Ayinde Olatunde O, Oladeji Bibilola D, Abdulmalik Jibril, Jordan Keely, Kola Lola, Gureje Oye
Department of Psychiatry, University College Hospital, Ibadan, PMB 5116, Nigeria.
College of Global Public Health, New York University, New York, USA.
BMC Health Serv Res. 2018 Nov 22;18(1):879. doi: 10.1186/s12913-018-3716-3.
Even though integrating mental health into maternal and child health (MCH) is widely accepted as a means of closing the treatment gap for maternal mental health conditions in low- and middle-income countries (LMIC), there are not many studies on the quality of the currently available mental health care for mothers in these countries. This study assessed the existing organization of service for maternal mental health, the actual care delivered for perinatal depression, as well as the quality of the care received by affected women presenting to primary care clinics in Ibadan, Nigeria.
The Assessment of Chronic Illness Care (ACIC) tool was administered to the staff in 23 primary maternal care clinics and key informant interviews were conducted with 20 facility managers to explore organizational and administrative features relevant to the delivery of maternal mental health care in the facilities. Detection rate of perinatal depression by maternal care providers was assessed by determining the proportion of depressed antenatal women identified by the providers. The women were then followed up from the antenatal period up until 6 months after childbirth to track their experience with care received.
All the facilities had ACIC domain scores indicating poor capacity to offer quality chronic care. Emerging themes from the interviews included severe manpower shortage and absence of administrative and clinical support for manpower training and care provision. Only 31 of the 218 depressed women had been identified by the maternal care providers as having a psychological problem throughout the follow-up period. In spite of the objective evidence of inadequate care, most of the perinatal women rated the service provided in the facilities as being of good quality (96%) and reported being satisfied with the care received (98%).
There are major inadequacies in the organisational and administrative profile of these primary maternal care facilities that militate against the provision of quality chronic care. These inadequacies translate to a large treatment gap for women with perinatal depression. Lack of awareness by service users of what constitutes good quality care, indicative of low service expectation, may hamper user-driven demand for quality improvement.
尽管将心理健康纳入妇幼保健（MCH）被广泛认为是缩小低收入和中等收入国家（LMIC）孕产妇心理健康状况治疗差距的一种手段，但关于这些国家目前为母亲提供的心理健康护理质量的研究并不多。本研究评估了尼日利亚伊巴丹初级保健诊所现有的孕产妇心理健康服务组织、围产期抑郁症的实际护理情况，以及受影响妇女接受护理的质量。
对23家初级孕产妇保健诊所的工作人员使用慢性病护理评估（ACIC）工具，并与20名机构管理人员进行关键信息访谈，以探讨与机构中孕产妇心理健康护理提供相关的组织和管理特征。通过确定孕产妇护理提供者识别出的抑郁产前妇女比例，评估孕产妇护理提供者对围产期抑郁症的检出率。然后对这些妇女从孕期一直随访到产后6个月，以跟踪她们接受护理的经历。
所有机构的ACIC领域得分表明其提供优质慢性病护理的能力较差。访谈中出现的新主题包括严重的人力短缺以及缺乏对人力培训和护理提供的行政和临床支持。在218名抑郁妇女中，只有31名在整个随访期间被孕产妇护理提供者识别为有心理问题。尽管有客观证据表明护理不足，但大多数围产期妇女将机构提供的服务评为质量良好（96%），并报告对所接受的护理感到满意（98%）。
这些初级孕产妇保健机构在组织和管理方面存在重大不足，不利于提供优质的慢性病护理。这些不足导致围产期抑郁症妇女存在较大的治疗差距。服务使用者对优质护理的构成缺乏认识，表明服务期望较低，这可能会阻碍用户推动的质量改进需求。
