Tracking Maternal Depression and Child Growth
This idea proposes to incorporate depression and developmental screenings into the already existing National Program on Immunization (NPI) in Nigeria. The specific objectives would be to recognize postpartum depression (PPD) among mothers attending immunization clinics early enough and also to assess infant growth and recognize any delay or deviation from the expected developmental milestones in relation to World Health Organization (WHO) recommendations. This would encourage early interventions both for the mothers and the infants by treating the depression in the mothers, if present and providing nutritional and other health related advice to the mothers to improve the growth and milestones developments of their children.
Research consistently suggests that maternal post-partum depression (PDD) may lead to impaired maternal–infant interactions and negative perceptions of normal infant behavior. There is evidence from developed countries that a compromised mother–infant relationship adversely affects the child's cognitive, social, behavioral and emotional development. Infants of mothers with PPD are more likely to be abused and neglected and diagnosed with failure to thrive and hospitalized for poor health.
A Typical Immunization Clinic in Nigeria
Health Education to Mothers on Normal Development and Neurodevelopmental Disorders in an Immunization Clinic in Nigeria
Parental Group Therapy and Physical Therapy for children with Neurodevelopmental Disorders screened positive at Immunization Clinic in Nigeria
In a developing country like Nigeria, there are many factors that may be working against the optimal development of children. Such factors included poverty, diseases, inadequate housing and overcrowding among others. With the additional factor of maternal PPD, child underdevelopment may worsen. The achievement of the Millennium
Development Goals to improve maternal health, reduce child mortality, promote gender equality, empower women, achieve universal primary education and eradicate extreme poverty and hunger cannot be achieved unless there is a specific focus on maternal and child mental health. Therefore, addressing maternal PPD through early detection and interventions may improve optimal development of children in low resource countries like Nigeria.
National Program on Immunization (NPI) would provide the best forum for early screening of mothers for PPD and interventions in Nigeria. NPI would also serve a useful avenue of screening for developmental concerns in Nigerian infants and children.
The project will introduce screening for maternal postpartum depression (PPD) and deviation in normal child development into already existing NPI at PHC level in selected Local Government Areas (LGAs) of Lagos State, Nigeria. The interventions at this level will include educating parents about PPD and Normal Developmental Milestones, counseling and support for the family by establishment of Family Support Groups where parents can share their apprehension and concerns before referral to tertiary care center for further evaluation and specific interventions as required by identified mothers and children.
The mothers would be screened for post-partum depression and their children growth trajectory would be assessed during every visits to the NPI Clinic until the children achieved the age of 12 months (1 year) [Updated 12/21/14].
For those mothers screened positive for post-partum depression at any point during their visits to NPI Clinic, baseline assessment and interventions would be provided, the mothers and children would then be followed up every three (3) months for further evaluation to see if positive results are being achieved both for the mothers and children and possible review of intervention plans, if necessary. The interventions for identified mothers would include a combination of pharmacotherapy and psychotherapy. The interventions for the children would include offering of nutritional and other health related advice based on clinical evaluation of each child [Updated 12/21/14].
Our team at
Childhood Neuropsychiatric Disorders Initiatives comprises of multidisciplinary professionals like Psychiatrists, Pediatricians, Psychologists, Social Workers among others to provide multidisciplinary interventions. The project would collaborate with Federal Neuropsychiatric Hosital, Yaba, Lagos State, Nigeria, where mothers that need indepth assessment and possible in-patient interventions would be referred and followed up. This project will also collaborate with
University Center for Excellence in Developmental Disabilities (UCEDD) and the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) Programme in Boston. Childhood Neuropsychiatric Disorders Initiatives presently has an
ongoing collaboration with these Institutions [Updated 12/11/14].
This project, if funded will launch into the already existing support being enjoyed by an
existing project taking place in two Local Government Areas (LGAs) of Lagos State, Nigeria, concerned with screening for Neurodevelomental disorders among children under the age of 3 years attending immuniation clinics, the project is presently being funded by Grand Challenges Canada.
It is believed that this project would succeed because the
idea behind the project has been piloted successfully in some Immunization clinics in South-Eastern Nigeria. During the initial pilot of the idea,
limitations regarding the follow-up and interventions for the mothers and children because of lack of funding were identified as follows: "the design was cross-sectional and hence the growth parameters of the infants studied were measured only once. There was no follow up of the cases to monitor the growth trend of the infants over time and to see whether resolution of maternal PPD over time would reverse the negative association observed in the growth parameters of the infants. This is an area where future wider implementation of this idea needs attention". [Updated 12/26/14].
If funded, this idea would address
these limitations over one year period to detect the benefit of early identification and interventions for the possibility of future scale-up and policy formulation to promote the implementation of the idea nationwide in Nigeria. [Updated 12/26/14].
Who will benefit from this idea and where are they located?
The primary target population for this project will be the mothers and children attending Immunization Schedules under NPI at PHC levels in Lagos State. Lagos State is the second most populous State in Nigeria after Kano out the 36 States and FCT in Nigeria.
How could you test this idea in a quick and low-cost way right now?
- By carrying out a cross sectional survey of the ideas which has already been prototyped in a previous study (http://www.sciencedirect.com/science/article/pii/S0163834313002521).
- By carrying out pre and post test knowledge assessment of the mothers about postpartum depression and normal developmental milestones in their children.
- By quickly assessing the cross sectional association between postpartum depression and failure to thrive in the children at the immunization clinics which has also been prototyped in a previous study (http://www.sciencedirect.com/science/article/pii/S0163834313002521).
What kind of help would you need to make your idea real?
Feedback from the OpenIDEO community on how the ideas can be further improved.
Is this an idea that you or your organization would like to take forward?
Yes. I am ready and interested in testing this idea and making it real in my community.