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Abstract

Women are twice at risk of developing depression compared to men. This risk is even higher during pregnancy where many physiological, hormonal, social, and psychological changes occur. Prevalence studies show perinatal mental disorders are at least as prevalent in sub-Saharan Africa as they are in high-income and other low- and middle-income sub-regions. The mean weighted prevalence of both antenatal and postpartum depression are 11.3% and 18.3%, respectively, and the mean prevalence of both prenatal and postpartum anxiety is 14.8% and 14%, respectively in both high and low- and middle-income countries. Although maternal mental disorders, including antenatal depression, are widespread and have serious consequences, there remains a lack of understanding and inadequate care provided to pregnant women, by midwives who are their main healthcare providers. Therefore, this study aims to explore the midwives’ knowledge of antenatal depression before and after a training session on antenatal depression. The study will follow a qualitative research methodology and will be conducted in a Community Healthcare Center, in South Africa. In-depth individual interviews will be conducted with the midwives who attend to pregnant women at the study site before and after a training session on antenatal depression. Elo and Knygas’ content analysis will be used to analyse data. It is hoped that the results of the study may provide support for advocating the integration of mental health services into maternal care programmes.

Keywords

antenatal depression knowledge midwives South Africa pregnamt women

Background and Study Justification

One of the main causes of pregnancy-related morbidity and death is maternal depression, a non-psychotic depressive episode that is linked to behavioral, emotional, and cognitive issues (Sutherland et al., 2022). According to prevalence studies, perinatal mental disorders are at least as prevalent in sub-Saharan Africa as they are in high-income (HIC) and other low-to middle-income sub-regions (LMIC) (Ng’oma et al., 2019; Nweke et al., 2024). A systematic review found that the mean weighted prevalence of both antenatal and postpartum depression was 11.3% and 18.3%, respectively, and the mean prevalence of both prenatal and postpartum anxiety was 14.8% and 14%, respectively in both HICs and LMICs (Ng’oma et al., 2019; Nweke et al., 2024). This presents a global public health concern according to the World Health Organization (WHO, 2021) who reported that depression during pregnancy ranks third internationally in terms of disease burden among women between the ages of 14 and 44. By 2030, according to WHO projections, it may surpass heart disease and traffic accidents (WHO, 2021).

In sub-Saharan Africa, studies report rates of prenatal depression of 8.3%–26.6% (Adeoye et al., 2022) in Nigeria, 12%–18.7% in Tanzania and Kenya (Ngocho et al., 2022; Nweke et al., 2024; Tele et al., 2022). On the other hand, in three South African provinces i.e. Limpopo, KwaZulu Natal, and Cape Town prenatal depression ranged between 31.7% to 44% (Govender et al., 2020; Ramohlola et al., 2022). This is despite, the South African government, through its National Development Plan (NDP) National Mental Health Policy Framework and Strategic Plan (2013–2020), committing itself to providing support for the mental health of its citizens, including pregnant women (South African Department of Health, 2011). Regardless of its commitment the integration of perinatal mental health care and routine screening for antenatal depression has been overlooked (Brown & Sprague, 2021). This neglect not only increases the risk of inadequate care, mismanagement, and non-compliance with prenatal visits but also raises the likelihood of adverse delivery outcomes for both mother and child (Mokwena & Modjadji, 2022; Simonovich et al., 2021). These children may also require longer hospital stays due to various health conditions that can persist into childhood, adolescence, and adulthood (Frayne et al., 2019; Howard & Khalifeh, 2020). Moreover, maternal depression can have intergenerational effects, as Dadi et al. (2020) found that offspring of depressed mothers are more likely to experience depression in their teenage years and as mothers themselves. It is reiterated that the primary risk factor for postpartum depression is depression during pregnancy (Khan et al., 2020). Thus, the pregnant woman’s mental state not only negatively affects the pregnancy outcome but also impacts the health of her unborn child (Pereira et al., 2012).

