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Exposure to a multitude of risks, including food insecurity, poverty, and – perhaps most prominently – HIV can be damaging for early childhood survival, healthy growth and development. Yet, guidance regarding the implementation factors that contribute to early child development-focussed programme success is lacking in low- and middle-income countries broadly, and sub-Saharan Africa in particular. Having access to guidelines for practice and implementation could assist in improving the implementation of programmes to improve early childhood development. We conducted a narrative review of the literature with the goal of identifying how implementation features of these early interventions may influence the effectiveness of such work in the complex contexts which characterise this region. Our final review included 197 for final analysis. There were two primary cross-cutting findings. Firstly, the benefit for parents was less clear than they were for children, and secondly, while the benefits for children were clear, those most at risk benefited the most. Home visiting was found to be the predominant service delivery platform, and positive outcomes for children were reported when home visiting programmes were implemented by trained non-professionals, whereas positive parent outcomes were reported more frequently when delivered by professionals. In early childhood care and education programmes, positive outcomes for children and parents were reported when they were implemented by both trained non-professionals and professionals. Trained non-professionals facilitating parent groups produced similar benefits to groups run by professionals. Take-home lessons for successful programmes were that high levels of attendance, regular sessions of at least an hour duration, with the programme continuing for more than 6 months and closer to a year are key for effectiveness. [ABSTRACT FROM AUTHOR]

Scientific and policy advances are putting early childhooddevelopment (ECD) at the center of efforts to improve humandevelopment. This study was undertaken to understand whatknowledge and attitudinal barriers exist that 25 hinder the full-scaleroll-out of services for the youngest children and their families.We used anthropological methods honed by the FrameworksInstitute to plumb beliefs about early childhood development amongmembers of the public and implementation and policy stakeholders,and compare those with the findings from ECD research. Whilemembers of the public and stakeholders agree on the importance ofECD, as demonstrated in other country settings, a major barrier todirecting services to the youngest children is a perceptual tendencyto 'age up'. That is, to consider learning and other important skillsas being acquired in the pre-school rather than infancy period.Communication strategies that incorporate debate are neededto give full effect to the ECD and related policies, especiallyaround the topics of prioritizing the youngest 40 children, physicalpunishment, child rights, and the pervasiveness Q5 of threats toECD arising from poverty and disadvantage. [ABSTRACT FROM AUTHOR]

Abstract: Most low‐ and middle‐income countries lack resources with which to implement public health programs. As such, there is a necessity to facilitate programing that judiciously makes use of what resources there are. However, despite evidence for the efficacy of many interventions, translating these into real‐world effectiveness, and then into scalability, is complex and has often been neglected. We draw on a case study of Philani+ (a maternal and child health intervention implemented in South Africa) to distil eight features of health programing that aid intervention effectiveness. We argue that implementation science should turn its attention to the human resource “process” features of interventions. We describe the importance of staff selection (rigorous selection and hiring procedures); training (developing a set of common core pragmatic problem‐solving skills); monitoring (feedback about quality); community and institutional support (rapport with intervention communities); the importance of stable leadership (consistent leadership focusing on how to optimize the potential of staff); the importance of implementing with sustainable, long‐term change in mind; and, finally, we describe how cultivating consistency within an organization requires disciplined action and disciplined focus on the organization's vision. [ABSTRACT FROM AUTHOR]

