• Africa
• Associated factors
• Depressive symptoms
• People living with HIV
• Pooled prevalence

• Humans
• HIV Infections/psychology
• HIV Infections/epidemiology
• Depression/epidemiology
• Depression/psychology
• Africa/epidemiology
• Prevalence
• Female
• Social Stigma
• Social Support

• Edinburgh Postnatal Depression Scale
• antenatal
• antepartum
• depression
• perinatal
• prenatal

• Child
• Development
• Nutrition
• Stunting
• WASH

• R33 HD103101 NICHD NIH HHS
• R61 HD103101 NICHD NIH HHS

• Humans
• Female
• Zimbabwe
• Cognition
• HIV Infections/prevention & control
• Male
• Pregnancy
• Child
• Rural Population
• Child Development
• Follow-Up Studies
• Infant
• Pregnancy Complications, Infectious

• Wellcome Trust
• R33 HD103101 NICHD NIH HHS
• R61 HD103101 NICHD NIH HHS
• National Institutes of Health
• Thrasher Research Fund
• Innovative Methods and Metrics for Agriculture and Nutrition Actions

• diagnostic tools
• maternal mental health
• mental conditions
• mental disorders
• postpartum women
• pregnant women
• primary care
• screening tools

• Humans
• Female
• Primary Health Care
• Africa South of the Sahara
• Pregnancy
• Mass Screening
• Psychometrics
• Mental Disorders/diagnosis
• Mental Health
• Pregnancy Complications/diagnosis

• Edinburgh Postnatal Depression Scale
• FGM
• Somalia

• Child
• Humans
• Female
• Circumcision, Female/adverse effects
• Cross-Sectional Studies
• Depression/epidemiology
• Depression/etiology
• Somalia
• Postpartum Period

• DSM-5
• EPDS
• MINI
• postpartum depression
• validation

• D43 TW010543 FIC NIH HHS
• R01 HD111692 NICHD NIH HHS
• African Development Bank

• Infant, Newborn
• Infant
• Child
• Pregnancy
• Female
• Humans
• Depression/diagnosis
• Birth Weight
• Zimbabwe/epidemiology
• Maternal Health Services
• Parturition
• Prenatal Care

• Wellcome Trust
• D43 TW010313 FIC NIH HHS
• AMARI

• Humans
• Child
• Zimbabwe
• Anthropometry
• Surveys and Questionnaires
• Africa, Northern

• Wellcome Trust
• R33 HD103101 NICHD NIH HHS
• R61 HD103101 NICHD NIH HHS
• 108065/Z/15/Z Wellcome Trust
• Foundation for the National Institutes of Health
• Thrasher Research Fund
• Innovative Methods and Metrics for Agriculture and Nutrition Actions

• CESD-10
• EPDS
• PHQ-2
• PHQ-9
• Postpartum depression
• Screening
• Sub-Saharan Africa

• Female
• Humans
• Depression
• Depression, Postpartum/diagnosis
• Depression, Postpartum/epidemiology
• Depressive Disorder, Major/diagnosis
• Depressive Disorder, Major/epidemiology
• Kenya/epidemiology
• Mass Screening
• Patient Health Questionnaire
• Postpartum Period
• Psychiatric Status Rating Scales
• Surveys and Questionnaires

• R01 HD094630 NICHD NIH HHS
• F31 HD101149 NICHD NIH HHS
• R01 AI125498 NIAID NIH HHS
• F32 HD108857 NICHD NIH HHS
• P30 AI027757 NIAID NIH HHS
• R01 HD100201 NICHD NIH HHS

• Global mental health
• low- and middle-income countries
• post-traumatic stress disorder
• psychological testing
• rating scales

• Miscarriage
• Zimbabwe
• low birthweight
• neonatal mortality
• obstetric care
• preterm birth
• stillbirth

