title: Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs.
abstract: Perinatal mental illness is a common and important public health problem, especially in low and middle-income countries (LMICs). This study aims to explore the barriers and facilitators, as well as perceptions about the feasibility and acceptability of plans to deliver perinatal mental health care in primary care settings in a low income, rural district in Uganda.
  
  
  
  Six focus group discussions comprising separate groups of pregnant and postpartum women and village health teams as well as eight key informant interviews were conducted in the local language using a topic guide. Transcribed data were translated into English, analyzed, and coded. Key themes were identified using a thematic analysis approach.
  
  
  
  Participants perceived that there was an important unmet need for perinatal mental health care in the district. There was evidence of significant gaps in knowledge about mental health problems as well as negative attitudes amongst mothers and health care providers towards sufferers. Poverty and inability to afford transport to services, poor partner support and stigma were thought to add to the difficulties of perinatal women accessing care. There was an awareness of the need for interventions to respond to this neglected public health problem and a willingness of both community- and facility-based health care providers to provide care for mothers with mental health problems if equipped to do so by adequate training.
  
  
  
  This study highlights the acceptability and relevance of perinatal mental health care in a rural, low-income country community. It also underscores some of the key barriers and potential facilitators to delivery of such care in primary care settings. The results of this study have implications for mental health service planning and development for perinatal populations in Uganda and will be useful in informing the development of integrated maternal mental health care in this rural district and in similar settings in other low and middle income countries.
authors.affiliation: Butabika Hospital, Makerere University, P.O.Box 24136, Kampala, Uganda. jnakku@yahoo.com.
authors.forename: Juliet E M
authors.initials: JE
authors.lastname: Nakku
authors.affiliation: Makerere University, Kampala, Uganda.
authors.forename: Elialilia S
authors.initials: ES
authors.lastname: Okello
authors.affiliation: Butabika Hospital, Makerere University, P.O.Box 24136, Kampala, Uganda.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Kizza
authors.affiliation: Department of Psychiatry and Mental Health, Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Simone
authors.initials: S
authors.lastname: Honikman
authors.affiliation: Butabika Hospital, Makerere University, P.O.Box 24136, Kampala, Uganda.
authors.forename: Joshua
authors.initials: J
authors.lastname: Ssebunnya
authors.affiliation: Ministry of Health, Kampala, Uganda.
authors.forename: Sheila
authors.initials: S
authors.lastname: Ndyanabangi
authors.affiliation: Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia.|King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hanlon
authors.affiliation: Butabika Hospital, Makerere University, P.O.Box 24136, Kampala, Uganda.
authors.forename: Fred
authors.initials: F
authors.lastname: Kigozi
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003906:Developing Countries; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000600:supply & distribution; D001523:Mental Disorders / Q000628:therapy*; D008603:Mental Health; D008605:Mental Health Services / Q000600:supply & distribution; D008875:Middle Aged; D009035:Mothers / Q000523:psychology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D036301:Qualitative Research; D012424:Rural Population; D057545:Social Stigma; D014454:Uganda; D055815:Young Adult
keywords: Community mental health; Maternal mental health; Mental health services; Perinatal mental health; Postnatal depression; Primary health care