Although maternal mental disorders, including antenatal depression, are widespread and have serious consequences, there remains a lack of understanding and inadequate care provided to pregnant women, particularly by midwives who are their main healthcare providers (Howard & Khalifeh, 2020). Midwives have different levels of knowledge regarding the occurrence and signs of antenatal depression (Howard & Khalifeh, 2020; Martin et al., 2020). This can be partially attributed to the lack of clear guidelines for detecting and addressing mental health problems during pregnancy (Chorwe-Sungani, 2022). Moreover, midwives showcased diverse viewpoints regarding the potential causes of depressive symptoms during pregnancy. It could be argued that midwives in LMICs have inadequate knowledge about antenatal mental health not because they are uninterested, but mainly due to a scarcity of training resources. Despite this, midwives in LMICs, South Africa included, remain highly confident in the mental health treatment plan they adhere to and play a crucial role in connecting pregnant women with social workers, clinical psychologists, and psychiatrists to ensure high-quality mental health care. Throughout this process, midwives are confronted with challenges such as frustration from their heavy workload and lack of communication with other healthcare workers, as well as resistance from mothers due to stigma and poor healthcare facilities conditions (Chorwe-Sungani, 2022). We can therefore hypothesize that the training and education provided to midwives may not sufficiently equip them to effectively screen and refer women who exhibit antenatal depression regularly. The level of knowledge that midwives have about antenatal depression screening and referral should therefore be explored.

Research Questions

1. What is the level of knowledge of midwives regarding antenatal depression screening and referral before exposure to an education training module?

2. What is the level of knowledge of midwives regarding antenatal depression screening and referral after exposure to an education training module?

Study Approach and Design

The study will employ a qualitative approach that is exploratory and descriptive, situated within the paradigm of social constructivism (Gillet, 1998). The researchers consider this methodology to be suitable since they hold the belief that knowledge is constructed through social interactions. The aim is to actively involve the study participants in meaningful conversations (Hammarberg et al., 2016). Furthermore, the focus of this study is on the experiences of interviewees and how they perceive the world (DeJonckheere & Vaughn, 2019) and antenatal depression. Finally, the semi-structured interviews will allow the analysis and comparison of the participants’ responses (McIntosh & Morse, 2015) before and after the training session on antenatal depression

Study Setting

The healthcare system in South Africa is split between public and private sectors, catering to different demographics. The private sector mainly serves affluent, educated individuals who are members of medical aid schemes, while the public sector caters to the less educated population who rely on state-funded healthcare services (Malakoane et al., 2020). To address these disparities, the post-apartheid South African government has committed to promoting Universal Health Coverage (UHC). Therefore, the selected community healthcare center (CHC) antenatal care clinic situated in Durban is the focus of this study as it primarily serves those reliant on state-funded healthcare services. Durban, is a popular coastal city in South Africa’s KwaZulu-Natal province, with a young population of 61% under the age of 35. The selected community is an informal settlement with women often working as domestic workers with low earnings due to limited education and skills, impacting their health and living standards. Men in the area typically work as taxi conductors or laborers, earning modest incomes that affect their access to basic necessities and adequate housing. Around 400 pregnant women receive routine antenatal care every month at the CHC. Out of these 400 visits, approximately 140 are first visits. From February 2023 to January 2024, 1592 women received antenatal care services at the clinic. All services provided at this specific CHC are completely free of charge. Additionally, the CHC has an outpatient mental healthcare division, which is managed by a trained mental healthcare nurse. There is also a weekly visiting clinical psychologist and psychiatrist available. If any antenatal women are screened positive for depression, they will be referred to the outpatient department (OPD) by the treating midwife at the antenatal clinic. At the OPD, a registered psychiatric nurse, who is trained and capable of providing immediate mental healthcare, will attend to the patient. The mental health nurse will then schedule an appointment for the patient with the clinical psychologist and psychiatrist. The visiting psychiatrist is authorized to initiate treatment for the patient. However, in cases of acute psychosis, the patient is referred to a tertiary hospital located 4.2 km away from the CHC for further mental healthcare. While receiving mental healthcare at the tertiary hospital, the patient will also continue to receive maternity healthcare at the CHC.

Study Participants

This study will target all consenting midwives employed at the CHC of interest who actively provide antenatal care services during the data collection period. Any unconsenting midwives, those not on duty during the data collection period due to leave of absence will be excluded from the study.

Sampling

The researchers plan to select participants who possess expertise in the topic being discussed. Therefore, they will employ the non-probability purposive sampling method. The expected sample size will range from six (6) to 16 individuals, as suggested by Braun and Clarke (2019).

