Assessing the Quality of Maternal Mental Illness Care Across Maternity Care Settings in Southwestern Uganda.

objectiveMaternal mental illness (MMI) is associated with many adverse effects on the mother, baby, and family, which can be overcome by timely and appropriate interventions to meet women's needs. The quality of care for MMI is crucial for timely management yet not well studied, especially in low- and middle-income countries like Uganda. This study aimed to evaluate the capacity of maternity care facilities to deliver quality care for MMI and to explore the women's needs and barriers to MMI care delivery in Southwestern Uganda.

methodsWe used mixed methods to study health workers in maternity care settings as well as pregnant and postpartum women from various health facility levels. The Assessment of Chronic Illness Care (ACIC) tool was used to assess the capacity to screen and manage MMI in maternity health care settings. Antepartum and postpartum women who had been screened positive for MMI had their file records reviewed to confirm whether the health workers also detected MMI symptoms and/or documented any interventions toward their MMI symptoms. They also reported on the quality of care received and how accessible it was using both qualitative and quantitative approaches. IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States) was used for the analysis of quantitative findings while qualitative results followed thematic content analysis.

resultsAll healthcare facilities had ACIC domain scores indicating no or little capacity to manage women with MMI. Maternal care providers detected only 33.3% (16 of 48) of mothers with MMI. A limited proportion of women with MMI received proper treatment (27.1% psychological, 8.3% pharmacological). Emerging themes from interviews included a shortage of maternity care workers as well as poor communication, assessment, and management skills among care providers. More than half (52.1%) of the women who screened positive for MMI did not consider themselves sick, and more than half (54.2%) lacked the financial means to pay for medical care services.

conclusionThe capacity to screen and manage MMI is suboptimal, and women with MMI are unable to recognize that they are unwell. It is crucial to enhance the proportion of women with MMI who are adequately diagnosed and treated by increasing the number of maternal care providers who are skilled and knowledgeable about MMI. There is also a need to raise public awareness about the causes and presentation of MMI, as well as what constitutes quality care, to enhance health-seeking behaviors and encourage service-user-driven quality improvement.