Honduras has experienced moderate economic growth in the past decade, in line with the rest of the region. Despite this growth track record, limited opportunities for decent jobs for the majority of workers have resulted in stagnant poverty and inequality rates that are still the highest in Central America (CA). In parallel, progress in human development indicators has also been mixed in the last decade. In education, while primary enrollment has significantly increased, low coverage at all other levels of education, inequalities in access and low quality persist. In health, Honduras is close to achieving the 2015 child mortality Millennium Development Goals (MDGs), but maternal mortality, noncommunicable diseases (NCDs), and violence pose additional challenges. And despite advances in setting up a social protection system, fiscal sustainability and lack of coordination among interventions prevail, undermining poverty reduction efforts. The ability of the Honduras government to expand safety nets, to increase the access and quality of public education and health services, to engage in active labor market policies, and to improve human development indicators in general, remains limited for a number of reasons. First, overall real social public spending has been on the decline in the last few years. Second, low revenues and fiscal deterioration pose challenges to adequately financing needed social sector improvements. Third, challenges in budget formulation and execution (mainly due to institutional factors) also diminish the impact of social spending. But more importantly, Honduras needs to significantly improve the effectiveness and efficiency of its social spending. This note argues that moving forward Honduras should prioritize three main aspects: a) to rationalize and increase the effectiveness of social public spending by enhancing the pro-poor features of targeting mechanisms; b) to significantly redress the imbalance between recurrent spending, especially the wage bill, and capital expenditure; and c) to continue strengthening information systems tools, legislation, and institutions in an effort to consolidate programs into fewer and higher impact interventions. Sector-specific challenges aligned with these broad objectives are addressed below.
Since the Asian Financial Crisis in the late 1990s and through the Global Financial Crisis of the last decade, commendable progress has been made by the member states of the Association of South East Asian Nations (ASEAN) in improving economic and human development outcomes both within each country and across countries. Since 1997, the economies of the poorest countries in the ASEAN, Cambodia, Lao PDR, Myanmar and Vietnam, have generally grown faster than the richer economies, which has reduced gaps in per capita incomes. Overall, child mortality rates have been cut by two-thirds across the ASEAN. And significant reductions have occurred even in some of the poorer member countries such as Cambodia and Lao PDR. However, this report The ASEAN Equitable Development Monitor (henceforth referred to as The Monitor), also shows that much remains to be done to ensure that the poorest members of the ASEAN community, within countries and across countries, are not left behind as the countries of the ASEAN integrate further. In both policies and development outcomes, differences across the countries of the ASEAN remain large. In this context, the monitor is designed to facilitate further discussion on policies and programs that can promote inclusive growth within ASEAN member countries and across the ASEAN community. It presents a number of indicators that are intended to provide a summary of development outcomes across and within the ten ASEAN countries and over time. On this basis, the monitor is intended to help policymakers in ASEAN member states to identify areas of concerns and prioritize national and regional interventions. The monitor tracks indicators across two broad sets of development outcomes and policies: (i) economic development; and (ii) human development.
Like other countries in the Middle East and North Africa region, Algeria has undergone a demographic transition. But Algeria's fertility decline defies conventional explanation. Despite inauspicious starting conditions-a high total fertility rate, reluctant policy environment, and delayed implementation of a national family planning program-Algeria has surpassed some of its neighbors in fertility reduction. Before its fertility transition, Algeria had one of the highest crude birth rates in the world, nearly 50 per 1,000. The fertility transition began in 1965-70, before any significant government support for or investment in population control or family planning and before significant external donor funding became available. Since then, profound changes in the traditional family model have led to a 64 percent decline in the total fertility rate in recent decades, from 6.76 in 1980 to 2.41 in 2006. Overall, Algeria's fertility decline is best understood in terms of changes in behavior, especially the delay in age at first marriage, the increase in contraceptive use, and-to a certain degree-the negative effects of the economic crisis manifested in the housing shortage and unemployment of young adults.
