"Pain in my heart": Understanding perinatal depression among women living with HIV in Malawi.

BackgroundPerinatal depression (PND) can interfere with HIV care engagement and outcomes. We examined experiences of PND among women living with HIV (WLWH) in Malawi.MethodsWe screened 73 WLWH presenting for perinatal care in Lilongwe, Malawi using the Edinburgh Postnatal Depression Scale (EPDS). We conducted qualitative interviews with 24 women experiencing PND and analyzed data using inductive and deductive coding and narrative analysis.ResultsWomen experienced a double burden of physical and mental illness, expressed as pain in one's heart. Receiving an HIV diagnosis unexpectedly during antenatal care was a key contributor to developing PND. This development was influenced by stigmatization and social support.ConclusionsThese findings highlight the need to recognize the mental health implications of routine screening for HIV and to routinely screen and treat PND among WLWH. Culturally appropriate mental health interventions are needed in settings with a high HIV burden

The feasibility and acceptability of a task-shifted intervention for perinatal depression among women living with HIV in Malawi: a qualitative analysis

Abstract Background Perinatal depression (PND) is prevalent and negatively impacts HIV care among women living with HIV (WLHIV), yet PND remains under-identified in Malawian WLHIV. Accordingly, this formative study explored perceptions of the feasibility and acceptability of an integrated, task-shifted approach to PND screening and treatment in maternity clinics. Methods We completed consecutive PND screenings of HIV+ women attending pre- or post-natal appointments at 5 clinics in Lilongwe district, Malawi. We conducted in-depth interviews with the first 4-5 women presenting with PND per site (n = 24 total) from July to August 2018. PND classification was based on a score ≥ 10 on the Edinburgh Postnatal Depression Scale (EPDS). We conducted 10 additional in-depth interviews with HIV and mental health providers at the 5 clinics. Results Most participants endorsed the feasibility of integrated PND screening, as they believed that PND had potential for significant morbidity. Among providers, identified barriers to screening were negative staff attitudes toward additional work, inadequate staffing numbers and time constraints. Suggested solutions to barriers were health worker training, supervision, and a brief screening tool. Patient-centered counselling strategies were favored over medication by WLHIV as the acceptable treatment of choice, with providers supporting the role of medication to be restricted to severe depression. Providers identified nurses as the most suitable health workers to deliver task-shifted interventions and emphasized further training as a requirement to ensure successful task shifting. Conclusion Improving PND in a simple, task-shifted intervention is essential for supporting mental health among women with PND and HIV. Our results suggest that an effective PND intervention for this population should include a brief, streamlined PND screening questionnaire and individualized counselling for those who have PND, with supplemental support groups and depression medication readily available. These study results support the development of a PND intervention to address the gap in treatment of PND and HIV among WLHIV in Malawi

MOESM1 of Increasing insecticide resistance in Anopheles funestus and Anopheles arabiensis in Malawi, 2011–2015

Additional file 1: Table S1. Approximate locations of villages sampled from 2011 to 2015. Asterisks indicate latitude and longitude were estimated as the average of other villages in the same district or were estimated as the centroid of the district. Table S2. Mortality of An. funestus in WHO susceptibility tests against deltamethrin. 95% confidence limits and sample size are given in parentheses. Table S3. Mortality of An. funestus in WHO susceptibility tests against permethrin. 95% confidence limits and sample size are given in parentheses. Table S4. Mortality of An. funestus in WHO susceptibility tests against bendiocarb. 95% confidence limits and sample size are given in parentheses. Table S5. Mortality of An. funestus in WHO susceptibility tests against propoxur. 95% confidence limits and sample size are given in parentheses. Table S6. Mortality of An. funestus in WHO susceptibility tests against DDT. 95% confidence limits and sample size are given in parentheses. Table S7. Mortality of An. funestus in WHO susceptibility tests against malathion or pirimiphos-methyl (Chikwawa, Ntwana, 2015 only). 95% confidence limits and sample size are given in parentheses. Table S8. Mortality of An. arabiensis in WHO susceptibility tests against deltamethrin. 95% confidence limits and sample size are given in parentheses. Table S9. Mortality of An. arabiensis in WHO susceptibility tests against permethrin. 95% confidence limits and sample size are given in parentheses. Table S10. Mortality of An. arabiensis in WHO susceptibility tests against bendiocarb. 95% confidence limits and sample size are given in parentheses