• Malnutrition

• Wellcome Trust
• R01 HD060338 NICHD NIH HHS
• National Institutes of Health, USA
• UNICEF
• Saxon Graham
• Graduate Student Association at the University at Buffalo, the State University of New York
• Department for International Development (DFID), UK
• Wellcome Trust, UK
• Swiss Agency for Development
• Bill & Melinda Gates Foundation

• Maternal health
• Mental health
• Perinatal depression
• Psychometrics
• Sub-saharan Africa
• Validity

Pregnant and postpartum women (PPW) in sub‐Saharan Africa are at disproportionately high risk of HIV infection compared to non‐pregnant women. When used consistently, pre‐exposure prophylaxis (PrEP) can prevent HIV acquisition and transmission to the foetus or infant during these critical periods. Recent studies have demonstrated associations between mental health challenges (e.g. depression and traumatic stress associated with intimate partner violence) and decreased PrEP adherence and persistence, particularly among adolescents, younger women and women in the postpartum period. However, mental health is not currently a major focus of PrEP implementation research and programme planning for PPW.

PrEP implementation programmes for PPW need to assess and address mental health barriers to consistent PrEP use to ensure effectiveness and sustainability in routine care. We highlight three key research priorities that will support PrEP adherence and persistence: (1) include mental health screening tools in PrEP implementation research with PPW, both to assess the feasibility of integrating these tools into routine antenatal and postpartum care and to ensure that limited resources are directed towards women whose symptoms may interfere most with PrEP use; (2) identify cross‐cutting, transdiagnostic psychological mechanisms that affect consistent PrEP use during these periods and can realistically be targeted with intervention in resource‐limited settings; and (3) develop/adapt and test interventions that target those underlying mechanisms, leveraging strategies from existing interventions that have successfully mitigated mental health barriers to antiretroviral therapy use among people with HIV.

For PPW, implementation of PrEP should be guided by a robust understanding of the unique psychological difficulties that may act as barriers to uptake, adherence and persistence (i.e. sustained adherence over time). We strongly encourage PrEP implementation research in PPW to incorporate validated mental health screening tools and ultimately treatment in routine antenatal and postnatal care, and we stress the potential public health benefits of identifying women who face mental health barriers to PrEP use.

• PrEP
• barriers
• mental health
• postpartum
• pregnancy
• sub-Saharan

• Consensus
• Depression, Postpartum/diagnosis
• Female
• Humans
• Patient Reported Outcome Measures
• Quality of Life
• Reproducibility of Results

• child undernutrition
• complementary feeding
• home fortification
• nutrient supplements
• stunting
• wasting

• Africa South of the Sahara/epidemiology
• Bangladesh/epidemiology
• Child Development/drug effects
• Child Nutrition Disorders/epidemiology
• Child, Preschool
• Dietary Supplements
• Effect Modifier, Epidemiologic
• Female
• Haiti/epidemiology
• Humans
• Infant
• Infant Nutritional Physiological Phenomena
• Lipids/administration & dosage
• Male
• Nutritional Status
• Randomized Controlled Trials as Topic

• 001 World Health Organization
• P30 DK056341 NIDDK NIH HHS
• P30 DK092950 NIDDK NIH HHS
• Bill and Melinda Gates Foundation

• Associated factors
• Postpartum depression
• Prevalence
• Uganda

• dimensions
• food insecurity
• households
• measures
• water insecurity

• Food Insecurity
• Food Supply
• Humans
• Infant
• Reproducibility of Results
• Water Insecurity
• Zimbabwe

• 2R01HD060338-06 NIH HHS
• 093768/Z/10/Z Wellcome Trust
• 108065/Z/15/Z Wellcome Trust
• 203905/Z/16/Z Wellcome Trust

• Zimbabwe
• gender norm attitudes
• maternal depression
• stunting
• women's decision making
• women's empowerment