Interview Guide

The interview guide could not be developed on a pre-used and validated guide. Therefore, the research team attempted to develop a guide based on the objective of the training session on antenatal depression (see Supplemental File 1). However, because the aim is to provide the midwives with a module that is tailored to their specific needs, they will include what will transpire from the interviews in the module. As of May 2024, OBB and EMK have already interviewed five midwives. The preliminary analysis indicated the significance of incorporating a section on promoting women to disclose their HIV status with their partners and family members. This is because participants have cited it as a contributing factor to depression among young pregnant women. Further significant findings resulting from the interview with the midwives will be reviewed with the research team for potential incorporation in the training session on antenatal depression upon consensus. The addition to the guide will be reported accordingly in the subsequent reports.

Data Collection

The main goal of the project is to provide the midwives with a training session on antenatal depression screening. Therefore, two researchers (OBB and EMK) will first interview the midwives before the training session. The findings from these interviews will be added to the training session on antenatal depression as the goal is to provide a module that is specific to the needs of the midwives in the selected clinic. Data will be gathered through individual in-depth interviews until data saturation and redundancy are attained, following an interview guide. The interviews will be conducted in either English or IsiZulu, based on the midwives’ preference, and will be audio-recorded and then transcribed verbatim. Each interview is expected to last between 30 to 45 minutes. Field notes will be recorded while conducting interviews. To date, five interviews have been conducted with the midwives. After the first two interviews, the transcripts were sent to a member of the team to ensure that OBB and EMK did not ask leading questions. All the comments and suggestions were included in the subsequent interviews.

The training session on antenatal depression will be introduced in June for three days to allow all to the midwives to attend the session according to their schedules. It will be a 3-h, in-person training that focuses on antenatal depression and its symptomatology, utilisation, scoring, and interpretation of the 10-item Edinburgh Postnatal Depression Scale (EPDS) and referral processes to a mental healthcare division within the community centre. It has been arranged that the first 3 hours of each day will be allocated to the training. The reason behind this is that the clinic follows a three-step procedure for patient flow, with the meeting with the midwife being the final step. This allows for a limited time of 2–3 hours for their training. These steps involve registering the patient into the electronic system, measuring vital signs such as pulse, blood pressure, and temperature, and conducting urine dipstick tests. Additionally, routine laboratory tests including haemoglobin, tuberculosis, HIV, and Covid tests are also performed. The duration of this process can vary depending on the number of patients present at the clinic on that particular day. Consequently, the midwives are granted a two-hour break before they commence attending to the women. In the absence of an antenatal screening tool, the midwives will be introduced to the EDPS tool. They will be required to systematically screen every woman from July 2024 over six months by ensuring that the antenatal woman completes the EPDS, followed by him/her (midwife) scoring and interpreting the screening results.

Six months after the training session on antenatal depression, OBB and EMK will interview the same midwives about their knowledge of antenatal depression. A question about their experiences with a focus on barriers to the utilisation of the depression screening tool and implementation of the referral process will be added to the guide. identify. Only midwives who work in the antenatal clinic, have attended the training session, and have voluntarily administered the EPDS tool to antenatal women will be recruited for the post-module interviews. Their knowledge before and after the training will be presented to see if there is a change or improvement.

Data Analysis

The research will employ the Inductive Approach of Content Analysis, as described by Elo and Kyngäs (2008). This systematic method involves condensing extensive text into fewer content categories through the application of explicit coding rules. The content analysis is structured into three primary phases: Preparation, Organization, and Reporting.

Organising and Preparation of Data

One researcher (EMK) will transcribe all interviews verbatim and the other two (OBB, LL) will validate the transcriptions. Participants will be requested to select pseudonyms to maintain confidentiality and improve direct quotations. The researchers will read through all the interviews, gaining a comprehensive understanding of the whole, which will allow them to reflect on its significance. Any underlying meanings will be noted in the margins.

Coding of the Data

In accordance with the study’s objective, participants’ understanding of antenatal depression screening and referral will be emphasized in all interviews. Common ideas expressed in the individual interviews will be highlighted and marked, creating text segments. A suitable phrase will be assigned to accurately describe each text segment, resulting in codes. The researchers will utilize the most descriptive language to provide a topic for all related codes, forming categories. The corresponding codes will be grouped, and sub-categories will be identified within each theme as applicable. These categories will then be analyzed for each interview and across all interviews.