Child development in low and middle income countries (LMIC) is compromised by multiple risk factors. Reducing children’s exposure to harmful events is essential for early childhood development (ECD). In particular, preventing violence against children – a highly prevalent risk factor that negatively affects optimal child development – should be an intervention priority. We used the Child Health and Nutrition Initiative (CHNRI) method for the setting of research priorities in integrated Early Childhood Development and violence prevention programs (ECD+). An expert group was identified and invited to systematically list and score research questions. A total of 186 stakeholders were asked to contribute five research questions each, and contributions were received from 81 respondents. These were subsequently evaluated using a set of five criteria: answerability; effectiveness; feasibility and/or affordability; applicability and impact; and equity. Of the 400 questions generated, a composite group of 50 were scored by 55 respondents. The highest scoring research questions related to the training of Community Health Workers (CHW’s) to deliver ECD+ interventions effectively and whether ECD+ interventions could be integrated within existing delivery platforms such as HIV, nutrition or mental health platforms. The priority research questions can direct new research initiatives, mainly in focusing on the effectiveness of an ECD+ approach, as well as on service delivery questions. To the best of our knowledge, this is the first systematic exercise of its kind in the field of ECD+. The findings from this research priority setting exercise can help guide donors and other development actors towards funding priorities for important future research related to ECD and violence prevention. [ABSTRACT FROM AUTHOR]

Adolescents living in low- and-middle incomeand middle-income countries are at a particular risk of poor mental health. Caregiver mental health plays a crucial role in a child's emotional and behavioural development and may directly impact a child's risk for future development of mental health problems. Data collected as part of a two-decade longitudinal multiphase research project were used. Participants, originally women in their third trimester of pregnancy (n = 449), were recruited from a peri-urban impoverished community outside of Cape Town, South Africa, and assessed at several time-points over subsequent years. Data collected during the three phases of the research were used to assess the effects of early and current caregiver depression on adolescent internalising and externalising behaviour. Analyses of Covariance models were used to explore the effect of caregiver depression on adolescent internalising and externalising behaviour, while controlling for multiple covariates. We analysed data for 313 adolescent participants and their primary caregivers. Caregiver depression patterns had a significant main effect on externalising behaviour, F(3,305) = 4.10 (p = 0.007), but not on internalising behaviour, F(3,305) = 2.71 (p = 0.09). Post-hoc analysis showed that those adolescents exposed to early and current caregiver depression scored on average 3.83 points (95% CI [0.99; 6.66]) higher in externalising behaviour than those exposed to no caregiver depression. Also, adolescents who experienced a change in caregiver, compared to those whose biological mother were still their primary caregiver, reported significantly higher levels of externalising behaviour F(1,305) = 5.10, p = 0.03. The study findings provide crucial insight into critical periods of risk, as well as opportunities for prevention. Preventive interventions should ideally target caregivers and adolescents to prevent or reduce behavioural problems and disrupt intergenerational cycles of mental disorders or behavioural problems. [ABSTRACT FROM AUTHOR]

In a Perspective, Mark Tomlinson discusses research on early interventions to support child development in developing countries. [ABSTRACT FROM AUTHOR]

ABSTRACT The vast majority of infants are born in poor countries, but most of our knowledge about infants and children has emerged from high-income countries. In 2003, M. Tomlinson and L. Swartz conducted a survey of articles on infancy between 1996 and 2001 from major international journals, reporting that a meager 5% of articles emanated from parts of the world other than North America, Europe, or Australasia. In this article, we conducted a similar review of articles on infancy published between 2002 and 2012 to assess whether the status of cross-national research has changed in the subsequent decade. Results indicate that despite slight improvements in research output from the rest of world, only 2.3% of articles published in 11 years included data from low- and middle-income countries-where 90% of the world's infants live. These discrepancies are indicative of the progress still needed to bridge the so-called 10/90 gap (S. Saxena, G. Paraje, P. Sharan, G. Karam, & R. Sadana, ) in infant mental health research. Cross-national collaboration is urgently required to ensure expansion of research production in low-resource settings. [ABSTRACT FROM AUTHOR]

