Dadi Abel Fekadu, Miller Emma R, Azale Telake, Mwanri Lillian
College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Int J Ment Health Syst. 2021 May 5;15(1):41. doi: 10.1186/s13033-021-00466-y.
Qualitative studies evaluating maternal mental health services are lacking in Ethiopia, and the available evidence targets severe mental illnesses in the general population. We conducted a qualitative study to explore barriers to, enablers of, or opportunities for perinatal depression health services implementations in Ethiopia.
We conducted a total of 13 face to face interviews with mental and maternal health service administrators from different levels of the Ethiopian healthcare system. We interviewed in Amharic (a local language), transcribed and translated into English, and imported into NVivo. We analysed the translated interviews inductively using thematic framework analysis.
The study identified: (i) health administrators' low literacy about perinatal depression as individual level barriers; (ii) community low awareness, health-seeking behaviours and cultural norms about perinatal depression as socio-cultural level barriers; (iii) lack of government capacity, readiness, and priority of screening and managing perinatal depression as organisational level barriers; and (iv) lack of mental health policy, strategies, and healthcare systems as structural level barriers of perinatal mental health implementation in Ethiopia. The introduction of the new Mental Health Gap Action Programme (mhGap), health professionals' commitment, and simplicity of screening programs were identified enablers of, or opportunities for, perinatal mental health service implementation.
This qualitative inquiry identified important barriers and potential opportunities that could be used to address perinatal depression in Ethiopia. Building the capacity of policy makers and planners, strengthening the mental healthcare system and governance should be a priority issue for an effective integration of maternal mental health care with the routine maternal health services in Ethiopia.
埃塞俄比亚缺乏评估孕产妇心理健康服务的定性研究，现有证据主要针对普通人群中的严重精神疾病。我们开展了一项定性研究，以探索埃塞俄比亚围产期抑郁症健康服务实施的障碍、促进因素或机会。
我们共对埃塞俄比亚医疗系统不同层级的精神卫生和孕产妇健康服务管理人员进行了13次面对面访谈。我们用阿姆哈拉语（当地语言）进行访谈，转录并翻译成英语，然后导入NVivo。我们采用主题框架分析法对翻译后的访谈进行归纳分析。
该研究确定了：（i）卫生管理人员对围产期抑郁症认知不足，这是个体层面的障碍；（ii）社区对围产期抑郁症的认知度低、就医行为及文化规范，这是社会文化层面的障碍；（iii）政府在筛查和管理围产期抑郁症方面能力不足、准备不充分且未将其列为优先事项，这是组织层面的障碍；（iv）缺乏心理健康政策、战略和医疗体系，这是埃塞俄比亚围产期心理健康实施的结构层面障碍。新的《精神卫生差距行动计划》（mhGap）的推出、卫生专业人员的承诺以及筛查项目的简易性被确定为围产期心理健康服务实施的促进因素或机会。
这项定性研究确定了可用于解决埃塞俄比亚围产期抑郁症的重要障碍和潜在机会。加强政策制定者和规划者的能力、强化精神卫生保健系统和治理，应是埃塞俄比亚将孕产妇精神卫生保健有效纳入常规孕产妇保健服务的优先事项。