Representing the Findings

The results, groupings, and sub-groupings will be displayed in a tabular format. A detailed description of the findings, including direct quotes from the participants, will also be provided. The categories will be expanded and elucidated by integrating the literature review with the findings, enhancing the depth of the results. The data will be analysed individually by the researchers (OBB, LL & EMK), who will then convene at regular intervals to discuss the identified categories and sub-categories. NVIVO version 12 will be utilized to facilitate the manual data analysis process. The results will be reported following the Standards for Reporting Qualitative Research (O’Brien et al., 2014).

Techniques to Enhance Trustworthiness

The authors will take measures to ensure the quality of the data by following established methods of trustworthiness (Johnson et al., 2020; Lincoln & Guba, 1985). To guarantee credibility, a detailed description of the research process will be provided. Additionally, the data analysis process will involve double-checking the emerging findings with the participants to ensure objectivity in data representation. Finally, the other members of the research team made up of academics from two local universities and a non-government organisation in South Africa and one LMIC university in Ghana will validate the emerging findings. Regular discussions between the research team will also take place to address emerging sub-categories and categories. Confirmability will be achieved by validating transcripts against live audio-recordings, study objectives, and emerging sub-categories and categories. Dependability will be ensured through the provision of a comprehensive description of the study methodology and data. To ensure transferability to other contexts, a detailed account of the research will be provided. Additionally, the quality of the research report will be based on COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. (Tong et al., 2007).

Ethics and Dissemination

This study will adhere to the guidelines outlined in the Declaration of Helsinki (64th WMA General Assembly, Fortaleza, Brazil, October 2013). Since this research is qualitative and relies on interviews, it is considered to have minimal risks associated with it. However, if a research participant expresses any discomfort during the interview related to their experiences of dealing with antenatal depression, the interview will be temporarily paused. Furthermore, if a participant wishes to withdraw from the research, the research will be immediately discontinued. Vulnerable participants will not be included in the study to ensure their protection. All research-related documents, including case report forms, will be recorded and labeled with the research subject identification code instead of the participant’s name. No personally identifiable information, such as name, resident registration number, address, or phone number, will be recorded. The utmost effort will be made to safeguard personal information. Any records that could potentially identify the research subject will be kept confidential. Research data will be securely stored in locked cabinets, with access limited to authorized researchers only. Additionally, all documents containing research data will be stored on computer storage devices in locked research rooms, protected by security settings that require separate passwords for access. This ensures that the records are protected from unauthorized access. The findings of the study will be disseminated through publication in reputable journals and magazines, as well as presentations at credible conferences. Both the participants and the research setting will be anonymized to maintain confidentiality. The research protocol has also been submitted to the University of KwaZulu-Natal Biomedical Research Ethics Committee and received approval in January 2024 (BREC/00005625/2023). The research has also received approval from the KwaZulu-Natal Department of Health (KZ_222308_024).

Discussion

Women are twice at risk of developing depression compared to men (Guo et al., 2021). This is independent of their age, nationality, and some biological processes like genetically determined vulnerability and hormonal fluctuations (Luciano et al., 2022). Furthermore, the risk of developing depression is higher in certain periods such as pregnancy (Howard & Khalifeh, 2020) where many physiological, hormonal, social, and psychological changes occur (Insan et al., 2022), leading to depressive and comorbid anxiety symptoms (Chandra & Nanjundaswamy, 2020; Rajkumar, 2022). Recent literature highlights that depressive symptoms during pregnancy include depressed mood, low self-esteem, loss of appetite, feelings of fatigue, and poor concentration (Bedaso et al., 2021). In a minority of cases, pregnant depressed women show suicidal ideation (Koire et al., 2022). In LMICs, the incidence of antenatal depression is higher (Wisner et al., 2020), probably due to the lack of integration between psychiatric and gynecological units, poor understanding and acceptance of mental health conditions, and higher socio-economic deprivation (Shidhaye et al., 2016). The majority of studies carried out so far have mainly focused primarily on risk factors, effects, treatment, and prevention of perinatal and/or postnatal depression depressive symptoms with the onset during the post-partum period (Luciano et al., 2022).

