The first 1000 days of a child provide a unique opportunity to shape healthier and prosperous futures. A mother who is cared for emotionally is better able to care for herself and consequently her children. We appeal for mental health care for all mothers!

1. The Western Cape 1st 1000 Days Initiative:
Review and Future Focus
Perinatal Mental Health
Dr Simone Honikman
October 2017

2. In South Africa
In High Income Countries
Maternal depression
16-20%
22-47%
Periurban
• Antenatal 22%
• Postnatal 35%
Rural
• Antenatal 47%
and anxiety?
In Low and Middle Income
Countries
10-13%

3. Maternal Outcomes
Complications
during birth
Suicide
Poor use of
services
Loss of economic
potential
Domestic violence
Problems with
bonding
Drinking/drugs

4. Child Outcomes
Low Birth
Weight,
prematurity
Difficulties with
breastfeeding
Difficulty bonding
Crying and
irritability
Abandonment
abuse or neglect
Mental health
and conduct
problems
Impaired
language and
motor skills
sickness and
immunisation
non-adherence

5. Clinical services:
principles of how we respond
• Prepare the environment – policy and relationships
• Support the providers
• Routine and integrated
• Early detection and referral
• Adapt evidence-based psychosocial intervention to meet
clients’ needs
– on-site
– brief (2-3 sessions)
– linked to social support
• Liaison (social support, medical support) and follow-up
• Monitor and evaluate

6. Where have MMH matters
been recognized?
• Basic Antenatal Care – procedures and new training
• Postnatal Care Policy and guidelines 2016
• General IEC Materials for booking mothers
• Community Based Services
• Catch and Match
• Screening and referral procedures (in process)
• Patient-Centred Maternity Code
• Recognising abuse – zero tolerance
• Client feedback mechanisms
• Staff support and debriefing
• Training
• People’s Development Centre (DoH training unit)
• First Thousand Days
• Theory of Change
• IEC materials
• Maternity Stationery
• Primary Care Guidelines PACK

7. PMH within TOC

8. First 1000 Days – info material

9. Other
Viral load Date
Viral load Date
CD 4: ART initiated on (date):
Date: Reactive
HIV retest at 20 weeks: Reactive Non-reactive
Urine MCS
Reactive
Rapid syphilis test:
Rhesus:
COUNSELLING
Nutrition
HIV
Mental health
Alcohol/ substances/ tobacco
Declined
IPT
Declined
Non-reactive
2
nd
HIV test:
N
Hb g/dl Tetanus toxoid: 1
st
Declined
Infant feeding
Parental preparedness
Pos Neg Pos NegRepeat syphilis test:
3
rd
Antibodies: Y
FUTURE CONTRACEPTION (provide dual protection)
Injectable Oral
Intra-uterine
device
Tubal ligation Implant
Non-reactive
Name & Title
Domestic violence
Booking visit and assessment of risk done by:
Misc
A = Alive
md md y
Not done
Ultrasound
FL
AC
LNMP
Done
Vulva &
Vagina:
BMI:
BPD
y
Congenital Other
Referral:
NAME:
FOLDER NO:
DATE OF BIRTH:
LEVEL OF CARE
Sex Complications
Age: (yrs)
OBSTETRIC &
NEONATAL HISTORY ID = Infant Death
NND = Neonatal Death
IUD = Intra-uterine Death
Year Gestation Delivery Weight
Details:
Family
History
Twins Diabetes
CLINIC
EXAMINATION
BP
kg
VAGINAL EXAMINATION
WeightcmHeight
TB
Diabetes Cardiac
Single / Married / Stable relationship
TB
No Tobacco Alcohol Substances
HIV retest at 32 weeks:
Co-trimoxazole
TB symptom
screen:
Cervix:
Uterus:
Y
MEDICAL & GENERAL HISTORY
Hypertension Epilepsy
Other (specify)
Operations:
Descriptions of complications:
Medication:
Allergies:
Psycho-social risk factors: Yes
1
st
Date
/ Urine:
Result:
Pap Smear done?
HIV Psych
If yes to any of the above give further details, e.g. duration:
Abdomen:
Lungs:
Heart:
Thyroid:
Date:N
G P
3
rd
Transport when in labour:
GESTATIONAL AGE
SF measurement:
cm
Average gestation
HC
d d m m y y
Antenatal clinic: Delivery site:
Placenta
Date:
Y NCertain?
Labour companion
INVESTIGATIONS
Rx received:
MUAC:
y y
U/SDates
Breasts:
SF height
According
to
Estimated date of delivery
d d m m
2
nd
Date 1 Date 2
ANTENATAL RECORD

10. Antenatal care record: changes up close

11. PACK material

12. MMH - where are the gaps?
• Resource mapping
• Stepped care referral pathways
• Standard Operating Procedures
• Mental health counsellors
• What cadre?
• What training?
• What clinical supervision?

13. MMH - where are the gaps?
• Lack of policy implementation
• Resource allocation
• Attendant HR procedures missing – KPAs, job
descriptions
• Attendant M&E procedures/indicators missing
• Accountability?
• Where there is implementation
– what can we learn?
• Armchair intersectoral
collaboration
• DoH and DSD
• DoH and NPOs

14. Simone.Honikman@uct.ac.za
Dr Simone Honikman, PMHP Director
www.pmhp.za.org
http://perinatalmentalhealth.wordpress.com/