There are three main messages running throughout this report. First, Non Communicable Diseases (NCDs) can impose large health, financial and economic costs on countries. This is particularly important in the Pacific where Government already finances, and provides, the bulk of health services. Second, risk factors in the Pacific are feeding a pipeline of potentially expensive to treat NCDs, including diabetes and heart disease, but governments are already fiscally constrained in how much more they can provide to the health system. Third, from public health and public finance perspective, many of the NCDs are avoidable, or their health and financial costs can at least be postponed, through good primary and secondary prevention. This will require a more coherent approach to health system financing, and health system operations more generally.
Higher education (HE) systems worldwide are faced with three main challenges: providing young people with the skills required by the job market; improving access to high quality services; and seeking out new sources of financing to cope with the growing student demand. This document will provide evidence on the need to seek sustainable financing strategies for countries in Middle East and North Africa (MENA), whether they are high income economies, such as the oil producing countries, or low to middle income economies. Chapter one presents an overall description of HE graduates and the many challenges they face in their transition into the workforce. The different elements that affect this transition are discussed and special attention is given to the mismatches between labor supply and demand. Chapter two analyses the current levels of spending on HE, projects the future financing gaps taking into account the need to continue expanding access and improving quality and relevance, and provides a framework for funding approaches linked to meeting access, equity, and quality goals. Chapter three outlines ways of using current funds in more effective ways, emphasizing the need to align financing allocations with policy goals. Innovative funding allocations that link funding to performance and demand- as well as supply-side mechanisms are discussed. Chapter four discusses different ways to diversify sources of funding and presents alternative methods of cost-sharing. The chapter emphasizes the equity measures needed for cost-sharing mechanisms, such as student fees, and provides an overview of student loan programs used in MENA and elsewhere. Chapter five discusses the role of private provision of HE, and how this can be an alternative to increase access and quality, provided the necessary regulatory and quality controls are in place. Chapter six describes an alternative source of funding not yet common in MENA, namely the use of philanthropic resources to build endowments to support HE.
This overview summarizes the key findings of the eight chapters and one policy note. It is organized as follows. The first section provides a background of Guangdong, while the second describes the current situation of inequality in the province. Next is a discussion of the potential impacts of the transfer of industrial activities ('industrial transfer') in mitigating regional disparity, followed by the recommendation of a three pillar strategy for Guangdong. The fifth section focuses on the elimination of absolute poverty through the minimum living allowance (Dibao) system, and the sixth turns to policy actions needed to increase opportunities for the rural population by moving them to jobs, increasing their access to finance, and ensuring that their land rights are better protected. The seventh section further assesses Guangdong's options for investing in people through more equitable service delivery in compulsory education, skill development, and health care, with the aim of enhancing the capacity of the poor to seize and utilize opportunities. The last section concludes this overview.
