The silent burden: a landscape analysis of common perinatal mental disorders in low- and middle-income countries.

BACKGROUND: Mental health has long fallen behind physical health in attention, funding, and action-especially in low- and middle-income countries (LMICs). It has been conspicuously absent from global reproductive, maternal, newborn, child, and adolescent health (MNCAH) programming, despite increasing awareness of the intergenerational impact of common perinatal mental disorders (CPMDs). However, the universal health coverage (UHC) movement and COVID-19 have brought mental health to the forefront, and the MNCAH community is looking to understand how to provide women effective, sustainable care at scale. To address this, MOMENTUM Country and Global Leadership (MCGL) commissioned a landscape analysis in December 2020 to assess the state of CPMDs and identify what is being done to address the burden in LMICs. METHODS: The landscape analysis (LA) used a multitiered approach. First, reviewers chose a scoping review methodology to search literature in PubMed, Google Scholar, PsychInfo, and Scopus. Titles and abstracts were reviewed before a multidisciplinary team conducted data extraction and analysis on relevant articles. Second, 44 key informant interviews and two focus group discussions were conducted with mental health, MNCAH, humanitarian, nutrition, gender-based violence (GBV), advocacy, and implementation research experts. Finally, reviewers completed a document analysis of relevant mental health policies from 19 countries. RESULTS: The LA identified risk factors for CPMDs, maternal mental health interventions and implementation strategies, and remaining knowledge gaps. Risk factors included social determinants, such as economic or gender inequality, and individual experiences, such as stillbirth. Core components identified in successful perinatal mental health (PMH) interventions at community level included stepped care, detailed context assessments, task-sharing models, and talk therapy; at health facility level, they included pre-service training on mental health, trained and supervised providers, referral and assessment processes, mental health support for providers, provision of respectful care, and linkages with GBV services. Yet, significant gaps remain in understanding how to address CPMDs. CONCLUSION: These findings illuminate an urgent need to provide CPMD prevention and care to women in LMICs. The time is long overdue to take perinatal mental health seriously. Efforts should strive to generate better evidence while implementing successful approaches to help millions of women "suffering in silence."

Otoadmittance in normal subjects.

Otoadmittance audiometry was performed on a group of young subjects (18-30 years old) with normal hearing. Mean values and standard deviations for static admittance, conductance and susceptance were computed on the basis of the point of maximum compliance, as well as the point of zero cross (drum-free position). In addition, the values of curve width for conductance and susceptance, middle ear pressure and the threshold of the acoustic reflex for pure tones and interrupted tones were evaluated. Subjects presenting an abnormality of the tympanic membrane were studied as a separate group. The results obtained in this study were compared with those reported in the literature.

Auditory brain stem responses in cerebellopontine angle tumors.

The characteristic features of auditory brain stem responses (ABSR) are described in seven cases of cerebellopontine angle tumors: five acoustic neuromas, one congenital cholesteatoma, and one meningioma. An attempt is made to correlate the N1 response with the degree of auditory nerve involvement, to gain information about the presence of brain stem displacement, and to evaluate the cranial extension of the lesion by recording responses to contralateral stimuli. The empirical nature of deductions based on crossed stimulation is emphasized. In tumors originating from the VIIIth nerve, the ABSR pattern is characterized by a well-defined N1 complex, indistinct or absent additional responses, and prolonged brain stem conduction time (BSCT) on the affected side whenever its assessment is feasible. Recording from the affected side on stimulation of the contralateral side may show normal responses from stations central to the auditory nerve in cases of small-sized tumors. Medium or large tumors may be accompanied by abnormal N2 and/or N3 responses suggesting involvement of these stations.

Measurement of auditory brain stem potentials in Bell's palsy.

Auditory brain stem potentials (ABP) were recorded in 27 patients with Bell's palsy during the early phase of the disease and 1-3 months later. Pathological findings were observed in 6 patients, the dominant features being prolonged brain stem transmission time and diminished amplitude of the second wave. The extension of the pathological process in the so called idiopathic peripheral facial paralysis appears to vary. The observation of brain stem involvement in some patients with Bell's palsy may have important clinical implications.

Sleep apnea following bilateral excision of carotid body tumors.

A patient is described who developed apnea, hypertention, and tachycardia following the excision of bilateral carotid body tumors. Hypertension and tachycardia resulted, most probably, from bilateral ablation of the carotid sinus and/or the nerve of Hering. These phenomena have been described in the literature. The pathogenesis of the apneic attacks may be related to the ablation of the peripheral sensory organs (both carotid bodies), interference with the function of the respiratory automatic control system, and impaired control of ventilation during non-REM sleep. Temporary unilateral paralysis of the hypoglossal nerve with partial airway obstruction possibly represented a mechanical trigger. The apneic attacks subsided but bouts of hypertention and tachycardia persist.

Adenocarcinoma of the epiglottis. Report of a case and review of the literature.

The larynx is rarely the site of an adenocarcinoma. About 60 patients were described in the literature, and the epiglottis was primarily involved in only three. We studied a fourth case in a 77-year-old man. Adenocarcinoma of the larynx is a highly lethal neoplasm that tends to spread to both regional lymph nodes and distant sites. Despite radical surgical measures, the cure rate is low.

