How effective are community health workers in managing and preventing perinatal depression in sub-Saharan Africa? A systematic review of quantitative evidence.

The accessibility to the prevention and management of perinatal depression can be improved by using community health workers. This review was aimed at determining the effectiveness of interventions led by community health workers (CHWs) in reducing depressive symptoms and the prevalence of depression during the perinatal period. We conducted a search in PubMed, CINAHL, SCOPUS, and ProQuest Databases of Dissertation and Thesis (PQDT) to locate studies conducted in sub-Saharan Africa. We appraised the quality of eligible studies using standardized critical appraisal instruments from the Joanna Briggs Institute (JBI). We extracted data from the included studies using an a priori prepared data extraction tool. We pooled the findings of the studies using meta-analysis. The initial search yielded 199 studies, out of which we included 16 articles in this review. During the first 3 months after birth, CHW-led preventive psycho-social interventions reduced the risk of depressed mood by 35% [RR = 0.65(0.46,092)] [low-quality evidence]. The interventions reduced the risk of depressed mood by 32% 6-months post-birth [RR = 0.68(0.52, 0.87)] [very low-quality evidence]. The effect of the interventions is sustained through 9-12 months after birth resulting in a reduction in the risk of depressed mood by 38% [RR = 0.72(0.54,0.96)] [low-quality evidence]. Among women with moderate depressive symptoms, compared to usual care, CHW-led therapeutic psycho-social interventions reduced the symptoms by an average of 0.71 [SMD = -0.71 (-0.84, -0.59) units during the first 3 months after birth. The effect lasts 9-12 months after birth [SMD = -0.28 (-0.41, -0.15)] [Moderate-quality evidence]. In conclusion, the work of CHWs may be integrated into the prevention and management of perinatal depression after careful analysis of the feasibility, applicability and meaningfulness of the interventions to local context. High-quality randomized trials may help to inform further optimization of the role of CHWs in reducing the risk of depressed mood and depressive symptoms during perinatal period.