Assessing Frontline Health Workers’ Capacity to Detect and Manage Perinatal Depression in Primary Health Facilities in Kaduna South, Kaduna State, Nigeria

Abstract

Background: Perinatal depression (PND), a depressive mood occurring during pregnancy or within one year after childbirth, is one of the most common yet under-recognized maternal mental health conditions worldwide. It affects 10–25% of women, with higher rates in low- and middle-income countries where sociocultural stigma, weak healthcare systems, and limited awareness impede detection and treatment. In Nigeria, where primary health centers (PHCs) are the first point of maternal care, frontline health workers (FHWs) play a crucial role in identifying and managing PND. However, little is known about their capacity to detect, support, and treat affected women, especially in northern regions like Kaduna State.

Objective: To assess the knowledge, attitudes, and existing care practices of frontline health workers toward perinatal depression, identify factors influencing their willingness to deliver PND-related services, and examine the relationship between knowledge and practice at the PHC level in Kaduna South Local Government Area (LGA).

Methodology: A descriptive cross-sectional study design with a mixed-methods approach was used. A multistage sampling technique selected 198 respondents, including nurses, midwives, community health officers, and community health extension workers, from 37 PHCs across six randomly selected wards of Kaduna South LGA. Data were collected using a structured, self-administered questionnaire adapted from validated tools and analyzed with SPSS version 25. Descriptive statistics summarized socio-demographics, while Chi-square tests evaluated associations between knowledge, attitudes, and practices at a 5% significance level.

Results: Awareness of perinatal depression was high (89.9%), with 62.1% of respondents rating their knowledge as good. However, the understanding of severe or atypical symptoms remained limited. Most respondents displayed positive attitudes, showing confidence in recognizing PND and willingness to refer women for mental health support, but a minority (10%) still attributed depression to spiritual causes. Routine screening for PND was inconsistent; only a small proportion reported conducting regular assessments. Training significantly influenced behavior: respondents with prior mental health training were more likely to screen or refer affected women (p < 0.05). Knowledge was positively associated with willingness to deliver PND-related services. Major barriers included inadequate training, high workload, stigma, and poor referral systems.

Conclusion: Frontline health workers in Kaduna South demonstrate strong awareness and generally positive attitudes toward perinatal depression, yet a persistent gap exists between knowledge and practice. Limited training opportunities and sociocultural misconceptions continue to impede effective detection and management at the PHC level. Strengthening workforce capacity through continuous professional education, integrating validated tools such as the Edinburgh Postnatal Depression Scale (EPDS) into antenatal and postnatal services, and establishing clear referral pathways are essential to improving maternal mental health outcomes.