Multifocal extraosseous eosinophilic granuloma of the head and neck.

Multifocal eosinophilic granuloma (Hand-Schüller-Christian disease) confined to soft tissues in the head and neck region is described in a man, 32 years of age. The lesions were detected at varying time intervals within a period of 14 months. They were located in the gingivae, the submaxillary salivary glands, the thyroid gland, and in the dermal lining of the external auditory meatus. Clinical, histologic, ultrastructural, and immunohistochemical findings are presented and discussed. Some of these findings go along with the tenet that the typical proliferating histiocyte in eosinophilic granuloma is a pathologic Langerhans' cell, or a close kindred to it.

Sudden deafness due to infection by Mycoplasma pneumoniae.

A case is described of sudden unilateral deafness associated with Mycoplasma pneumoniae. The hearing function of the patient returned to normal on the third day of treatment with tetracycline. M pneumoniae is a common causative agent of protean respiratory disease and the true incidence of hearing loss in these cases may be higher than reflected by the occasional reports. Therefore, appropriate laboratory studies should be included in the evaluation of sensorineural loss associated with diverse infections of the respiratory tract. Prompt diagnosis facilitates the administration of specific treatment. However, the actual contribution of tetracyclines to restoration of hearing cannot be assessed.

Maturation of auditory brainstem potentials in neonates and infants.

Auditory brainstem evoked potentials (ABP) were recorded in 59 healthy neonates and infants whose age ranged from 3 days to 18 months (6 age groups). Latencies of individual waves and the interpeak latencies (IPL) of I-III, III-V and I-V were analysed. A different maturational pattern was observed in the pontomedullary and the pontomesencephalic segments of the brainstem. Latencies of all waves except wave I were longer in male than in female babies. Establishment of normative data related to the technical variables employed by the individual team is a sine qua non prerequisite for adequate neurological evaluation of ABP.

Amyloidosis of Waldeyer's ring. A clinical and ultrastructural report.

Amyloidosis of the tonsil is a rare condition and amyloidosis of Waldeyer's ring has not been previously reported. The present study describes a case of amyloidosis of the tonsil, nasopharynx and base of tongue in a 35-year-old patient in otherwise good health and without clinical symptoms. The possibility of systemic amyloidosis was excluded by clinical examination and biopsy of rectal and buccal mucosae. Electron microscopy showed the presence of typical amyloid fibrils. Large masses of the fibrils were closely surrounded by cells which appeared to be phagocytic. The ultrastructure of these cells is described. This case is considered to be a unique type of organlimited amyloidosis of Waldeyer's ring.

Impairment of cellular immunity in patients with malignant external otitis.

Immunological studies were performed on 4 elderly diabetic patients with Malignant External Otitis caused by Pseudomonas aeruginosa. Impairment of cellular immunity was found. Skin tests for delayed hypersensitivity to PPD, SK-SD and Mumps antigen were negative and stimulation rates of peripheral blood lymphocytes by PHA, Con-A and PWM were depressed in all 4 patients. Serum immunoglobulins and complement levels were normal except in one case in which paraprotein IgG was found. Peripheral blood lymphoid cell markers and the neutrophil nitroblue tetrazolium (NBT) test were within normal limits in the 2 patients tested. These results indicate that cellular immune deficiency predisposes to the development of Malignant External Otitis in elderly diabetic patients.

Auditory brain stem responses in thyroid dysfunction.

A characteristic pattern of ABR was observed in hyper-and hypofunction of the thyroid gland. The most conspicuous change took place in the BSCT. Its value correlated well with the level of serum T4. Dynamic changes of ABR pattern were recorded during the development of myxedema and on return to an euthyroid state. This preliminary study suggests that examinations of ABR may serve as a tool in the overall assessment of thyroid status.

Availability of long-acting and permanent family-planning methods leads to increase in use in conflict-affected northern Uganda: evidence from cross-sectional baseline and endline cluster surveys.

Humanitarian assistance standards require specific attention to address the reproductive health (RH) needs of conflict-affected populations. Despite these internationally recognised standards, access to RH services is still often compromised in war. We assessed the effectiveness of our programme in northern Uganda to provide family planning (FP) services through mobile outreach and public health centre strengthening. Baseline (n=905) and endline (n=873) cross-sectional surveys using a multistage cluster sampling design were conducted in the catchment areas of four public health centres in 2007 and 2010. Current use of any modern FP method increased from 7.1% to 22.6% (adjusted odds ratio [OR] 3.34 [95% confidence interval (CI) 2.27-4.92]); current use of long-acting and permanent methods increased from 1.2% to 9.8% (adjusted OR 9.45 [95%CI 3.99-22.39]). The proportion of women with unmet need for FP decreased from 52.1% to 35.7%. This study demonstrates that when comprehensive FP services are provided among conflict-affected populations, women will choose to use them. The combination of mobile teams and health systems strengthening can make a full range of methods quickly available while supporting the health system to continue to provide those services in challenging and resource-constrained settings.