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The Western Cape 1st 1000 Days Initiative:
Review and Future Focus
Perinatal Mental Health
Dr Simone Honikman
October 2017
In South Africa
In High Income Countries
Maternal depression
16-20%
22-47%
Periurban
• Antenatal 22%
• Postnatal 35%
Rural
• Antenatal 47%
and anxiety?
In Low and Middle Income
Countries
10-13%
Maternal Outcomes
Complications
during birth
Suicide
Poor use of
services
Loss of economic
potential
Domestic violence
Problems with
bonding
Drinking/drugs
Child Outcomes
Low Birth
Weight,
prematurity
Difficulties with
breastfeeding
Difficulty bonding
Crying and
irritability
Abandonment
abuse or neglect
Mental health
and conduct
problems
Impaired
language and
motor skills
sickness and
immunisation
non-adherence
Clinical services:
principles of how we respond
• Prepare the environment – policy and relationships
• Support the providers
• Routine and integrated
• Early detection and referral
• Adapt evidence-based psychosocial intervention to meet
clients’ needs
– on-site
– brief (2-3 sessions)
– linked to social support
• Liaison (social support, medical support) and follow-up
• Monitor and evaluate
Where have MMH matters
been recognized?
• Basic Antenatal Care – procedures and new training
• Postnatal Care Policy and guidelines 2016
• General IEC Materials for booking mothers
• Community Based Services
• Catch and Match
• Screening and referral procedures (in process)
• Patient-Centred Maternity Code
• Recognising abuse – zero tolerance
• Client feedback mechanisms
• Staff support and debriefing
• Training
• People’s Development Centre (DoH training unit)
• First Thousand Days
• Theory of Change
• IEC materials
• Maternity Stationery
• Primary Care Guidelines PACK
PMH within TOC
First 1000 Days – info material
Other
Viral load Date
Viral load Date
CD 4: ART initiated on (date):
Date: Reactive
HIV retest at 20 weeks: Reactive Non-reactive
Urine MCS
Reactive
Rapid syphilis test:
Rhesus:
COUNSELLING
Nutrition
HIV
Mental health
Alcohol/ substances/ tobacco
Declined
IPT
Declined
Non-reactive
2
nd
HIV test:
N
Hb g/dl Tetanus toxoid: 1
st
Declined
Infant feeding
Parental preparedness
Pos Neg Pos NegRepeat syphilis test:
3
rd
Antibodies: Y
FUTURE CONTRACEPTION (provide dual protection)
Injectable Oral
Intra-uterine
device
Tubal ligation Implant
Non-reactive
Name & Title
Domestic violence
Booking visit and assessment of risk done by:
Misc
A = Alive
md md y
Not done
Ultrasound
FL
AC
LNMP
Done
Vulva &
Vagina:
BMI:
BPD
y
Congenital Other
Referral:
NAME:
FOLDER NO:
DATE OF BIRTH:
LEVEL OF CARE
Sex Complications
Age: (yrs)
OBSTETRIC &
NEONATAL HISTORY ID = Infant Death
NND = Neonatal Death
IUD = Intra-uterine Death
Year Gestation Delivery Weight
Details:
Family
History
Twins Diabetes
CLINIC
EXAMINATION
BP
kg
VAGINAL EXAMINATION
WeightcmHeight
TB
Diabetes Cardiac
Single / Married / Stable relationship
TB
No Tobacco Alcohol Substances
HIV retest at 32 weeks:
Co-trimoxazole
TB symptom
screen:
Cervix:
Uterus:
Y
MEDICAL & GENERAL HISTORY
Hypertension Epilepsy
Other (specify)
Operations:
Descriptions of complications:
Medication:
Allergies:
Psycho-social risk factors: Yes
1
st
Date
/ Urine:
Result:
Pap Smear done?
HIV Psych
If yes to any of the above give further details, e.g. duration:
Abdomen:
Lungs:
Heart:
Thyroid:
Date:N
G P
3
rd
Transport when in labour:
GESTATIONAL AGE
SF measurement:
cm
Average gestation
HC
d d m m y y
Antenatal clinic: Delivery site:
Placenta
Date:
Y NCertain?
Labour companion
INVESTIGATIONS
Rx received:
MUAC:
y y
U/SDates
Breasts:
SF height
According
to
Estimated date of delivery
d d m m
2
nd
Date 1 Date 2
ANTENATAL RECORD
Antenatal care record: changes up close
PACK material
MMH - where are the gaps?
• Resource mapping
• Stepped care referral pathways
• Standard Operating Procedures
• Mental health counsellors
• What cadre?
• What training?
• What clinical supervision?
MMH - where are the gaps?
• Lack of policy implementation
• Resource allocation
• Attendant HR procedures missing – KPAs, job
descriptions
• Attendant M&E procedures/indicators missing
• Accountability?
• Where there is implementation
– what can we learn?
• Armchair intersectoral
collaboration
• DoH and DSD
• DoH and NPOs
Simone.Honikman@uct.ac.za
Dr Simone Honikman, PMHP Director
www.pmhp.za.org
http://perinatalmentalhealth.wordpress.com/

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First 1000 days and maternal mental health

