title: Maternal mental health in primary care in five low- and middle-income countries: a situational analysis.
abstract: BACKGROUND
  The integration of maternal mental health into primary health care has been advocated to reduce the mental health treatment gap in low- and middle-income countries (LMICs). This study reports findings of a cross-country situation analysis on maternal mental health and services available in five LMICs, to inform the development of integrated maternal mental health services integrated into primary health care.
  
  
  METHODS
  The situation analysis was conducted in five districts in Ethiopia, India, Nepal, South Africa and Uganda, as part of the Programme for Improving Mental Health Care (PRIME). The analysis reports secondary data on the prevalence and impact of priority maternal mental disorders (perinatal depression, alcohol use disorders during pregnancy and puerperal psychosis), existing policies, plans and services for maternal mental health, and other relevant contextual factors, such as explanatory models for mental illness.
  
  
  RESULTS
  Limited data were available at the district level, although generalizable data from other sites was identified in most cases. Community and facility-based prevalences ranged widely across PRIME countries for perinatal depression (3-50 %) and alcohol consumption during pregnancy (5-51 %). Maternal mental health was included in mental health policies in South Africa, India and Ethiopia, and a mental health care plan was in the process of being implemented in South Africa. No district reported dedicated maternal mental health services, but referrals to specialised care in psychiatric units or general hospitals were possible. No information was available on coverage for maternal mental health care. Challenges to the provision of maternal mental health care included; limited evidence on feasible detection and treatment strategies for maternal mental disorders, lack of mental health specialists in the public health sector, lack of prescribing guidelines for pregnant and breastfeeding women, and stigmatising attitudes among primary health care staff and the community.
  
  
  CONCLUSIONS
  It is difficult to anticipate demand for mental health care at district level in the five countries, given the lack of evidence on the prevalence and treatment coverage of women with maternal mental disorders. Limited evidence on effective psychosocial interventions was also noted, and must be addressed for mental health programmes, such as PRIME, to implement feasible and effective services.
authors.affiliation: Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa. emily.baron@uct.ac.za.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Baron
authors.affiliation: Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.|King's College London, Institute of Psychiatry, Centre for Global Mental Health, London, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hanlon
authors.affiliation: Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa.
authors.forename: Sumaya
authors.initials: S
authors.lastname: Mall
authors.affiliation: Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Simone
authors.initials: S
authors.lastname: Honikman
authors.affiliation: Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa.
authors.forename: Erica
authors.initials: E
authors.lastname: Breuer
authors.affiliation: University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Tasneem
authors.initials: T
authors.lastname: Kathree
authors.affiliation: Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal.
authors.forename: Nagendra P
authors.initials: NP
authors.lastname: Luitel
authors.affiliation: Butabika National Mental Hospital, Kampala, Uganda.
authors.forename: Juliet
authors.initials: J
authors.lastname: Nakku
authors.affiliation: Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa.|King's College London, Institute of Psychiatry, Centre for Global Mental Health, London, UK.
authors.forename: Crick
authors.initials: C
authors.lastname: Lund
authors.affiliation: Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Girmay
authors.initials: G
authors.lastname: Medhin
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.|Public Health Foundation of India, New Delhi, India.|Sangath, Goa, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.affiliation: University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Inge
authors.initials: I
authors.lastname: Petersen
authors.affiliation: Sangath, Goa, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Shrivastava
authors.affiliation: Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa.|Alan J Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Mark
authors.initials: M
authors.lastname: Tomlinson
mesh_terms: D003156:Community Mental Health Services / Q000458:organization & administration*; D005002:Ethiopia; D005190:Family; D005260:Female; D006801:Humans; D007194:India; D008427:Maternal Health Services / Q000458:organization & administration*; D001523:Mental Disorders / Q000628:therapy; D008603:Mental Health; D009390:Nepal; D010347:Patient Care Planning; D011203:Poverty / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011320:Primary Health Care / Q000458:organization & administration*; D011634:Public Health; D013019:South Africa; D014454:Uganda