Violence against children is prevalent across all countries and cultures, with the burden of child injury and violence heaviest in low- and middle-income (LAMI) settings. There are several types of program to prevent child abuse, with family-based approaches to prevention being the most comprehensively researched and successful interventions in high-income settings. In LAMI countries, however, there is very little research evidence for the prevention of child abuse. We conducted a systematic search of relevant databases for studies published between 1995 and 2011 and the search revealed only one relevant study. There is thus a need for research into child maltreatment prevention in LAMI settings, taking account of local resources and contexts. In the light of the lack of evidence, we focus on two case studies that document the use of home visiting by community health workers perinatally to improve maternal and child outcomes. We propose four areas for action moving forward, including increased investment in early intervention and prevention programs, development of a research agenda that prioritizes prevention research, integration of implementation research into efforts to scale up interventions, and improving systematically collected information on child maltreatment. [ABSTRACT FROM PUBLISHER]

Crick Lund and colleagues describe their plans for the PRogramme for Improving Mental health carE (PRIME), which aims to generate evidence on implementing and scaling up integrated packages of care for priority mental disorders in primary and maternal health care contexts in Ethiopia, India, Nepal, South Africa, and Uganda. [ABSTRACT FROM AUTHOR]

Background: Despite a large growth in evidence on violence against women (VAW) over the last 25 years, VAW persists, as do gaps in the field's knowledge of how to prevent and respond to it. To ensure that research on VAW in low- and middle-income countries (LIMCs) is addressing the most significant gaps in knowledge, and to prioritise evidence needs to reduce VAW and better support victims/survivors, the Sexual Violence Research Initiative (SVRI) and Equality Institute (EQI) led a process of developing a global shared research agenda (GSRA) on VAW in LMICs. Methods: The GSRA was developed through a six-stage adaptation of the Child Health and Nutrition Research Initiative (CHNRI) method, which draws on the principle of the 'wisdom of the crowd'. These steps included: a review of the literature on VAW in LMICs and development of domains; the generation of research questions within four domains by an Advisory Group; the consolidation of research questions; scoring of research questions by a Global Expert Group and the Advisory Group according to three criteria (applicability, effectiveness and equity); consultation and validation of the findings with the Advisory Group; and wide dissemination of the findings. Results: The highest ranked research questions in the GSRA pertain to the domain of Intervention research, with some highly ranked questions also pertaining to the domain of Understanding VAW in its multiple forms. Questions under the other two domains, Improving existing interventions, and Methodological and measurement gaps, were not prioritised as highly by experts. There was strong consistency in top ranked research questions according to experts' characteristics, albeit with some important differences according to experts' gender, occupation and geographical location. Conclusions: The GSRA findings suggest that currently the VAW field is shifting towards intervention research after several decades of building evidence on understanding VAW, including prevalence, drivers and impacts of violence. The findings also suggest a strong emphasis on under-served populations, and under-researched forms of VAW. Future priority setting exercises in LMICs that seek to decolonise knowledge should ensure that methodologies, and modalities of engagement, put diverse voices at the centre of engagement. Trial registration Not applicable [ABSTRACT FROM AUTHOR]

The author comments on the rate of spending of low and middle-income countries (LAMICs) on mental health. A description of the treatment gap in people with mental disorders in LAMICs is provided. The author attributes the burden of mental disorders in low-income countries to the failures of human development targets of the Millennium Development Goals (MDGs). The author explains the importance of a public health approach to mental health care.

Intimate partner violence (IPV) is a common traumatic stressor for women worldwide, especially for women living in low-and-middle-income countries. One of the most common correlates of IPV victimization is alcohol use, but the dynamics of IPV and drinking among women are not well understood. Although some research suggests that women drink in the aftermath of IPV to cope with distress related to the violence they experienced, other studies imply that higher levels of alcohol use among one or both partners in a relationship make violence more likely. In this study, we examine this question in a secondary analysis of a longitudinal study of a population cohort of pregnant women in South Africa (N = 1238) using a Bayesian approach to latent growth curve structural equation modeling. Results indicate that on average, IPV decreases and alcohol use increases over time and that these trajectories are associated with each other. Further, results suggest that although IPV drives drinking (rather than the other way around), higher average levels of alcohol use are associated with a slower decrease in IPV. Findings have implications for future research on the association between IPV and alcohol use, as well as for clinical intervention for women who experienced IPV. [ABSTRACT FROM AUTHOR]

