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New ProjectHospital-based pilot implementation study for screening, management and follow-up of peri-natal depression cases
India (MSAI) - Parul Institute of Medical Sciences & Research, Vadodara, Gujrat
Kandarp Narendra Talati (MBA, MPH) Dr. Niraj Bharadva (MD Community Medicine)
Type of Research Project
- Basic science
What is the background of the project?
The peri-natal depression encompasses the time from conception to the end of the first postpartum year. During this stressful phase women undergo profound physical, emotional changes. They are vulnerable to develop mental health disorders. Cohort studies from both India and Pakistan provide evidence that maternal depression is an independent risk factor for poor infant growth. A systematic review published in Lancet talks about high prevalence of PND in low-income and middle-income countries. PND affects about one in four women ante- partum and one in ﬁve women post-partum. One of the key challenges identified by the paper suggests the need for studies to determine the prevalence and risk factors of PND. The paper also recommended designing integrated care programmes aimed at identifying and treating women with PND. Hence, we propose this implementation research study to pilot screening, management and follow-up of PND cases at Parul Sevashram Hospital. The findings will provide epidemiological insights into the prevalence of PND in local community and also managerial insights on how to integrate the screening, management and follow-up component, within routine hospital procedures, to ensure optimum contact opportunities with the ante-natal and post-natal mothers.
What is the aim of the project?
● To design, implement and manage hospital-based intervention protocol for routine screening, clinical management, follow-up and effectiveness of treatment of peri-natal depression cases ● To assess prevalence, incidence and potential risk factors for peri-natal depression among pregnant women and mothers of infant (<6 months age) visiting routine OPD/IPD at Parul Sevashram Hospital
What techniques and methods are used?
Study Design: a) Implementation research to integrate PND screening, management and follow-up protocol as part of routine hospital OPD/IPD procedures for relevant patient group b) Exploratory longitudinal cohort study to understand prevalence, incidence, potential risk factors, effectiveness of interventions and implications of PND on infant boding, feeding practices and growth indicators (underweight, stunting, wasting) Screening Plan: All eligible women attending routine OPD for themselves or their infants at O&G, pediatrics, psychiatric, breastfeeding clinic of Parul Sevashram Hospital, Limda, district Vadodara, Gujarat, will be screened for PND. Routine screening at least once in each trimester during pregnancy, prior to discharge after delivery and at months 1, 2, 3 and 6 post-delivery will be emphasized in line with recommendations by the National Perinatal Association, USA. Study tools: A brief questionnaire assessing socio economic and demographic details, past reproductive history and screening for potential risk factors. The EPDS tool for assessing PND, with women scoring >10.5 will be categorized as ‘positive’ and >15 as ‘severe.’ A 25-item Postpartum Bonding Questionnaire (PBQ), for those screened positive for PND and are in post-natal stage, to understand mother’s feelings or attitudes towards her baby. All items need to be rated by a mother on 6-point Likert scale ranging from always (score 0) to never (score 5). The four subscales of PBQ questionnaire and their cut-off values are mentioned herein below. Plan of analysis: Descriptive statistics will be performed to report implementation research outcome measures, socio- demographic characteristics, prevalence and incidence measures. Bivariate analysis will be performed to explore all possible risk factors for PND. Multivariable logistic regression will be used to identify independent effect of the risk factors on PND. Significance will be considered at the p value<0.05. PND – Paroxysmal Nocturnal Dyspnea OPD – Out patient department of a hospital IPD – In-patient department of a hospital O AND G – obstetrician and gynecology department EPDS – Edinburgh Postnatal Depression Scale
What is the role of the student?
- The student will mainly observe
- The student will observe the practical experiments but will be highly involved in the analysis of the results
What are the tasks expected to be accomplished by the student?
● Understand the research question; ● Observe the research methodology and provide (Minimum 10 lines, provide detailed explanation) technical critiques based on review on literature, group discussions and personal insights; ● Monitoring data collection, data cleaning and database management; ● Design plan of analysis and reporting preliminary research findings; ● Data analysis together with study investigators and biostatistician; ● Writing scientific report/abstract for conference presentation
Will there be any theoretical teaching provided (preliminary readings, lectures, courses, seminars etc)
Preliminary readings, orientation sessions to scientific writing (grant writing, research abstracts and manuscript) by tutor(s)
What is expected from the student at the end of the research exchange? What will be the general outcome of the student?
- The student will prepare a poster - The student will prepare a presentation - The student will prepare a scientific report - The student will prepare an abstract - The student’s name will be mentioned in a future publication
What skills are required of the student? Is there any special knowledge or a certain level of studies needed?
Proficient English writing, team work, basic internet search (preferred: PUBMED search), interest in scientific reading, writing and abstraction
Are there any legal limitations in the student’s involvement
Type of students accepted
This project accepts: - Medical students - Graduated students (less than 6 months) - Pre-Medical students from the American-British system
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