• Child
• Female
• Growth Disorders/epidemiology
• Growth Disorders/prevention & control
• Humans
• Infant
• Infant Nutritional Physiological Phenomena
• Mothers
• Nutritional Status
• Pregnancy
• Rural Population
• Sanitation
• Zimbabwe/epidemiology

• Wellcome Trust
• R01 HD060338 NICHD NIH HHS
• 093768/Z/10/Z Wellcome Trust
• 108065/Z/15/Z Wellcome Trust
• UNICEF
• Direktion für Entwicklung und Zusammenarbeit
• Wellcome Trust
• UK Department for International Development
• Bill and Melinda Gates Foundation

There is a high burden of depression globally, including in South Africa. Maternal depression is associated with poverty, unstable income, food insecurity, and lack of partner support, and may lead to poor outcomes for mothers and children. In South Africa one-third of working women are in informal work, which is associated with socioeconomic vulnerability.

A cross sectional survey explored work setting and conditions, food security and risk of depression among informal working women with young children (0–3 years). Depression risk was assessed using the Edinburgh Postnatal Depression Score (EPDS) and Whooley score. Food insecurity was evaluated using Household Food Insecurity Access Scale. Data was analysed using SPSS and Stata.

Interviews were conducted with 265 informal women workers. Types of work included domestic work, home-based work, informal employees and own account workers, most of whom were informal traders. Most participants (149/265; 56.2%) earned between US$70–200 per month, but some participants (79/265; 29.8%) earned < US$70 per month, and few earned > US$200 per month (37/265; 14.0%). Many participants experienced mild (38/267; 14.3%), moderate (72/265; 27.2%) or severe (43/265; 16%) food insecurity. Severe food insecurity was significantly higher among participants with the lowest income compared to those with the highest income (p = 0.027). Women who received financial support from the baby’s father were less likely to be food insecure (p = 0.03). Using EPDS scores, 22/265 (8.3%) women were designated as being at risk of depression. This was similar among postnatal women and women with older children. Household food insecurity was significantly associated with depression risk (p < 0.001).

Informal women workers were shown to be vulnerable with low incomes and high rates of food insecurity, thus increasing the risk for poor maternal health. However, levels of depression risk were low compared to previous estimates in South Africa, suggesting that informal workers may have high levels of resilience. Interventions to improve social protection, access to health services, and support for safe childcare in the workplace could improve the health and wellbeing of these mothers and support them to care for their children.

• Africa
• Antenatal depression
• Child health
• Food insecurity
• Informal economy
• Maternal health
• Postnatal depression
• South Africa
• Working women

• Africa
• Depression
• community health workers
• problem-solving therapy
• task sharing

• Zimbabwe
• caregiving
• depression
• gender norms attitudes
• maternal capabilities

postpartum depression (PPD) continues to become one of the major maternal health challenges across the globe but there is a paucity of recent data on its magnitude in Africa. This study was motivated by the need to update the current magnitude of PPD in Africa based on various assessment tools.

a total of 21 articles met the study criteria. Fifteen articles used the EPDS and six used other assessment tools. Postpartum depression among studies that used EPDS tool ranged from 6.9% in Morocco to 43% in Uganda and 6.1% in Uganda to 44% in Burkina Faso among studies that used other depression assessment tools. Sensitivity and specificity results of the EPDS ranged from 75%-100% and 87%-98% respectively.

a total of 21 articles met the study criteria. Fifteen articles used the EPDS and six used other assessment tools. Postpartum depression among studies that used EPDS tool ranged from 6.9% in Morocco to 43% in Uganda and 6.1% in Uganda to 44% in Burkina Faso among studies that used other depression assessment tools. Sensitivity and specificity results of the EPDS ranged from 75%-100% and 87%-98% respectively.

despite the limited dearth of literature, the magnitude of PPD in Africa remains high which suggests that PPD is still a neglected illness and calls for immediate interventions. EPDS is an effective tool with high sensitivity and specify in varying study contexts.