Maternal and child health programmes often use Community Health Workers (CHWs) to help address poor access to health care, particularly in low‐ and middle‐income countries (LMIC). Supervision has long been recognised as a critical ingredient of successful CHW programmes, yet it is often reported as either of poor quality or absent. There is little research on CHWs' own perception of supervision and to the best of our knowledge, there are no reviews synthesising the evidence of CHWs' experiences of supervision. This review identified and synthesised qualitative research evidence about the experiences and perceptions of supervision by CHWs in programmes targeting maternal and child health (MCH) in LMIC. Electronic searches were performed in the following databases: EMBASE, Medline, PsycINFO, ASSIA, ERIC and CINAHL. This review included studies during the period from 2000 to 2021. In total, 10,505 titles were screened for inclusion, of which 177 full‐text articles were retrieved and assessed. Ultimately, 19 articles were included in this review. Data extraction was based on the thematic synthesis approach: coding the text of included studies line‐by‐line; developing descriptive themes; and generating analytical themes. Four themes emerged: (1) frequency of supervision, (2) type of supervision, (3) supervision and motivation and (4) supportive supervision. Careful consideration needs to be taken of the model of supervision used, as primary care facility‐based supervisors (usually nurses), although skilled, may not have sufficient time to supervise. Employing supervisors whose sole responsibility is to supervise CHWs may be a good strategy to alleviate these issues. Sufficient time and resources need to be allocated to supervisors and they should be expected to perform regular in‐the‐field supervision. Involving some aspects of community oversight should also be considered. Supervisor skills and training and the long‐term retention of trained supervisors also need to be an important area of focus. [ABSTRACT FROM AUTHOR]

Exposure to violence is a serious mental and public health issue. In particular, children exposed to violence are at risk for poor developmental outcomes and physical and mental health problems. One area that has been shown to increase the risk for poor outcomes is the use of corporal punishment as a discipline method. While researchers are starting to ask children directly about their experiences of violence, there is limited research with children about their perspectives on physical punishment, particularly in low-and middle-income countries (LMIC). This paper begins to address this gap by reporting on the spontaneous data that emerged during 24 qualitative interviews that were conducted with children, aged 8–12 in South Africa. The themes that emerged indicated that corporal punishment is an everyday experience, that it has negative emotional and behavioral consequences, and that it plays a role in how children resolve interpersonal conflicts. The study highlights the challenges for violence prevention interventions in under-resourced contexts. [ABSTRACT FROM AUTHOR]