  • 1. The Western Cape 1st 1000 Days Initiative: Review and Future Focus Perinatal Mental Health Dr Simone Honikman October 2017
  • 2. In South Africa In High Income Countries Maternal depression 16-20% 22-47% Periurban • Antenatal 22% • Postnatal 35% Rural • Antenatal 47% and anxiety? In Low and Middle Income Countries 10-13%
  • 3. Maternal Outcomes Complications during birth Suicide Poor use of services Loss of economic potential Domestic violence Problems with bonding Drinking/drugs
  • 4. Child Outcomes Low Birth Weight, prematurity Difficulties with breastfeeding Difficulty bonding Crying and irritability Abandonment abuse or neglect Mental health and conduct problems Impaired language and motor skills sickness and immunisation non-adherence
  • 5. Clinical services: principles of how we respond • Prepare the environment – policy and relationships • Support the providers • Routine and integrated • Early detection and referral • Adapt evidence-based psychosocial intervention to meet clients’ needs – on-site – brief (2-3 sessions) – linked to social support • Liaison (social support, medical support) and follow-up • Monitor and evaluate
  • 6. Where have MMH matters been recognized? • Basic Antenatal Care – procedures and new training • Postnatal Care Policy and guidelines 2016 • General IEC Materials for booking mothers • Community Based Services • Catch and Match • Screening and referral procedures (in process) • Patient-Centred Maternity Code • Recognising abuse – zero tolerance • Client feedback mechanisms • Staff support and debriefing • Training • People’s Development Centre (DoH training unit) • First Thousand Days • Theory of Change • IEC materials • Maternity Stationery • Primary Care Guidelines PACK
  • 8. First 1000 Days – info material
  • 9. Other Viral load Date Viral load Date CD 4: ART initiated on (date): Date: Reactive HIV retest at 20 weeks: Reactive Non-reactive Urine MCS Reactive Rapid syphilis test: Rhesus: COUNSELLING Nutrition HIV Mental health Alcohol/ substances/ tobacco Declined IPT Declined Non-reactive 2 nd HIV test: N Hb g/dl Tetanus toxoid: 1 st Declined Infant feeding Parental preparedness Pos Neg Pos NegRepeat syphilis test: 3 rd Antibodies: Y FUTURE CONTRACEPTION (provide dual protection) Injectable Oral Intra-uterine device Tubal ligation Implant Non-reactive Name & Title Domestic violence Booking visit and assessment of risk done by: Misc A = Alive md md y Not done Ultrasound FL AC LNMP Done Vulva & Vagina: BMI: BPD y Congenital Other Referral: NAME: FOLDER NO: DATE OF BIRTH: LEVEL OF CARE Sex Complications Age: (yrs) OBSTETRIC & NEONATAL HISTORY ID = Infant Death NND = Neonatal Death IUD = Intra-uterine Death Year Gestation Delivery Weight Details: Family History Twins Diabetes CLINIC EXAMINATION BP kg VAGINAL EXAMINATION WeightcmHeight TB Diabetes Cardiac Single / Married / Stable relationship TB No Tobacco Alcohol Substances HIV retest at 32 weeks: Co-trimoxazole TB symptom screen: Cervix: Uterus: Y MEDICAL & GENERAL HISTORY Hypertension Epilepsy Other (specify) Operations: Descriptions of complications: Medication: Allergies: Psycho-social risk factors: Yes 1 st Date / Urine: Result: Pap Smear done? HIV Psych If yes to any of the above give further details, e.g. duration: Abdomen: Lungs: Heart: Thyroid: Date:N G P 3 rd Transport when in labour: GESTATIONAL AGE SF measurement: cm Average gestation HC d d m m y y Antenatal clinic: Delivery site: Placenta Date: Y NCertain? Labour companion INVESTIGATIONS Rx received: MUAC: y y U/SDates Breasts: SF height According to Estimated date of delivery d d m m 2 nd Date 1 Date 2 ANTENATAL RECORD
  • 10. Antenatal care record: changes up close
  • 12. MMH - where are the gaps? • Resource mapping • Stepped care referral pathways • Standard Operating Procedures • Mental health counsellors • What cadre? • What training? • What clinical supervision?
  • 13. MMH - where are the gaps? • Lack of policy implementation • Resource allocation • Attendant HR procedures missing – KPAs, job descriptions • Attendant M&E procedures/indicators missing • Accountability? • Where there is implementation – what can we learn? • Armchair intersectoral collaboration • DoH and DSD • DoH and NPOs
  • 14. Simone.Honikman@uct.ac.za Dr Simone Honikman, PMHP Director www.pmhp.za.org http://perinatalmentalhealth.wordpress.com/

Editor's Notes

  1. Hartley M, Tomlinson M, Greco E, Comulada WS, Stewart J, le Roux I, et al. Depressed mood in pregnancy: Prevalence and correlates in two Cape Town peri-urban settlements. Reproductive Health. 2011 Jan;8(1):9. 11. Cooper PJ, Tomlinson M, Swartz L, Woolgar M, Murray L, Molteno C. Post-partum depression and the mother-infant relationship in a South African peri-urban settlement. The British Journal of Psychiatry. 1999 Dec 1;175(6):554–8. 12. Rochat TJ, Tomlinson M, Bärnighausen T, Newell M-L, Stein A. The prevalence and clinical presentation of antenatal depression in rural South Africa. Journal of affective disorders. 2011 Aug 29;