Perinatal Mental Health in Fragile Systems: Innovation from Kaduna’s Primary Health Care Framework
1
Treatment Services, Kaduna State Substance Abuse and Mental Health Services Agency (KADSAMHSA), Kaduna, Nigeria
2
Public Health, Kaduna State Ministry of Health, Kaduna, Nigeria
3
Public Health, State Primary Healthcare Board (SPHCB), Kaduna, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Perinatal mental health conditions (PNMH) represent a significant health challenge, particularly in low-resource settings characterised by fragile health systems.¹˒² In Nigeria, socio-cultural complexities and limited access to specialised care exacerbate vulnerabilities, leading to adverse outcomes for both mothers and infants.³˒⁴ We explored an initiative aimed at the integration of PNMH services into the existing PHC framework.⁵
METHODS:
We utilised a quasi-experimental design across selected PHC facilities in 10 local government areas. The study population included pregnant women and mothers with infants up to one year postpartum attending routine PHC services. The intervention comprised capacity building of PHC nurses, community health extension workers (CHEWs), and volunteer community health workers on basic PNMH screening using validated tools such as the Edinburgh Postnatal Depression Scale (EPDS),⁶ psychoeducation, and initial supportive counselling. Clear referral pathways were established to relevant services for complex cases, in line with WHO mhGAP recommendations.⁷ Integrated care delivery involved embedding PNMH screening and brief interventions within routine antenatal and postnatal visits. Data collection included pre- and post-intervention assessments of health worker knowledge and confidence, routine service registers documenting PNMH screenings and referrals, and follow-up surveys.⁸
RESULTS:
A total of 5,000 perinatal women were screened, with a PNMH prevalence rate of 30% identified, consistent with estimates from low- and middle-income settings.²˒³ 75% were successfully linked to follow-up psychosocial support or specialised care, representing a substantial increase from a baseline of less than 10%. Similar task-shifting and PHC-based models have demonstrated comparable improvements in service uptake.⁸˒⁹ PHC workers reported increased confidence and competence in identifying and managing PNMH conditions.
CONCLUSIONS:
These findings underscore how adapting perinatal mental health services to PHC frameworks can significantly improve access to care and early intervention in fragile health systems.¹˒⁷ Sustained impact will require advanced training, strengthened supervision, and targeted community-level stigma reduction interventions.¹⁰
Perinatal mental health conditions (PNMH) represent a significant health challenge, particularly in low-resource settings characterised by fragile health systems.¹˒² In Nigeria, socio-cultural complexities and limited access to specialised care exacerbate vulnerabilities, leading to adverse outcomes for both mothers and infants.³˒⁴ We explored an initiative aimed at the integration of PNMH services into the existing PHC framework.⁵
METHODS:
We utilised a quasi-experimental design across selected PHC facilities in 10 local government areas. The study population included pregnant women and mothers with infants up to one year postpartum attending routine PHC services. The intervention comprised capacity building of PHC nurses, community health extension workers (CHEWs), and volunteer community health workers on basic PNMH screening using validated tools such as the Edinburgh Postnatal Depression Scale (EPDS),⁶ psychoeducation, and initial supportive counselling. Clear referral pathways were established to relevant services for complex cases, in line with WHO mhGAP recommendations.⁷ Integrated care delivery involved embedding PNMH screening and brief interventions within routine antenatal and postnatal visits. Data collection included pre- and post-intervention assessments of health worker knowledge and confidence, routine service registers documenting PNMH screenings and referrals, and follow-up surveys.⁸
RESULTS:
A total of 5,000 perinatal women were screened, with a PNMH prevalence rate of 30% identified, consistent with estimates from low- and middle-income settings.²˒³ 75% were successfully linked to follow-up psychosocial support or specialised care, representing a substantial increase from a baseline of less than 10%. Similar task-shifting and PHC-based models have demonstrated comparable improvements in service uptake.⁸˒⁹ PHC workers reported increased confidence and competence in identifying and managing PNMH conditions.
CONCLUSIONS:
These findings underscore how adapting perinatal mental health services to PHC frameworks can significantly improve access to care and early intervention in fragile health systems.¹˒⁷ Sustained impact will require advanced training, strengthened supervision, and targeted community-level stigma reduction interventions.¹⁰
| eISSN: | 2654-1459 |
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