Research on antenatal depression in low- and middle-income countries (LMICs) is limited, particularly in terms of midwives’ knowledge of the subject. Where there is a controversial debate on whether antenatal depression is linked to postnatal depression (Luciano et al., 2022), one could assume that midwives’ knowledge of postnatal depression is similar to their knowledge of antenatal depression. However, unless this is explicitly investigated, the extent to which knowledge of postnatal depression can be assumed to translate to antenatal depression may be limited. Therefore, this qualitative study aims to address this gap by examining midwives’ literacy on antenatal depression before and after a training session on antenatal depression. Specifically, the study will provide insights into midwives' understanding of antenatal depression screening and referral. The findings of this study will not only contribute to the existing knowledge on antenatal depression but will also serve as a foundation for the development of a context-specific and socio-economically relevant antenatal depression screening tool for Sub-Saharan African countries. Additionally, this project will generate data to support the integration of mental healthcare services into primary healthcare settings for maternal health. The project’s findings will be disseminated through various channels, including reports, datasets, policy briefings, fact sheets tailored to different audiences, and peer-reviewed publications.

Supplemental Material

Supplemental Material - Knowledge of Midwives Regarding Antenatal Depression, Screening, and Referral in South Africa: A Qualitative Study Protocol

Supplemental Material for Knowledge of Midwives Regarding Antenatal Depression, Screening, and Referral in South Africa: A Qualitative Study Protocol by Olivia B. Baloyi, Luke Laari, Cedric X. Mbobnda Kapche, and Esther L. Mbobnda Kapche in International Journal of Qualitative Methods.

Footnotes

Author’s Note

The study protocol will be conducted in partial fulfilment of the first author’s research project on antenatal depression screening and referral in South Africa. The overall aim of the project is to adopt and integrate an effective strategy aimed at implementing a routine antenatal depression screening and referral protocol for women receiving antenatal care at a selected community healthcare center in South Africa. The quantitative and longitudinal parts of the project will be described in other reports.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Research Foundation Thutuka grant (TTK23041994789, South Africa) and the lead author of the paper (OBB), was funded by Office of Global and Community Health Initiatives (OGACHI) through DUKE University, School of Nursing, North Carolina, USA. This research is supported by the College of Health Sciences of the University of KwaZulu-Natal, South Africa.

Ethical Statement

ORCID iD

Esther L. Mbobnda Kapche

Supplemental Material

Supplemental material for this article is available online.

References

Adeoye

I. A.

Sogbesan

Esan

(2022). Prevalence, associated factors and perinatal outcomes of antepartum depression in Ibadan Nigeria. BMC Pregnancy and Childbirth, 22(1), 219. https://doi.org/10.1186/s12884-022-04549-7

Bedaso

Adams

Peng

Sibbritt

(2021). The relationship between social support and mental health problems during pregnancy: A systematic review and meta-analysis. Reproductive Health, 18(1), 162. https://doi.org/10.1186/s12978-021-01209-5

Brown

Sprague

(2021). Health care providers’ perceptions of barriers to perinatal mental healthcare in South Africa. BMC Public Health, 21(1), 1905. https://doi.org/10.1186/s12889-021-11954-8

Chandra

Nanjundaswamy

(2020). Pregnancy specific anxiety: An under-recognized problem. World Psychiatry, 19(3), 336–337. https://doi.org/10.1002/wps.20781

Chorwe-Sungani

(2022). Screening for antenatal depression by midwives in low resource settings in primary care settings in Malawi. Healthcare Access, 125. https://doi.org/10.5772/intechopen.97411

Dadi

A. F.

Miller

E. R.

Mwanri

(2020). Postnatal depression and its association with adverse infant health outcomes in low- and middle-income countries: A systematic review and meta-analysis. BMC Pregnancy and Childbirth, 20(1), 416. https://doi.org/10.1186/s12884-020-03092-7

DeJonckheere

Vaughn

(2019). Semistructured interviewing in primary care research: A balance of relationship and rigour. Family Medicine and Community Health, 7(2), Article e000057. https://doi.org/10.1136/fmch-2018-000057

Elo

Kyngäs

(2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107–115. https://doi.org/10.1111/j.1365-2648.2007.04569.x

Frayne

Nguyen

Allen

Hauck

Liira

Vickery

(2019). Obstetric outcomes for women with severe mental illness: 10 years of experience in a tertiary multidisciplinary antenatal clinic. Archives of Gynecology and Obstetrics, 300(4), 889–896. https://doi.org/10.1007/s00404-019-05258-x

10.

Gillett

(1998). Relativism and the social-constructivist paradigm. Philosophy, Psychiatry, and Psychology, 5(1), 37–48.

11.

