[#WHD2017 Africa Blog Series] Inspiring African innovations: Intervention Addressing Perinatal Depression in Rwanda

This blog is part of our series celebrating World Health Day 2017. This year's theme is Depression: Let's Talk and we're showcasing inspiring innovations addressing depression across Africa.

MHIN Africa innovation on depression 9: A Community-Based Intervention To Address Perinatal Depression In Rwanda

A Community-Based Intervention To Address Perinatal Depression In Rwanda is a prevention-focused intervention providing emotional support to all new mothers in communities through regular visits by trained local women leaders.

Tell us about your country’s context and the circumstances that inspired your innovation

Perinatal depression is a condition that affects a relatively large number of women and can have serious consequences for the health and well-being of both the mother and her infant. There are several factors that increase the risk for perinatal depression including poverty and food insecurity, young age at pregnancy, and previous mental health issues (Patel et al., 2004).

Rwanda is a relatively poor country, in the bottom third of the UN Human Development Index, and a post genocide society where the prevalence of depression among the general population is generally high (Munyandamutsa, 2012).

There was only one previous study examining rates and predictors of perinatal depression in Rwanda (Umuziga, 2013). In a sample of 165 women visiting a paediatric clinic in one district, Umuziga found relatively high rates of women at risk of depression. Consistent with other research, she found risk factors for depression included a poor relationship with one’s husband, having many children, and being a very young mother.

Despite the high rates in this one study and the elevated risk factors, little was known about the broader prevalence and predictors of perinatal depression, and whether simple community-based interventions could reduce the rates.

What aspect of your project are you most excited about? How is the project innovative or unique?

To our knowledge, our project was the first to document rates of perinatal depression in a community sample in Rwanda. It is used by existing local resources (community women leaders). It built collaborative networks and strong partnerships linking resources at multiple levels: the community (village residents; parents’ evenings; local health centres), the intermediate level (the mental health unit at the district hospital; district director of health; local authorities in charge of social affairs, gender and security) and the central level (mental health division and the maternal and child health division of the Ministry of Health; University of Rwanda). These partnerships built knowledge about screening, provided referrals and offered support to women affected by perinatal depression.

Have you noticed an impact ‘on the ground’? What is the best feedback you have received (from service users, team members, or otherwise)?

With this project, Community Women Leaders (CWLs) took on a new role in providing support to new mothers that was a natural fit to their existing roles.
CWLs provided valued support to women, but also some of their husbands, who contacted CWLs to talk about problems in their relationships.
Advocacy by CWLs for mothers included involving Community Women Leaders who connected women to existing support:

  • to wise men in the village who helped address and resolve conflict in marriages
  • to health centers for health-related problems 
  • to mental health services at the district hospital
  • to local authorities for conflict resolution or accessing available resources, such as adding mothers and their families to the list of those in needing financial support and connecting them to ibibina (financial mutual support networks)

The mental health division of the Ministry of Health has recommended screening of all new mothers.

What’s next?

Implement and improve the model in a number of other provinces in Rwanda. Validate a 3-item screening tool for use by community health centres

What is the one message about depression you want people to take away from your innovation?

Peer and husband psychosocial support are essential tools to alleviate perinatal depression.

For more African innovations featured in this series, please visit the [#WHD2017 Africa Blog Series].

Task sharing
Detection and diagnosis
Treatment, care and rehabilitation
Training, education and capacity building
Depression/anxiety/stress-related disorders
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