Reactive attachment disorder (RAD) is a psychiatric disorder developing in early or middle childhood as a consequence of significant failures in the caregiving environment. RAD results in children failing to relate socially, either by exhibiting markedly inhibited behaviour or by indiscriminate social behaviour and is associated with significant socio-behavioural problems in the longer term. This study examined RAD in South Africa, a setting with high environmental risks. We recruited a sub-sample of 40 10-year-old children from a cohort enrolled during pregnancy for whom early attachment status was known. Children were purposefully selected to represent the four attachment categories using the data available on the strange situation procedure (SSP) at 18 months. The Manchester Child Attachment Story Task (MCAST) assessed current attachment and RAD was diagnosed using a standardised assessment package. A high proportion of the children (5/40% or 12.5%) fulfilled diagnostic criteria for RAD; all were boys and were displaying the disinhibited type. SSP classification at 18 months was not significantly associated with RAD symptoms at age of 10 years, while current MCAST classifications were. This suggests that children in this sample are at much higher risk of RAD than in high-income populations, and despite a fairly typical attachment distribution in this population at 18 months, RAD was evidenced in later childhood and associated with current attachment disorganisation. The strengths of this research include its longitudinal nature and use of diagnostic assessments. Given increasing evidence that RAD is relatively stable over time and introduces longer term socio-behavioural risks; the high rate of RAD in this sample (12.5%) highlights potential developmental threats to children in low- and middle-income countries (LMICs). Our results should be interpreted with caution given sample size and risk of selection bias. Further research is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and thus may be partially responsible for intergenerational transmission of risk associated with maternal ACEs. However, the extent to which prenatal depressive symptoms mediate the association between maternal ACEs and foetal attachment is unknown.Methods: Data on foetal attachment, ACEs, and prenatal depression came from mothers in their third trimester of pregnancy (n = 1,185) located across eight MICs, participating in the prospective birth cohort Evidence for Better Lives Study - Foundational Research (EBLS-FR). Data were from the baseline measurement.Results: Full-sample path mediation analyses, adjusting for relevant covariates, suggested a full mediating effect of prenatal depression. However, at the individual-country level, both positive and negative effects of ACEs on foetal attachment were observed after the inclusion of depressive symptoms as a mediator, suggesting cultural and geographical factors may influence a mother's empathic development after ACE exposure.Limitations: As no follow-up measurements of depressive symptoms or postnatal attachment were included in the analyses, the findings cannot be extrapolated to the postnatal period and beyond. Further, causality cannot be inferred as the study was observational.Conclusions: The findings reinforce the importance of screening for prenatal depression during antenatal care in MICs. Addressing prenatal depression within maternal health care may support foetal attachment and contribute to reducing the intergenerational transmission of disadvantage. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Traumatic brain injury (TBI) has wide-ranging neuropsychological, physical, social and financial implications. The impact on caregivers of moderate to severe TBI survivors, particularly in low- and middle-income countries, is under-investigated. AIM: Identify and describe the experiences of caregivers' of moderate to severe TBI survivors postdischarge from healthcare facilities. METHODS: A scoping review was conducted utilising seven electronic databases. Two reviewers screened articles using eligibly criteria related to setting (postdischarge), caregiving (informal), age of TBI survivors (> 18 years) and injury severity (moderate-severe). Studies published in English between 1999 –2018 were included. RESULTS: Fourteen articles met the inclusion criteria. Articles reporting on the same sample were merged during data charting. The final analyses included 11 articles comprised of qualitative, quantitative and mixed-methods studies. Ten themes were identified: psychological distress, social functioning, financial burden, family experiences, coping strategies, access to services, time burdens and physical, cognitive and behavioural difficulties. Characteristics of caregivers and TBI survivors were also reported. CONCLUSION: Caregivers of moderate to severe TBI survivors experience challenges in various life domains, and there is limited research concerning caregivers in low- and middle-income countries. Future research should focus on understanding more nuanced experiences across various environments, which may increase comprehensive, flexible and long-term support. [ABSTRACT FROM AUTHOR]

Studies in high-income countries (HICs) have shown that variability in maternal-fetal attachment (MFA) predict important maternal health and child outcomes. However, the validity of MFA ratings in low- and middle-income countries (LMICs) remains unknown. Addressing this gap, we assessed measurement invariance to test the conceptual equivalence of the Prenatal Attachment Inventory (PAI: Muller, 1993) across eight LMICs. Our aim was to determine whether the PAI yields similar information from pregnant women across different cultural contexts. We administered the 18-item PAI to 1181 mothers in the third trimester (Mean age = 28.27 years old, SD = 5.81 years, range = 18–48 years) expecting their first infant (n = 359) or a later-born infant (n = 820) as part of a prospective birth cohort study involving eight middle-income countries: Ghana, Jamaica, Pakistan, Philippines, Romania, South Africa, Sri Lanka and Vietnam. We used Multiple Group Confirmatory Factor Analyses to assess across-site measurement invariance. A single latent factor with partial measurement invariance was found across all sites except Pakistan. Group comparisons showed that mean levels of MFA were lowest for expectant mothers in Vietnam and highest for expectant mothers in Sri Lanka. MFA was higher in first-time mothers than in mothers expecting a later-born child. The PAI yields similar information about MFA across culturally distinct middle-income countries. These findings strengthen confidence in the use of the tool across different settings; future studies should explore the use of the PAI as a screen for maternal behaviour that place children at risk. [ABSTRACT FROM AUTHOR]