Govender

Naidoo

Taylor

(2020). Antenatal and postpartum depression: Prevalence and associated risk factors among adolescents’ in KwaZulu-natal, South Africa. Depression Research and Treatment, 2020(6), Article 5364521. https://doi.org/10.1155/2020/5364521

12.

Guo

Zheng

Gan

Zhang

Chen

Liang

Kuang

(2021). The prevalence of and factors associated with antenatal depression among all pregnant women first attending antenatal care: A cross-sectional study in a comprehensive teaching hospital. BMC Pregnancy and Childbirth, 21(1), 713. https://doi.org/10.1186/s12884-021-04090-z

13.

Hammarberg

Kirkman

De Lacey

(2016). Qualitative research methods: When to use them and how to judge them. Human Reproduction, 31(3), 498–501. https://doi.org/10.1093/humrep/dev334

14.

Howard

L. M.

Khalifeh

(2020). Perinatal mental health: A review of progress and challenges. World Psychiatry, 19(3), 313–327. https://doi.org/10.1002/wps.20769

15.

Insan

Weke

Rankin

Forrest

(2022). Perceptions and attitudes around perinatal mental health in Bangladesh, India and Pakistan: A systematic review of qualitative data. BMC Pregnancy and Childbirth, 22(1), 293. https://doi.org/10.1186/s12884-022-04642-x

16.

Johnson

J. L.

Adkins

Chauvin

(2020). A review of the quality indicators of rigor in qualitative research. American Journal of Pharmaceutical Education, 84(1), 7120. https://doi.org/10.5688/ajpe7120

17.

Khan

Waqas

Bilal

Mustehsan

Omar

Rahman

(2020). Association of maternal depression with diet: A systematic review. Asian Journal of Psychiatry, 52, Article 102098. https://doi.org/10.1016/j.ajp.2020.102098

18.

Koire

Nong

Cain

Greeley

Puryear

Van Horne

(2022). Longer wait time after identification of peripartum depression symptoms is associated with increased symptom burden at psychiatric assessment. Journal of Psychiatric Research, 152(6), 360–365. https://doi.org/10.1016/j.jpsychires.2022.06.046

19.

Lincoln

Y. S.

Guba

E. G.

(1985). Naturalistic inquiry. Sage.

20.

Luciano

Di Vincenzo

Brandi

Tretola

Toricco

Perris

Volpicelli

Torella

La Verde

Fiorillo

Sampogna

(2022). Does antenatal depression predict post-partum depression and obstetric complications? Results from a longitudinal, long-term, real-world study. Frontiers in Psychiatry, 13, Article 1082762. https://doi.org/10.3389/fpsyt.2022.1082762

21.

Malakoane

Heunis

J. C.

Chikobvu

Kigozi

N. G.

Kruger

W. H.

(2020). Public health system challenges in the free state, South Africa: A situation appraisal to inform health system strengthening. BMC Health Services Research, 20(1), 58. https://doi.org/10.1186/s12913-019-4862-y

22.

Martin

C. J. H.

Norris

Martin

C. R.

(2020). Midwives' role in screening for antenatal depression and postnatal depression. British Journal of Midwifery, 28(9), 666–672. https://doi.org/10.12968/bjom.2020.28.9.666

23.

McIntosh

M. J.

Morse

J. M.

(2015). Situating and constructing diversity in semi-structured interviews. Global Qualitative Nursing Research, 2, Article 2333393615597674. https://doi.org/10.1177/2333393615597674

24.

Mokwena

Modjadji

(2022). A comparative study of postnatal depression and associated factors in Gauteng and Free State provinces, South Africa. African Journal of Primary Health Care & Family Medicine, 14(1), e1–e11. https://doi.org/10.4102/phcfm.v14i1.3031

25.

Ngocho

J. S.

Minja

L. M.

Mwamba

R. N.

Knettel

B. A.

Kisigo

G. A.

Mmbaga

B. T.

Watt

M. H.

(2022). Prevalence and predictors of depression among women attending antenatal care in Moshi, Tanzania: A cross-sectional study. BMC Pregnancy and Childbirth, 22(1), 594. https://doi.org/10.1186/s12884-022-04917-3

26.

Ng'oma

Meltzer-Brody

Chirwa

Stewart

(2019). “Passing through difficult times”: Perceptions of perinatal depression and treatment needs in Malawi - a qualitative study to inform the development of a culturally sensitive intervention. PLoS One, 14(6), Article e0217102. https://doi.org/10.1371/journal.pone.0217102

27.

