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Introduction: We describe a facility mapping exercise conducted in two low-income/primary health facilities in Kenya to identify available service resources, cadres, and developmental partners as well as existing barriers and facilitators in the delivery of mental health services in general and specifically for peripartum adolescents in primary health care. We have tried to embrace the principles of integrating mental health services in primary care and keeping WHO mhGAP in mind. Additionally, primary care facilities’ capacity is a major limiting factor for expanding universal health coverage in low- and middle-income countries. Method and Measures: This study utilized a qualitative evidence synthesis through semi-structured facility services mapping and stakeholder interviews. Services-related data was collected from two facility in-charges using the Nairobi City County Human Resource Health Strategy record forms. Additionally, we conducted 12 key informant interviews (KIIs) with and clinical officers (Clinicians at diploma level), Nurses, Community Health Assistants (CHAs), Prevention of Mother-to-child Transmission of HIV Mentor Mothers (PMTCTMs), around both general and adolescent mental health as well as psychosocial services they offered. Using the World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) as a guideline for the interview, all KII questions were structured to identify the extent of mental health integration in primary health care services. Interview transcripts were then systematically analyzed for common themes and discussed by the first three authors to eliminate discrepancies. Results: Our findings show that health care services centered around physical health were offered daily while the mental health services were offered weekly through specialist services by the Ministry of Health directly or non-governmental partner. Despite Health care workers being aware of the urgent need to integrate mental health services into routine care, they expressed limited knowledge about mental health disorders, lack of trained mental health personnel, the need for more significant funding and resources to provide mental health services, and promotion of CMHS to treat mental health conditions in the primary care setting. Our stakeholders underscored the urgency of integrating mental health treatment, prevention, and well-being promotive activities targeting adolescents especially peripartum adolescent girls.Conclusion: There is a need for further refining of the integrated care model in mental health services and targeted capacity building for health care providers to deliver quality services.

Background: Cognitive interviewing is a well-recognized methodology to identify clinical and commonsensical relevance of mental health questionnaire items by our research participants. Depression is amongst the most common condition impacting pregnant and parenting adolescents in sub-Saharan Africa (SSA). In Kenya, studies have reported depression prevalence estimates of 12-50% in peripartum adolescents. While young people prefer using English, there has not been enough data to point to how well they respond to Kiswahili translations of the commonly used tools.Method: Thirty-two participants between ages 14-18 years were approached and through informed consent for them to participate. We used Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9) in English and Kiswahili versions to carry out the interviews and were coded along four domains of comprehension, retrieval, judgement and patient response. Scores were tabulated for all participants and simple reliability analyses were offered. The interviews were discussed within the team and tables were shared between three raters for further consensus. The interview transcripts were analyzed manually using thematic analysis.Discussion: We found that adolescents had challenges in fully understanding items in both set of tools however, EPDS was better received than PHQ-9. Psychometrically, EPDS English version and Kiswahili versions fared better than the PHQ-9 English and Kiswahili versions. PHQ-9 presented considerable issues with regards to semantic clarity however had simpler response options in comparison to EPDS which was more experientially appropriate, but response options were not simple. On our thematic analysis we felt that the adolescents were significantly challenged by the new, unanticipated pregnancy or motherhood experience. Poverty, poor partner support, discord with parents and distress in the family, and traumatic end of supportive and helpful relationships were the notable problems.Conclusion: While sensitive cross-cultural translations for the commonly used open access depression tools is critical, it is also pertinent to understand whether these are developmentally appropriate. Our participants had multiple psychosocial and material challenges that necessitate measures sensitive to their age, social context and health experiences. Additionally, we felt that both the tools may not be suitable for self-administration and may need involvement of a case worker or community health worker.