No data, no problem, no action: parenting programs in low-income countries. Making the social-emotional outcomes more visible

Systemic barriers and opportunities for implementing school-based social-emotional learning interventions in low-income and conflict-affected settings

Children living in low-income and conflict-affected settings face unique systemic risk factors that shape their social, emotional, and mental well-being. However, little is known about how these and other systemic factors may impede or support the delivery of social-emotional learning (SEL) interventions in these contexts. In this article, we draw from our experience delivering and evaluating a classroom-based SEL curriculum in Rio de Janeiro, Brazil to surface systemic barriers and opportunities for implementing SEL interventions in low-income, conflict-affected settings. Specifically, we identify (1) culture, (2) timing, and (3) government support and stability as factors underlying SEL program demand, dosage, quality, and effectiveness. We provide recommendations for improving implementation of SEL programs in low-income and conflict-affected contexts, including the importance of building pro-active partnerships, using qualitative research, and investing in adaptation to both understand and address systemic barriers.

Efficacy of learning through play plus intervention to reduce maternal depression in women with malnourished children: A randomized controlled trial from Pakistan✰

BACKGROUND

The risk factors and adverse outcomes related to maternal depression and child malnutrition are a leading cause of morbidity and mortality in low and middle-income countries (LMIC) including Pakistan. Above 25% of women suffer from maternal depression. Up to 50% children are under-nourished which contributes to 35% of all under-5 deaths in the country.

AIM

To determine the efficacy of Learning through Play Plus Thinking Healthy Program (LTP Plus) intervention to reduce maternal depression in mothers with undernourished children.

METHODS

In this randomised controlled trial, all eligible mothers presenting to the paediatric departments were invited to participate in the study. Out of the total 256 mothers screened, 107 were included, 54 of those were randomly allocated to LTP Plus group and 53 to treatment as usual (TAU). Edinburgh Postnatal Depression Scale (EPDS) was used to screen for depression. Hamilton Depression Rating Scale (HDRS), Maternal Attachment Inventory (MAI), Social Support Scale (OSLO-3) and the Euro-QoL (EQ-5D) were used to measure the severity of depression, mother-child attachment, level of support and health related quality of life dimensions. Assessments were completed at baseline, end of intervention (3 months from baseline) and at 6 months from baseline.

RESULTS

Mothers in the LTP Plus group significantly showed improvements in depression (p<0.001), social support (p = 0.02) and quality of life (p<0.001) at the end of the intervention (LTP Plus), as compared to the TAU group, which were sustained up to 6 months after baseline.

CONCLUSION

The outcomes of LTP Plus intervention for mothers of malnourished children show promising results in reducing maternal depression and improving child outcomes. A full trial with longer-term outcomes and cost-effectiveness needs to be conducted.

Maternal depression and mental health in early childhood: an examination of underlying mechanisms in low-income and middle-income countries

Studies examining mechanisms underlying associations between maternal depression and adverse child outcomes (including behaviour, socioemotional adjustment, and emotion regulation) indicate that during pregnancy, maternal depression could affect child outcomes through altered placental function, epigenetic changes in the child, and stress reactivity. Infection and dietary deficiencies in the mother and the child, together with the child's genetic vulnerability, might also affect outcome. Postnatally, associations between maternal depression and child outcome are influenced by altered mother-child interactions, sociodemographic or environmental influences, and social support. Knowledge is scarce on mechanisms in low-income and middle-income countries where maternal depression is highly prevalent, and stressful factors that influence the development of perinatal maternal depression and adverse child outcome (eg, food insecurity, perinatal infections, crowded or rural living conditions, and interpersonal violence) are both more intense and more common than in high-income countries. We reviewed evidence and use the biopsychosocial model to illustrate risk factors, mediators and moderators underlying associations between maternal depression and child outcomes in low-income and middle-income countries.