Effect of a lay counselor-delivered integrated maternal mental health and early childhood development group-based intervention in Northern Ghana: a cluster-randomized controlled trial

Joy Noel Baumgartner; Mohammed Ali; John A Gallis; Margaret Lillie; Raymond Owusu; Safiyatu Abubakr-Bibilazu; Haliq Adam; Raymond Aborigo; Elena McEwan; Yunji Zhou; Eunsoo Timothy Kim; Jessica Mackness; John Koku Awoonor Williams; John Hembling

doi:10.1017/gmh.2021.15

Effect of a lay counselor-delivered integrated maternal mental health and early childhood development group-based intervention in Northern Ghana: a cluster-randomized controlled trial

Glob Ment Health (Camb). 2021 May 26:8:e18. doi: 10.1017/gmh.2021.15. eCollection 2021.

Authors

Joy Noel Baumgartner^{1

2}, Mohammed Ali³, John A Gallis^{2

4}, Margaret Lillie², Raymond Owusu³, Safiyatu Abubakr-Bibilazu³, Haliq Adam³, Raymond Aborigo⁵, Elena McEwan⁶, Yunji Zhou^{2

4}, Eunsoo Timothy Kim², Jessica Mackness², John Koku Awoonor Williams⁷, John Hembling⁶

Affiliations

¹ University of North Carolina at Chapel Hill, 325 Pittsboro Street, Chapel Hill, NC 27516, USA.
² Duke Global Health Institute, Duke University, Durham, NC, USA.
³ Catholic Relief Services Country Office, Tamale, Ghana.
⁴ Duke Department of Biostatistics and Bioinformatics, Durham, NC, USA.
⁵ Navrongo Health Research Centre, Navrongo, Ghana.
⁶ Catholic Relief Services Head Quarters, Baltimore, MD, USA.
⁷ Ghana Health Service, Accra, Ghana.

Abstract

Background: Caregiver mental health is linked to early childhood development, yet more robust evidence of community-based interventions to prevent maternal depression and optimize socio-emotional development of young children is needed. Objectives of this cluster-randomized controlled trial (cRCT), based in Northern Ghana, are to assess the impact of the lay counselor-delivered, group-based Integrated Mothers and Babies Course and Early Childhood Development (iMBC/ECD) program on (1) the mental health of mothers of children under age 2; and (2) the socio-emotional development of their children.

Methods: This cRCT randomized 32 women's groups - 16 received iMBC/ECD content (intervention) and 16 received general health education content (control). Surveys were administered at baseline, immediate post-intervention, and 8-month post-intervention. The primary outcome was maternal depression [Patient Health Questionnaire (PHQ-9)], and the secondary outcome was child's socio-emotional development [Ages and Stages Questionnaire: Social Emotional (ASQ:SE-2)]. Qualitative interviews with 33 stakeholders were also conducted.

Results: In total, 374 participants were enrolled at baseline while pregnant with the index child, 19% endorsing moderate/severe depression. Of these, 266 (71.1%) completed the 8-month post-intervention survey (~19 months post-baseline). There were no significant effects of iMBC/ECD on PHQ-9 and ASQ:SE-2 scores. However, results favored the intervention arm in most cases. iMBC participants were highly satisfied with the program but qualitative feedback from stakeholders indicated some implementation challenges.

Conclusions: This real-world evaluation had null findings; however, post-intervention depression levels were very low in both arms (3%). Future research should examine the potential impact of women's groups on postpartum mental health more broadly with varying content.

Keywords: Early childhood development; Ghana; infant mental health; maternal depression; socio-emotional health.