Never Too Early. Targeting Maternal Mental Health to Improve Infant Outcomes; a Protocol for Adaptations of "The Thinking Healthy Programme" in the Philippines.

Megan Sambrook Smith*
Brighton and Sussex Medical School*
There is good evidence that maternal mental health is a public health priority for improving infant outcomes. The perinatal wellbeing of the mother not only affects maternal mortality but also the emotional, cognitive and physical development of the child. Children born to women with prenatal depression are at increased risk of being born premature and underweight with the biggest differences seen in low and middle income countries. Children also have increased cases of diarrheal episodes and pneumonia and are less likely to receive vaccinations. Implementing interventions that aim to reduce perinatal depression are of great importance to the wider global pediatric community, especially if the Sustainable Development Goals are to be achieved by 2030.

Why target maternal mental health in the Philippines: According to World Health Organization (WHO), 13% of all deaths in children under 5 in Philippines are caused by diarrheal disease and 28% is caused by pneumonia. Despite having direct links with infant outcomes, little recognition is given to the importance of maternal mental health. In some regions the prevalence of postnatal depression is as high as 22% however psychiatric services and human resources are extremely poor.

The proposed intervention: The "Thinking Healthy Programme", adapted from CBT, has been developed specifically for poor resource settings as a community based psychosocial intervention for perinatal depression. First delivered in Pakistan, it has since been adopted by WHO for global implementation alongside the mhGAP series. Preliminary studies have shown significant reductions in diarrheal episodes in infants and increased use of contraception (leading to reduced infant morbidity through adequate birth spacing). Infant nutrition and mineral deficiencies are also improved in the intervention group. In this review, this intervention is proposed to address the treatment gap with the secondary aim to improve pediatric health in Philippines.
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