Open Peer Review reports Background Perinatal mental health problems affect up to one in five women worldwide [1, 2]. Stress, anxiety and depression in pregnancy affect not only the mother but can also have long-term adverse effects on her child via biological mechanisms in utero [3]. Along with the impact on the mother and her developing infant, antenatal depression and anxiety are the most common predictors of postnatal depression [4, 5]. Postnatal depression can reduce her ability to provide sensitive and responsive caregiving that can potentially impair child development [6]. Mental health problems in the perinatal period are a particular challenge in low- and middle-income countries (LMICs) where they can be at least twice as frequent as in higher-income countries [1]. Our geographical context for this work will be The Gambia, in West Africa, where mental health services are minimal, services for perinatal mental health are non-existent and high levels of stigma associated with mental health issues, as well as specific local attitudes and beliefs, impede recognition and prevent help-seeking behaviour. It is thus of high priority to develop new low-cost, low-resource, non-stigmatising and culturally appropriate approaches to reduce symptoms of anxiety and depression perinatally, for the benefit of both the mother and child. The current project will test the hypothesis that the creative arts—in particular group-singing—will show special promise in alleviating perinatal mental distress in The Gambia. In high-income countries, such as the UK and the USA, singing in groups has been shown to be a powerful modulator of mood and emotion, evoking positive effects on mental health, well-being and social affiliation [7] via mechanisms involving synchrony and entrainment [8], the saliency of relational communicative features in musical interaction [9] and significant effects on the endocrine system [10]. In addition, the mother's voice is a key channel through which meaningful, sensitive and contingent interactions between the caregiver and infant can take place [11]. Recent studies have found that music and its use specifically during the perinatal period can reduce women's stress levels and depressive symptoms and increase women's attachment to their infant [12,13,14,15]. Music-centred approaches may be particularly fruitful in The Gambia as there are already a range of musical practices that specifically engage pregnant women and new mothers [16]. For instance, infant naming ceremonies occur 7 days after birth and are musical celebrations to recognise the new mother and her family [16]. Performances by Kanyeleng groups are closely associated with pregnancy and motherhood and are important in health communication [17]. These pre-existing cultural and creative practices provide an excellent context from which to explore, co-design and ultimately evaluate culturally situated, music-centred interventions that aim to reduce symptoms of anxiety and depression perinatally and facilitate mother-infant caregiving. Study aims This is a feasibility study which aims to inform the design of a larger trial to investigate a Community Health Intervention through Musical Engagement (CHIME) to help reduce symptoms of anxiety and depression in pregnant women compared to standard care. This article describes the trial protocol (version 1.0, 11/11/18). The protocol was prepared in accordance with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidance. The trial SPIRIT checklist can be viewed in Additional file 1. Objectives Our primary objective is to test (a) the feasibility of delivering a group-singing intervention to a sample of pregnant women in The Gambia using a stepped wedge design and (b) the feasibility of using standardised tools to measure the impact of this intervention on anxiety and depression symptoms, before and after the intervention. This objective can be broken down into five specific feasibility objectives: 1) To obtain demographic information on the eligible population 2) To determine if our measurement tools, the Edinburgh Postnatal Depression Scale (EPDS) and the Self-Reporting Questionnaire (SRQ-20), are useable 3) To determine if the intervention is deliverable 4) To determine if the stepped wedge trial design is deliverable and obtain information that will inform the definitive study. Specifically to: a. Assess recruitment and acceptability of randomising clinics b. Assess the recruitment rate of women to control and intervention groups c. Assess participants' adherence to the intervention group and follow-up in both arms d. Test the feasibility of data collection 5) To determine if this type of intervention is culturally appropriate and well received by the community and health workers. Methods/design We will be testing the feasibility of a stepped wedge cluster design, which differs from a parallel arm cluster design in that all clinics involved in the study receive the intervention [18]. Advantages over a parallel arm cluster trial include the requirement of a smaller sample size due to the availability of a within group comparison and prevention of potential disappointment for health clinics who are not randomised into the intervention. Study setting This multi-site study will recruit from four antenatal clinics in western Gambia. Study population All participants will be Mandinka or Wolof Gambian women who are pregnant. Inclusion criteria Pregnant (14–24 weeks gestation) Speak Wolof or Mandinka fluently Exclusion criteria At least one previous late term miscarriage Current psychosis or history of psychosis Withdrawal criteria If the participant develops any serious medical condition or the participant's mental health significantly declines (as assessed by the care team), and the care team deem it necessary, then she may be withdrawn from the study. Intervention The intervention will be delivered on the community level, meaning that it