Engaging Traditional Birth Attendants to Reduce Maternal Depression in Rural Kenya

The proportion of patients (mothers with maternal depression) with reduction of depressive symptoms at 3, 6, and 9 months from baseline, using the Edinburgh Postnatal Depression Scale. This tool has adequate sensitivity and specificity to identify depressive symptoms in the antenatal and postnatal periods. A score is calculated by adding the individual items for each question. A total score of 11 or more in the Kenyan context is considered a flag for the need for follow up of possible depressive symptoms.

The proportion of depressed patients at the TBA clinics experiencing intimate partner violence using the World Health Organization instrument to measure partner violence. This questionnaire measures violence from various aspects such as (i) physical, sexual, emotional, controlling behaviours and physical violence in pregnancy; (ii) physical and forms of violence by non-partners since age 15 years and (iii) Childhood sexual abuse before age 15 years. A "yes" in any of the items in the specific forms of violence indicates a positive score for that type of violence.

Change from baseline to 3, 6, and 9 months in quality of life domains using the World Health Organization Quality of Life questionnaire. The minimum and maximum scores for physical, psychological, social and environmental domains are (7-35), (6-30), (3-15) and (8-40) respectively. The domains are scored through a simple algebraic summation of each item in that scale and the raw scores transformed into a 0-100 scale by subtracting lowest possible raw score from actual raw score and dividing the total by the possible raw score range, then the total is multiplied by 100. Higher scores on each of the domains indicate higher quality of life.

Change in satisfaction levels among patients seeking TBA services

The proportion of patients with reduced suicidal behaviors such as ideations or attempts as measured using the Beck's Suicidality Scale at 3, 6, and 9 months. This scale assesses a patient's thoughts, plans and intent to commit suicide. There are no specific cut-off scores for severity classification. Therefore, the total scores calculated through summation of the items range from 0 to 42. Increasing scores reflect greater suicide risk.

Change from baseline to 6, and 9 months in disability scores using the World Health Organization Disability Assessment Schedule. This scale asks difficulties related to health/mental conditions. The "item-response-theory" (IRT)-based scoring which takes into account multiple levels of difficulty for each item is used. After summing the scores for all six different functioning domains: cognition, mobility, self-care, getting along, life activities (household and work/school) and participation, the summary scores are converted into a metric ranging from 0 to 100 (where 0 = no disability; 100 = full disability). High scores on a particular domain indicate significant and problematic areas for the individual.