User satisfaction with outpatient mental health services is an important factor in ensuring continued engagement with mental health services for people with mental health conditions. Yet, in many low and middle-income countries, including Malawi, there is a dearth of information about user's experiences of outpatient mental health care services, and little is known about which factors might affect user satisfaction. The aim of the present work was to evaluate user satisfaction with outpatient mental health services in southern Malawi and to explore whether social demographic variables, mental health status, and treatment characteristics explain variance in user satisfaction. This cross-sectional study was conducted in Malawi at one urban (Blantyre) and one rural (Thyolo) outpatient psychiatric clinics. Two-hundred and sixteen randomly sampled service users were enrolled into the study and completed the Charlestone Psychiatric Outpatient Satisfaction Scale (CPOSS). The unadjusted and adjusted associations between user satisfaction as the dependent variable, and participant socio-demographic characteristics as independent variables, were examined. Eighty percent of all participants were satisfied with the outpatient mental health services, although participants presenting to the rural clinic were less likely to be satisfied than participants presenting at the urban clinic, according to the adjusted odds ratio (AOR; AOR = 0.31; 95% confidence interval (CI): 0.13–0.76; p < 0.05). Any admission due to a mental health condition significantly explained variance in user satisfaction at the rural (Thyolo) study site; as those who had been admitted previously were less satisfied than those who had never been admitted (AOR = 0.11; 95% CI: 0.02–0.54; p < 0.05). As may be expected, these findings demonstrate that service user satisfaction is linked to service quality and past service experiences. Further research is required in order to nuance these findings in the context of Malawi's efforts to strengthen service quality. Nonetheless, rural facilities may require additional support to deliver satisfactory care. [ABSTRACT FROM AUTHOR]

CONTEXT: Although adolescent mental health interventions are widely implemented, little consensus exists about elements comprising successful models. OBJECTIVE: We aimed to identify effective program components of interventions to promote mental health and prevent mental disorders and risk behaviors during adolescence and to match these components across these key health outcomes to inform future multicomponent intervention development. DATA SOURCES: A total of 14 600 records were identified, and 158 studies were included. STUDY SELECTION: Studies included universally delivered psychosocial interventions administered to adolescents ages 10 to 19. We included studies published between 2000 and 2018, using PubMed, Medline, PsycINFO, Scopus, Embase, and Applied Social Sciences Index Abstracts databases. We included randomized controlled, cluster randomized controlled, factorial, and crossover trials. Outcomes included positive mental health, depressive and anxious symptomatology, violence perpetration and bullying, and alcohol and other substance use. DATA EXTRACTION: Data were extracted by 3 researchers who identified core components and relevant outcomes. Interventions were separated by modality; data were analyzed by using a robust variance estimation meta-analysis model, and we estimated a series of single-predictor meta-regression models using random effects. RESULTS: Universally delivered interventions can improve adolescent mental health and reduce risk behavior. Of 7 components with consistent signals of effectiveness, 3 had significant effects over multiple outcomes (interpersonal skills, emotional regulation, and alcohol and drug education). LIMITATIONS: Most included studies were from high-income settings, limiting the applicability of these findings to low- and middle-income countries. Our sample included only trials. CONCLUSIONS: Three program components emerged as consistently effective across different outcomes, providing a basis for developing future multioutcome intervention programs. [ABSTRACT FROM AUTHOR]

