Community Based Maternal Healthcare Services

Globally mental health conditions are of rising concern due to increased contribution to the global burden of disease. Mental health wellbeing cannot be determined by only the absence of mental disorders but also determined by related socio-economic, biological and environmental factors. Mental health disorders refer to a set of medical conditions that affect a person's thinking, feeling, mood, ability to relate to others, and daily functioning. According to the World Health Organization mental disorders comprise a broad range of problems, with different symptoms.

Depression is the most prevalent mental illness in the perinatal period, with research suggesting that around 10 to 14% of mothers are affected during pregnancy or after the birth of a baby. The key symptoms of depression include persistent sadness, fatigue and a loss of interest and enjoyment in activities. A number of studies have shown that many women who have postnatal depression have symptoms of depression in pregnancy, and can be identified in antenatal period. Better antenatal detection of depression therefore offers an opportunity for earlier intervention to address the illness and reduce the risk that will cause longer term problems for the mother or her baby.

Public services are failing to tackle perinatal mental disorders effectively due to lack of mental healthcare providers. To achieve Sustainable Development Goal (SDG), mental health services must be available at the community level in low socioeconomic country like Bangladesh. Moreover, due to lack of necessary training the healthcare providers at primary and secondary level, the patients with mental health problems cannot get adequate services to meet the requirements. Again they fail to refer the severely ill patients to the appropriate referral centre. Mental health issues are the vital for maintaining quality of life of people in developing countries like Bangladesh.

In Bangladesh there is a strong community-based healthcare network such as union health and family welfare centers at the union levels, community clinics at community levels to provide essential healthcare services especially for mother and child. Along with this the community health workers also provide maternal services through satellite clinics, out-reach centers and home visit. It is evidenced that community based intervention like counseling and psycho-social therapy by the non-mental health specialists such as community health workers compared to the usual maternal care is associated with the reduction of symptoms of common perinatal mental disorders. So, maternal healthcare services are the appropriate ones for providing primary mental healthcare services. There is needed to provide basic mental healthcare services along with maternal healthcare services from the community level health centers as well as by the community health workers for improving perinatal mental health status in Bangladesh. Objectives of this study are a) to develop a draft package of community-based primary mental healthcare services, b) to find the feasibility of the developed package for delivering with the maternal care services, c) to test the efficacy of the package of community-based primary mental healthcare services and d) to document the healthcare seeking behavior for perinatal mental disorders.

Methods The investigators will conduct a mixed method study to develop a package of community-based primary mental healthcare services (CBPMHC). Initially a draft package of services will be developed. Then, piloting will be done as cluster randomized control trial to test the efficacy of the package. The draft CBPMHC services package will be the intervention.