**6.3 Objectives of the algorithm**

The objectives of the Algorithm are to:


## **6.4 The principles underpinning algorithm**

The following principles will enable the Algorithm to be useful in the context of antenatal clinics in Malawi:


#### **6.5 Algorithm for screening**

The Algorithm, to ensure an effective and multidisciplinary approach to routine screening of depression in antenatal clinics, is diagrammatically presented in **Figure 1**.

#### **6.6 Components of the algorithm**

The components of the Algorithm include: antenatal services and antenatal care assessment; midwives' functions, screening instruments and mental health assessment.

### *6.6.1 Antenatal services and antenatal assessment*

Midwives provide antenatal services to the majority of women in Malawi. These services include antenatal assessment, encouraging good health habits, addressing pregnancy related complications and provision of psychosocial support. The World Health Organisation (WHO) recommends that antenatal care should consists of four visits for normal pregnancies with the first visit in the first trimester (before 12 weeks but not later than16 weeks) and subsequently at 24–28 weeks, 32 weeks and 36 weeks. An antenatal assessment includes taking a psychosocial, medical and

**Figure 1.** *Algorithm for screening of antenatal depression.*

obstetric history; a complete general and obstetrical examination; screening for HIV and Syphilis; and testing for proteinuria, blood/rhesus group and bacteriuria. History taking provides the midwife with an opportunity to screen for depression during the antenatal assessment.
