespread in the community and among health providers. In response to the lack of mental health services, midwives and community health workers supported the feasibility and acceptability of the integration of mental health services into maternal health services. Midwives were discussed as being key providers to conduct mental health screenings and provide initial psychosocial care for women. DISCUSSION: Integrated maternal and mental health interventions are needed to narrow the gap between the need for and availability of mental health services in rural Mali. Findings from this study underscore the great need for mental health services for women in the perinatal period who reside in rural Mali and that it is both feasible and acceptable to integrate mental health screening and low-level psychosocial care into antenatal care, delivered by midwives.
Authors: Shanon E McNab; Sean L Dryer; Laura Fitzgerald; Patricia Gomez; Anam M Bhatti; Edward Kenyi; Aleefia Somji; Neena Khadka; Suzanne Stalls Journal: BMC Pregnancy Childbirth Date: 2022-04-20 Impact factor: 3.105