• Africa
• Postpartum depression
• burden
• magnitude
• prevalence

• EPDS
• Foragers
• Hadza
• Maternal health
• Postpartum depression

This study aimed to assess the association between suicidal ideation among mothers living with HIV in Zimbabwe and the cognitive development of their children. Participants were mother–child dyads recruited from two rural districts in Zimbabwe. Data were collected at baseline and 12 months follow-up. Suicidal ideation was assessed using item-10 from the Edinburgh postnatal depression scale. Mixed-effects linear regression was used to assess the association of child cognitive outcomes at follow-up (using the Mullen scales of early learning) with maternal suicidal ideation. Mothers with suicidal ideation at baseline (n = 171) tended to be younger, unmarried, experienced moderate to severe hunger, had elevated parental stress and depression symptoms compared with non-suicidal mothers (n = 391). At follow-up, emerging maternal suicidal ideation was associated with poorer child cognitive outcomes (adjusted mean difference − 6.1; 95% CI − 10.3 to − 1.8; p = 0.03). Suicidal ideation affects child cognitive development and should be addressed, particularly in HIV positive mothers.

• Africa
• Child development
• HIV/AIDS
• Maternal mental health
• Suicidal ideation

The prevalence of post-natal depression (PND) is high in India, as it is in many other low to middle income countries. There is an urgent need to identify PND and treat the mother as early as possible. Among the many paper and pencil tests available to identify PND, the Edinburgh Postnatal Depression Scale (EPDS) is a widely used and validated measure in India. However, the summary diagnostic accuracy and clinical utility data are not available for this measure.

To establish summary data for the global diagnostic accuracy parameter as well as the clinical utility of the non-English versions of the EPDS in India.

Two researchers independently searched the PubMed, EMBASE, MEDKNOW and IndMED databases for published papers, governmental publications, conference proceedings and grey literature from 2000-2018. Seven studies that evaluated the diagnostic accuracy of EPDS in five Indian languages against DSM/ICD were included in the final analysis. Two other investigators extracted the Participants’ details, Index measures, Comparative reference measures, and Outcomes of diagnostic accuracy data, and appraised the study quality using QUADS-2. Deek’s plots were used to evaluate publication bias. We used the area under the curve of the hierarchical summary area under the receiver operating characteristic curve, with the random effect model, to summarize the global diagnostic accuracy of EPDS. Using the 2 × 2 table, we calculated positive and negative likelihood ratios. From the likelihood ratios, the Fagan’s nomogram was built for evaluating clinical utility using the Bayesian approach. We calculated the 95% confidence interval (95%CI) whenever indicated. STATA (version 15) with MIDAS and METANDI modules were used.

There was no publication bias. The area under the curve for EPDS was 0.97 (95%CI: 0.95-0.98). The pre-test probability for the nomogram was 22%. For a positive likelihood ratio of 9, the positive post-test probability was 72% (95%CI: 68%, 76%) and for a negative LR of 0.08, the negative post-test probability was 2% (95%CI: 1%, 3%).

In this meta-analysis, we established the summary global diagnostic parameter and clinical utility of the non-English versions of the EPDS in India. This work demonstrates that these non-English versions are accurate in their diagnosis of PND and can help clinicians in their diagnostic reasoning.

• Clinical-utility
• Diagnostic-accuracy
• Edinburgh Postnatal Depression Scale
• Meta-analysis
• India
• Validation

Antenatal depression is the most prevalent common mental health disorder affecting pregnant women. Here, we report the prevalence of and associated factors for antenatal depression among pregnant women attending antenatal care services in Harare, Zimbabwe.

From January–April 2018, 375 pregnant women, aged 16–46 years, residing mostly in Harare’s high-density suburbs were recruited from two randomly-selected polyclinics. Antenatal depression was measured using the Structured Clinical Interview for DSM-IV. Sociodemographic data including; maternal age, education, marital status, economic status, obstetric history and experiences with violence were also collected. Chi-square tests and multivariate logistic regression analysis were used to determine the association between antenatal depression and participants’ characteristics.

