Innovation summary

Perinatal depression is a risk factor for disability and social disadvantage in mothers, and impaired physical and cognitive development in their infants. Though effective treatment is available in Nigeria and globally, perinatal women with depression often do not receive the treatment they need due to the extent of the treatment gap.

The goal of this project is to test the effectiveness of a task-shifting intervention package for perinatal depression, delivered in primary and maternal care settings by community midwives and supported by general physicians, using modern technology.

The intervention package consists of psychoeducation, problem solving treatment, social network activation and parenting skills. Support for primary care workers is facilitated by a technological support platform.

Impact summary

  • 686 pregnant women to be included in the study – 452 in the intervention arm and 234 in the control arm
  • $1.3 million USD funded over three years (09/2012 – 09/2015)

“The training I received on how to identify and treat depression in perinatal women using the stepped care intervention package has changed my practice and improved my counseling skills.” 

Vincent Ladosu, Community Health Worker, Oyo State, Nigeria

This innovation is funded by Grand Challenges Canada.

Innovation details

The project seeks to answer the following question: “Is a stepped-care intervention programme for perinatal depression delivered midwives, in which medical and specialist supervision and support are provided with the use of readily available modern technology be more effective and cost-effective than care as usual at improving the clinical outcome of mothers and their infants”.

Through a mixed methods approach the following components will take place:

Development of an Intervention Package

The intervention package, which recognizes and treats perinatal depression in primary and maternal care settings, has been developed. The package adapts and contextualizes components of the mhGAP-IG for use in constrained health systems, focusing first on Nigeria, though translatable to other Sub-Saharan countries. The key feature of the package is the modified Problem Solving Treatment (PST), an approach that has proved to be successful in the treatment of common mental disorders.2 Relevant trainings for parents, on skills such as positive mother-child interactions and emotional communication and infant nutrition information, have also been included.

To understand and integrate the experiences of those with perinatal depression, particularly on health access, social support/exclusion and stigma, lay workers, relatives and former patients were consulted through qualitative and quantitative methods. Health providers were also consulted to understand the specific organizational details of maternity clinics specifically on the contextual details that needed to be taken into account.

Though the intervention package mostly aims to support health workers who manage perinatal depression, there is also an outreach component to assist health providers supervise and consult community health workers. This is achieved through complementing technology. Overall, the technological platform consists of:

  • Two-way mobile telephone communication between the psychiatrist and the primary care physician, the primary care physician and non specialist health care provider, the non specialist health care provider and women with perinatal depression. 
  • An automated voice messaging system to remind women with perinatal depression about their clinic appointments. The voice message also reinforces intervention messages and any homework given.
  • An automated text messaging system to inform and remind the non specialist health care provider about patient appointments.
  • A secure data bank for non-specialist health providers to input clinical data, accessible to psychiatrist(s) and primary care physician(s).

Testing the Effectiveness and Cost-Effectiveness of the Intervention Package

Following the development of the intervention package, a randomized controlled trial will be conducted in Osun State to test the effectiveness and cost effectiveness of the package. More information about the trial can be found under the impact tab.

Key drivers

Project Developed as a Task Shifting Model

The use of a task shifting model ensures that most of the care is delivered by primary health care workers with supervision provided by the primary health care physicians.

Use of Technology

The health providers have integrated use of mobile phones in their practice, using it to contact patients to remind them of the follow up appointments and activities for the week. This promotes a higher rate of follow up visits, especially since most of the patients use mobile phones (over 94% of Nigerians now use mobile phones).3

Therapy and Patient Booklets in Yoruba

All therapy sessions were conducted in Yoruba, a major local language of Nigeria. Patient information booklets in Yoruba were also provided to educate the patient about their illness and the treatment they are receiving. 


Study is still on-going but early challenges include technical hitches with the technological platform.


The intervention package is designed to be culturally and socially appropriate, pragmatic and highly scalable.

Future plans consist of developing a manual to guide future scale-up. In addition, the team plans to engage with service providers and policy makers to aid scale-up.

Evaluation methods

The intervention is being evaluated in a two-arm parallel cluster randomized controlled trial comparing the intervention package for maternal depression consisting mainly of the aforementioned psychological interventions and care as usual. The unit of allocation is maternal care clinics (MCCs). Consecutive new attendees to antenatal clinics are approached while waiting to see the midwife and screened by trained research staff for depression and eligibility for inclusion into the study. Eligible participants (EPDS score>12, gestational age 16-26 weeks) in the intervention arm received our stepped care intervention package while those in the control arm receive usual care.

Outcome measures include recovery from depression at 6 months postpartum, disability, parenting skills and home environment, experience of stigma and discrimination, service utilization, and infant development and well being.

Cost of implementation

The total cost of the project is $1,474,302 USD.

Impact details


  • The target number of people for inclusion is 686: 452 in the intervention arm and 234 in the control arm.


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