Innovation summary

Almost 60% of kids in Bangladesh are at risk of poor development due to low body weight, and under nutrition, poverty, and sub-optimal stimulation due to low parenting knowledge.1 The mother is usually the key childcare provider and her physical and mental health is a major predictor of child development, particularly in low and middle-income countries. Depression in particular is reported as a leading cause of disease burden for women and maternal mental health is identified as one of the major predictors of child development. 

The goal of the innovation is to improve care-giving practices of depressed mothers, and to reduce maternal depression, which subsequently will improve children’s health and development.

This project employs a two-pronged approach to maternal mental health of women living in Bangladesh. First, it uses Cognitive Behavioral Therapy (CBT) to manage mothers’ depression. Second, it trains depressed mothers on psychological stimulation (PS) to encourage them, despite their poor mental health, to care for their children. A combined program targeting both the mother and child can improve maternal mental health while additionally helping to ensure a nurturing environment for young children.

Impact summary

  • 115 mothers and their children will have access to the CBT intervention and PS training
  • 0.4 SD increase in  two or more of the measured scores (cognitive, motor, language and behavior) in children of the intervention group when compared to children in the control group

“You are asking me about the sad thoughts that I suppressed in my mind for long. Nobody ever wanted to know about these. I am feeling so light after sharing those with you”

-A mother enrolled in the project

​This innovation is funded by Grand Challenges Canada.

Innovation details

Though early stimulation interventions in Bangladesh have shown moderate improvements to child development, there are still some gaps in the pathway to delivery. One of these gaps is likely maternal depression as Bangladeshi mothers with subclinical depressive symptoms often do not seek treatment due to stigma. Due to this, depressed mothers often fail to provide sufficient stimulation and care for their children and in turn compromise benefits of existing early stimulation programs.

As mothers are usually the key providers of childcare, it is imperative to invest in maternal depression programs, which in turn can encourage higher adherence to early stimulation programs.

Rahman and colleagues tested an innovative model – The Thinking Healthy Programme – of community-based depression management using Cognitive Behavioral Therapy (CBT) in Pakistan and reported improvement in maternal depression 6 months postpartum.2 This innovation combines The Thinking Healthy Programme with an evidenced-based ECD program on psychological stimulation to achieve maximum benefits on reducing maternal depressive symptoms and also improving children’s overall development. In the team’s previous ECD work, it was found that minimum fortnightly contacts of stimulation workers are required to bring desired developmental benefit of children. This has been incorporated into this project by providing a combined intervention with fortnightly visits for up to one year by involving government health workers through home visits. 

Key drivers

Program Modified from Ongoing Feedback

Based on the lessons learned from the ongoing work, the project will be continuously modified by refining the intervention into one that is more comprehensive and integrated. Till date, modifications have included:

  • Further development of sessions so they are more interesting and participatory
  • Inclusion of a practical example in the session to help the mothers understand how to convert their negative thoughts to positive ones
  • Inclusion of brainstorming sessions to explore new ways to increase involvement of government officials in monitoring tasks

Challenges

Expectations for Higher Pay

Since government female health workers (FWA) and health assistants (HA) will add the intervention and training to their existing tasks as part of the governmental program, they expect extra compensation for their work

Scheduling Sessions

It has been quite difficult to schedule mothers’ sessions due to their schedules

Motivation and Monitoring

Hired governmental staff require lots of motivation and monitoring by the project’s resource person (project staff trainers)

Political Instability and Cultural Context

Smooth progress of the program is interrupted by political instability (strikes and road blockades), long absences due to grand festivals, and mothers’ lack of free time during harvesting seasons

Continuation

Findings of this program will contribute to develop a model that can be implemented in other districts, cities, and countries. 

Partners

Implementing Partners

Funder

Evaluation methods

The program will be evaluated through a randomized controlled trial. Outcome scores of 300 mother-child dyads (150 each in intervention and control arms) will be compared.

Outcome measures for mothers include:

  • Depression
  • Self esteem
  • Childcare practices

Outcome measures for children include:

  • Cognitive, motor, and language development
  • Measurement of amount of stimulation received at home
  • Child’s behavior

Impact details

Of the 115 mothers and children who will have access to the intervention and training, it is expected that children will have 0.4 SD higher scores compared to children in the control group in two or more of the following measures: cognitive, motor, language and behavior scores.

It is also expected that providers will have increase knowledge on managing and supporting maternal depression.

References

  1. Hamadani J. et al. (2010) The use of indicators of family care and their relation to child development in Bangladesh. Journal of Health, Population and Nutrition 28, 23-33.​
  2. Rahman A et al. (2008) The neglected ‘m’ in MCH programmes–why mental health of mothers is important for child nutrition. Tropical Medicine International Health 13: 579-83.

Tools

Associates

Fahmida Tofail
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Country

Bangladesh

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