https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61238-0.pdf

No health without mental health.

Mental health of young people: a global public-health challenge

Mental health of young people : a global public-health challenge. Commentary

OBJECTIVE: To review the evidence about the prevalence and determinants of non-psychotic common perinatal mental disorders (CPMDs) in World Bank categorized low- and lower-middle-income countries. METHODS: Major databases were searched systematically for English-language publications on the prevalence of non-psychotic CPMDs and on their risk factors and determinants. All study designs were included. FINDINGS: Thirteen papers covering 17 low- and lower-middle-income countries provided findings for pregnant women, and 34, for women who had just given birth. Data on disorders in the antenatal period were available for 9 (8%) countries, and on disorders in the postnatal period, for 17 (15%). Weighted mean prevalence was 15.6% (95% confidence interval, CI: 15.4-15.9) antenatally and 19.8% (19.5-20.0) postnatally. Risk factors were: socioeconomic disadvantage (odds ratio [OR] range: 2.1-13.2); unintended pregnancy (1.6-8.8); being younger (2.1-5.4); being unmarried (3.4-5.8); lacking intimate partner empathy and support (2.0-9.4); having hostile in-laws (2.1-4.4); experiencing intimate partner violence (2.11-6.75); having insufficient emotional and practical support (2.8-6.1); in some settings, giving birth to a female (1.8-2.6), and having a history of mental health problems (5.1-5.6). Protective factors were: having more education (relative risk: 0.5; P = 0.03); having a permanent job (OR: 0.64; 95% CI: 0.4-1.0); being of the ethnic majority (OR: 0.2; 95% CI: 0.1-0.8) and having a kind, trustworthy intimate partner (OR: 0.52; 95% CI: 0.3-0.9). CONCLUSION: CPMDs are more prevalent in low- and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history.

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Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(09)60741-8.pdf

Global patterns of mortality in young people: a systematic analysis of population health data

Background Community-based epidemiological data on post-partum depression from developing countries are scarce.

Aims To determine the incidence of and risk factors for developing post-partum depression in a cohort of women living in rural south India.

Method We assessed 359 women in the last trimester of pregnancy and 6-12 weeks after delivery for depression and for putative risk factors.

Results The incidence of post-partum depression was 11% (95% CI 7.1-14.9). Low income, birth of a daughter when a son was desired, relationship difficulties with mother-in-law and parents, adverse life events during pregnancy and lack of physical help were risk factors for the onset of post-partum depression.

Conclusions Depression occurred as frequently during late pregnancy and after delivery as in developed countries, but there were cultural differences in risk factors. These findings have implications for policies regarding maternal and childcare programmes.

/pdf/post-partum-depression-in-a-cohort-of-women-from-a-rural-1cwb8b8kpt.pdf

Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India. Incidence and risk factors

Suicides in young people in rural southern India.

Suicide rates have increased in many developing countries.1 But the reported rates are misleading because population counts are unreliable, and identifying suicides is problematic because of inefficient civil registration systems, non-reporting of deaths, variable standards in certifying death, and suicide's legal and social consequences.

Suicide rates were between 8.1 and 58.3/100 000 population for different parts of India.2 Police records, which under-report, were used to calculate these rates.

We used verbal autopsies in the 85 villages of the Kaniyambadi region of southern India (area 127 km2; population 108 873 in 1999) to calculate mean age and sex specific suicide rates for the period 1994-9.

A community health worker (a resident of the village), health aide, community nurse, and doctor reached a consensus on the cause of death. …

https://www.bmj.com/content/bmj/326/7399/1121.full.pdf

Evaluation of suicide rates in rural India using verbal autopsies, 1994-9

Aims: To evaluate the efficacy and acceptability of solar irradiation in the prevention of diarrhoeal morbidity in children under 5 years of age, in an urban slum in Vellore, Tamil Nadu. Methods: A total of 100 children were assigned to receive drinking water that had been subjected to solar disinfection in polyethylene terephthalate bottles. One hundred age and sex matched controls were also selected. Both groups were followed by weekly home visits for a period of six months for any diarrhoeal morbidity. At the end of the follow up period, the acceptability of the intervention was assessed by interviews, questionnaires, and focus group discussions. Results: There was significant reduction in the incidence, duration, and severity of diarrhoea in children receiving solar disinfected water, despite 86% of the children drinking water other than that treated by the intervention. The incidence of diarrhoea in the intervention group was 1.7 per child-year, and among controls 2.7 per child-year, with an incidence rate ratio of 0.64 (95% CI −0.48 to 0.86). The risk of diarrhoea was reduced by 40% by using solar disinfection. In qualitative evaluation of acceptability, most women felt that solar disinfection was a feasible and sustainable method of disinfecting water. Conclusions: Solar disinfection of water is an inexpensive, effective, and acceptable method of increasing water safety in a resource limited environment, and can significantly decrease diarrhoeal morbidity in children.

/pdf/solar-disinfection-of-water-for-diarrhoeal-prevention-in-4mzygc7k36.pdf

Solar disinfection of water for diarrhoeal prevention in southern India

Women often suffer silently with reproductive tract infections (RTIs). Studies of the prevalence of these infections in South Asia have been hindered by low participation rates and little is known about rates among the youngest married women. A community-based cross-sectional study of RTIs was conducted in 1996–1997 among married women 16–22 years of age in Tamil Nadu India. The women were questioned about symptoms received pelvic and speculum examinations and provided samples for laboratory tests. Qualitative and quantitative data on treatment-seeking behavior were collected. Fifty-three percent of women reported gynecologic symptoms 38% had laboratory findings of RTIs and 14% had clinically diagnosed pelvic inflammatory disease or cervicitis. According to laboratory diagnoses 15% had sexually transmitted infections and 28% had endogenous infections. Multivariate analysis found that women who worked as agricultural laborers had an elevated likelihood of having a sexually transmitted infection (odds ratio 2.4) as did those married five or more years (2.1). Two-thirds of symptomatic women had not sought any treatment; the reasons cited were absence of a female provider in the nearby health care center lack of privacy distance from home cost and a perception that their symptoms were normal. Young married women in this rural Indian community have a high prevalence of RTIs but seldom seek treatment. Education and outreach are needed to reduce the stigma embarrassment and lack of knowledge related to RTIs. The low social status of women especially young women appears to be a significant influence on their low rates of treatment for these conditions. (authors)

/pdf/reproductive-tract-infections-among-young-married-women-in-23hqigs4ca.pdf

Sulochana Abraham

Papers

Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India. Incidence and risk factors

Suicides in young people in rural southern India.

Evaluation of suicide rates in rural India using verbal autopsies, 1994-9

Solar disinfection of water for diarrhoeal prevention in southern India

Reproductive tract infections among young married women in Tamil Nadu, India.