The prevalence of antenatal depression was 23.47% (95% CI: 19.27–28.09). Multivariate logistic regression analysis revealed intimate partner violence (IPV) [OR 2.45 (95% CI: 1.47–4.19)] and experiencing negative life events [OR 2.02 (95% CI: 1.19–3.42)] as risk factors for antenatal depression, with being married/cohabiting [OR 0.45 (95% CI: 0.25–0.80)] being a protective factor.

The prevalence of antenatal depression is high with associated factors being interpersonal. Context-specific interventions are therefore needed to address the complexity of the factors associated with antenatal depression.

• Antenatal depression
• Associated factors
• Prevalence
• Zimbabwe

• Child cognitive development
• Common mental disorders
• HIV positive
• Maternal depression
• Sub-Saharan Africa

HIV-exposed children show signs of developmental delay. We assessed the impact of a pragmatic multicomponent intervention for caregivers of HIV-exposed children aged 0–2 years in Zimbabwe.

We conducted a cluster-randomised trial from 2016 to 2018. Clusters were catchments surrounding clinics, allocated (1:1) to either National HIV guidelines standard of care or standard care plus an 18-session group intervention comprising i) early childhood stimulation (ECS) and parenting training with home visits to reinforce skills and retention in HIV care; ii) economic strengthening. Primary outcomes measured 12 months after baseline (4.5 months postintervention completion) included: i) global child development measured using the Mullen early learning composite score; ii) retention in HIV care. Analysis used mixed effects regression to account for clustering and adjusted minimally for baseline prognostic factors and was by intention to treat.

Thirty clusters, 15 in each arm, were randomised. 574 dyads were recruited with 89.5% retained at follow-up. Ninety one of 281 (32.4%) were recorded as having received the complete intervention package, with 161/281 (57.3%) attending ≥14 ECS sessions. There was no evidence of an intervention effect on global child development (intervention mean 88.1 vs standard of care mean 87.6; adjusted mean difference=0.06; 95% CI −2.68 to 2.80; p=0.97) or infant retention in care (proportion of children who had missed their most recent HIV test: intervention 21.8% vs standard of care 16.9%, p=0.18). There was weak evidence that the proportion of caregivers with parental stress was reduced in the intervention arm (adjusted OR (aOR)=0.69; 95% CI 0.45 to 1.05; p=0.08) and stronger evidence that parental distress specifically was reduced (intervention arm 17.4% vs standard of care 29.1% scoring above the cut-off; aOR=0.56; 95% CI 0.35 to 0.89; p=0.01).

This multicomponent intervention had no impact on child development outcomes within 4.5 months of completion, but had an impact on parental distress. Maternal mental health remains a high priority.

PACTR201701001387209.

• Early childhood development
• HIV-exposed infants
• Internal savings and lending scheme
• RCT
• Zimbabwe

Despite widespread HIV screening and treatment programs across sub-Saharan Africa, many countries are not on course to meet the Joint United Nations Program on HIV/AIDS 90–90–90 targets. As mental health disorders such as depression are prevalent among people living with HIV, investment in understanding and addressing comorbid depression is increasing. This manuscript aims to assess depression and HIV management in sub-Saharan Africa using a 90–90–90 lens through a discussion of: depression and the HIV care continuum; the state of depression screening and treatment; and innovations such as task-shifting strategies for depression management. Due to the lack of mental health infrastructure and human resources, task-shifting approaches that integrate mental health management into existing primary and community health programs are increasingly being piloted and adopted across the region. Greater integration of such mental health care task-shifting into HIV programs will be critical to realizing the 90–90–90 goals and ending the HIV epidemic.

• Depression
• HIV/AIDS
• Mental health disorders
• Sub-Saharan Africa
• UNAIDS 90–90–90

• HIV
• South Africa
• adolescents
• children
• intervention
• mood