EXPanding Care fOr PeriNATal women with dEpression (EXPONATE)

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.