Background: There is a growing body of literature outlining the promise of mobile information and communication technologies to improve healthcare in resource-constrained contexts. Methods: We reviewed the literature related to mobile information and communication technologies which aim to improve healthcare in resource-constrained contexts, in order to glean general observations regarding the state of mHealth in high-income countries (HIC) and low- and middle-income countries (LMIC). Results: mHealth interventions in LMIC often differ substantively from those in HIC, with the former being simpler, delivered through a single digital component (an SMS as opposed to a mobile phone application, or ‘app’), and, as a result, targeting only one of the many factors which impact on the activation (or deactivation) of the target behaviour. Almost as a rule, LMIC mHealth interventions lack an explicit theory of change. Conclusion: We highlight the necessity, when designing mHealth interventions, of having a theory of change that encompasses multiple salient perspectives pertaining to human behaviour. To address this need, we explore whether the concept of Life History Strategy could provide the mHealth field with a useful theory of change. Life History Strategy Theory may be particularly useful in understanding some of the problems, paradoxes, and limitations of mHealth interventions found in LMIC. Specifically, this theory illuminates questions regarding ‘light-weight’ programmes which solely provide information, reminders, and other virtual ‘nudges’ that may have limited impact on behaviours governed by extrinsic structural factors. [ABSTRACT FROM PUBLISHER]

Background: In low and middle-income countries (LMIC), common mental disorders affecting pregnant women receive low priority, despite their disabling effect on maternal functioning and negative impact on child health and development. We investigated the prevalence of risk factors for antenatal depression among women living in adversity in a low-resource, urban setting in Cape Town, South Africa.Methods: The MINI Neuropsychiatric Interview (MINI Plus) was used to measure the diagnostic prevalence of depression amongst women attending their first antenatal visit at a primary-level, community-based clinic. Demographic data were collected followed by administration of questionnaires to measure psychosocial risk. Analysis examined the association between diagnosis of depression and psychosocial risk variables, and logistic regression was used to investigate predictors for major depressive episode (MDE).Results: Among 376 women participating, the mean age was 26 years. The MINI-defined prevalence of MDE was 22%, with 50% of depressed women also expressing suicidality. MDE diagnosis was significantly associated with multiple socioeconomic and psychosocial risk factors, including a history of depression or anxiety, food insecurity, experience of threatening life events and perceived support from family.Limitations: The use of self-report measures may have led to recall bias. Retrospective collection of clinical data limited our ability to examine some known risk factors for mental distress.Conclusion: These findings confirm the high prevalence of MDE among pregnant women in LMIC settings. Rates of depression may be increased in settings where women are exposed to multiple risks. These risk factors should be considered when planning maternal mental health interventions. [ABSTRACT FROM AUTHOR]

Context: A robust evidence base is now emerging that indicates that treatment for depression and alcohol use disorders (AUD) delivered in low and middle-income countries (LMIC) can be effective. However, the coverage of services for these conditions in most LMIC settings remains unknown. Objective: To describe the methods of a repeat cross-sectional survey to determine changes in treatment contact coverage for probable depression and for probable AUD in four LMIC districts, and to present the baseline findings regarding treatment contact coverage. Methods: Population-based cross-sectional surveys with structured questionnaires, which included validated screening tools to identify probable cases. We defined contact coverage as being the proportion of cases who sought professional help in the past 12 months. Setting: Sodo District, Ethiopia; Sehore District, India; Chitwan District, Nepal; and Kamuli District, Uganda Participants: 8036 adults residing in these districts between May 2013 and May 2014 Main Outcome Measures: Treatment contact coverage was defined as having sought care from a specialist, generalist, or other health care provider for symptoms related to depression or AUD. Results: The proportion of adults who screened positive for depression over the past 12 months ranged from 11.2% in Nepal to 29.7% in India and treatment contact coverage over the past 12 months ranged between 8.1% in Nepal to 23.5% in India. In Ethiopia, lifetime contact coverage for probable depression was 23.7%. The proportion of adults who screened positive for AUD over the past 12 months ranged from 1.7% in Uganda to 13.9% in Ethiopia and treatment contact coverage over the past 12 months ranged from 2.8% in India to 5.1% in Nepal. In Ethiopia, lifetime contact coverage for probable AUD was 13.1%. Conclusions: Our findings are consistent with and contribute to the limited evidence base which indicates low treatment contact coverage for depression and for AUD in LMIC. The planned follow up surveys will be used to estimate the change in contact coverage coinciding with the implementation of district-level mental health care plans. [ABSTRACT FROM AUTHOR]