Nweke

Ukwuoma

Adiuku-Brown

A. C.

Okemuo

A. J.

Ugwu

P. I.

Nseka

(2024). Burden of postpartum depression in sub-Saharan Africa: An updated systematic review. South African Journal of Science, 120(1/2), 1–12. https://doi.org/10.17159/sajs.2024/14197

28.

O’Brien

B. C.

Harris

I. B.

Beckman

T. J.

Reed

D. A.

Cook

D. A.

(2014). Standards for reporting qualitative research: A synthesis of recommendations. Journal of the Association of American Medical Colleges, 89(9), 1245–1251. https://doi.org/10.1097/ACM.0000000000000388

29.

Pereira

Bos

Marques

Maia

Soares

Valente

Nogueira

De Azevedo

Macedo

(2012). Short forms of the postpartum depression screening scale: As accurate as the original form. Archives of Women’s Mental Health, 16(1), 67–77. https://doi.org/10.1007/s00737-012-0319-6

30.

Rajkumar

(2022). The relationship between access to abortion and mental health in women of childbearing age: Analyses of data from the global burden of disease studies. Cureus, 14(11), Article e31433. https://doi.org/10.7759/cureus.31433

31.

Ramohlola

M. C.

Maimela

Ntuli

T. S.

(2022). Prevalence of and sociodemographic factors associated with antenatal depression among women in Limpopo Province, South Africa. South African Journal of Obstetrics and Gynaecology, 28(2), 52–56. https://doi.org/10.7196/sajog.2022.v28i2.2097

32.

Shidhaye

Shrivastava

Murhar

Samudre

Ahuja

Ramaswamy

Patel

(2016). Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India. The British Journal of Psychiatry: The Journal of Mental Science, 208(Suppl 56), s13–s20. https://doi.org/10.1192/bjp.bp.114.153700

33.

Simonovich

Nidey

Gavin

Piñeros-Leaño

Hsieh

Sbrilli

Ables-Torres

Huang

Ryckman

Tabb

(2021). Meta-analysis of antenatal depression and adverse birth outcomes in US populations, 2010-20. Health Affairs, 40(10), 1560–1565. https://doi.org/10.1377/hlthaff.2021.00801

34.

South African Department of Health . (2011). National Mental Health Policy Framework and Strategic Plan 2013-2020. Pretoria: Department of Health.

35.

Sutherland

Nestor

B. A.

Pine

A. E.

Garber

(2022). Characteristics of maternal depression and children’s functioning: A meta-analytic review. Journal of Family Psychology, 36(5), 671–680. https://doi.org/10.1037/fam0000940

36.

Tele

Kathono

Mwaniga

Nyongesa

Yator

Gachuno

Wamalwa

Amugune

Cuijpers

Saxena

McKay

Carvajal

Lai

Huang

K. Y.

Merali

Kumar

(2022). Prevalence and risk factors associated with depression in pregnant adolescents in Nairobi, Kenya. Journal of Affective Disorders Reports, 10, Article 100424. https://doi.org/10.1016/j.jadr.2022.100424

37.

Tong

Sainsbury

Craig

(2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care: Journal of the International Society for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042

38.

Wisner

Stika

Watson

(2020). Pregnant women are still therapeutic orphans. World Psychiatry, 19(3), 329–330. https://doi.org/10.1002/wps.20776

39.

World Health Organization . (2021). Depression. WHO. https://www.who.int/health-topics/depression#tab=tab_1

Supplementary Material

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Knowledge of Midwives Regarding Antenatal Depression,Screening,and Referral in South Africa: A Qualitative Study Protocol

Abstract

Keywords

Background and Study Justification

Research Questions

Study Approach and Design

Study Setting

Study Participants

Sampling

Interview Guide

Data Collection

Data Analysis

Organising and Preparation of Data

Coding of the Data

Representing the Findings

Techniques to Enhance Trustworthiness

Ethics and Dissemination

Discussion

Supplemental Material

Supplemental Material - Knowledge of Midwives Regarding Antenatal Depression, Screening, and Referral in South Africa: A Qualitative Study Protocol

Footnotes

Author’s Note

Declaration of Conflicting Interests

Funding

Ethical Statement

ORCID iD

Supplemental Material

References

Supplementary Material