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose.Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries.Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge.Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs. [ABSTRACT FROM AUTHOR]

Background: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. Methods: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. Results: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. Conclusions: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care. [ABSTRACT FROM AUTHOR]

A Correction to this paper has been published: https://doi.org/10.1007/s00737-021-01122-7 [ABSTRACT FROM AUTHOR]

Research suggests that parenting behaviours are negatively affected by parental trauma. However, thus far, the evidence base has provided limited insight into why this occurs. Further, the available evidence has focused largely on high income contexts (HICs), and we know much less about the experiences of parents in low- and middle-income countries (LMICs) who are frequently coping with multiple adversities. The current qualitative study aimed to gain a more in-depth understanding from the parent's perspective about whether and how their trauma impacted themselves and their parenting behaviours. We conducted interviews with 30 trauma-exposed, Xhosa speaking parents (28 mothers) from Khayelitsha, a township outside Cape Town in South Africa, 66% of whom reported experiencing moderate to severe posttraumatic stress symptoms. Five key themes were identified: consequences for parents as individuals (in terms of mental and physical health); the centrality of community and cultural context to parental experiences; consequences in terms of parenting capacity; trauma related effects on the child and how these may influence parental coping; and mechanisms of coping and achieving recovery. Findings highlight the difficult nature of parenting following trauma due to impacts on multiple areas of life, and suggest potential avenues for the development of parenting interventions in order to support parents and families more effectively following trauma. • Trauma exposure and posttraumatic distress present many challenges to LMIC parents. • Posttrauma anger, threat perceptions, poor coping may particularly affect parenting. • Physical consequences (e.g., loss of income) are also crucial for LMIC parents. • Perceived negative impacts for their children can compound parental distress. • Despite these challenges, parental bonds with their children may be retained. [ABSTRACT FROM AUTHOR]

• PTSD symptoms associated with blunted coristol reactivity in children from LMICs. • Sex differences in associations between PTSD and cortisol reactivity. • Girls with PTSD have blunted cortisol reactivity and boys have enhanced reactivity. • No association between trauma exposure and cortisol reactivity. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is implicated in the pathophysiology of post-traumatic stress disorder (PTSD). However, there has been little study of HPA stress reactivity in association with PTSD symptoms (PTSS) in children; and there is limited research on PTSD in low and middle-income countries, where trauma exposure is more common and co-occurring stressors more likely. We assessed the relationship between PTSS and cortisol stress reactivity in children aged 13 years (N = 291) from an impoverished South African community. HPA axis stress reactivity was indexed by salivary cortisol during the Trier Social Stress Test (TSST). In regression analyses both trauma exposure and PTSS showed small inverse associations with total cortisol output (area under the curve with respect to ground) during the TSST, but PTSS effects did not withstand correction for covariates. In addition, hierarchical linear modelling (HLM) found that PTSS were associated with alterations in the shape of the profile of cortisol reactivity that were moderated by sex. In girls, PTSS were associated with reduced linear slope but larger quadratic slopes, whereas the opposite pattern was found in boys. Thus, elevated PTSS were associated with overall blunted profiles of cortisol stress reactivity in girls, but a larger quadratic slope in boys reflects a steeper cortisol increase and decline in boys. There was no relationship between trauma exposure (with or without PTSS) and cortisol reactivity profiles in HLM analyses. In children from a high adversity, low and middle income country context, sex specific associations were found between PTSS and cortisol responses to psychosocial stress. Further research should probe HPA axis functioning more comprehensively in such populations to understand the biological associations of PTSS. [ABSTRACT FROM AUTHOR]