will include women with a range of anxiety and depression symptoms. Our primary aim is to reduce symptoms in those experiencing them (whether these are at a high level or a medium or low level). We anticipate this may also help to reduce their symptoms into the postnatal period. By including those with low and high levels of symptoms, rather than screening and including only those with high levels of symptoms, we will aim to avoid stigma and increase acceptability. The intervention has been developed following focus groups with various stakeholders including health professionals (midwives and community birth companions), pregnant women and musicians (griots and Kanyeleng groups). Four groups of 20 women between 14 and 24 weeks gestation will attend six 60-min group-singing sessions at their local antenatal clinic. This will take place in the morning as this is the time deemed to best suit the majority of women and clinics. Local Kanyeleng groups who specialise in musical practices to support women's health will lead the sessions. The content of the six sessions will be co-designed with the Kanyeleng groups via two extended workshops with the research team. All sessions will begin with a welcome song and end with a closing song. Some of the songs used during the main body of the session will cover topics including the (a) importance of the singing group in supporting each other, (b) importance of other positive relationships in their lives, (c) resilience to challenges and empowerment and (d) importance of being open, removing stigma to discuss challenges. One lullaby will be introduced at each session. Kanyeleng leaders will also be encouraged to ensure that all the women feel comfortable and are participating when they can. The nature of the intervention will necessarily vary somewhat across the four settings, especially as Wolof speaking groups and Mandinka groups have different and distinct cultural beliefs, practices and language. By using the Kanyeleng groups local to each of the four clinics involved, the sessions will be contextually appropriate, while the workshop with all four Kanyeleng groups before the intervention begins will ensure that the overarching goals, content and approach to session delivery are broadly standardised. Over the course of the 6-week intervention period, a research assistant will observe and video and audio record two singing sessions (the first and the fourth sessions) from each of the four clinics to ascertain, using a checklist, the extent to which the sessions conform to our articulated goals. A community health nurse at each clinic will be engaged to take attendance data and report any issues of concern to the research team. The control group will consist of four groups of 20 women between 14 and 24 weeks gestation from the same four clinics. These women will receive only standard care without any additional intervention. Randomisation and blinding As we will be testing the feasibility of delivering a stepped wedge cluster design, the four different antenatal clinics will be randomised with two sites starting first (creating the first sequence) and two starting 6 weeks later (the second sequence). Randomisation will be performed by the study statistician who will generate a randomisation list using software and apply it to the pre-concealed list of clinics. The researchers and participants will not be blinded to whether they are in the intervention or the control cohort. Outcome measurements Two local research assistants (RAs) will collect all measures orally as there is a high rate of illiteracy among the target population. All scales have been translated into Mandinka and Wolof. The translation method used was based on suggestions by the World Health Organisation, Hanlon et al. [19] and Cox, Holden and Henshaw [20]. First, the scales were translated into Mandinka and Wolof. An expert panel discussion then refined the translation before back translating it into English. The expert panel came together once more to resolve any remaining issues before finalising the translation. Two questionnaires will measure antenatal anxiety and depression symptoms. The Edinburgh Postnatal Depression Scale (EPDS) [21] is a ten-item scale that was developed to screen for postnatal depression. It has subsequently been validated to be used during pregnancy [22]. This measurement tool has been used and validated in other African contexts; however, there is no avaliable validated version of the EPDS in Mandinka or Wolof even though it has been used in The Gambia before [23]. The Self-report Questionnaire (SRQ-20) [24] is a 20-item scale developed by the World Health Organization to measure anxiety and depression symptoms in a variety of cultural contexts. It has been used in many different African contexts such as Ethiopia [19], South Africa [25] and Rwanda [26] and as a way to measure perinatal mental health [23]. However, the SRQ-20 has never been used in the Gambian context nor has it been translated into Wolof or Mandinka. Demographic outcomes We will collect demographic information about all participants. The data we will collect is as follows: date of birth, gestational age, time taken to get to the health centre, parity, gravida, place of birth, current place of residence, ethnic group, history of serious illness, occupation, husband's occupation, marital status, educational background and amount of regular musical engagement. Feasibility outcomes The feasibility outcomes are as follows: Recruitment rate Retention and attrition rates of participants Clinics' adherence to stepped wedge schedule Completeness of data by site and over time Video and audio recording of sessions to determine fidelity of the intervention at each site, i.e. whether key content emphasised in training workshops was being delivered at each site. Qualitative interviews with participants after the intervention to capture enjoyment and perceived benefit. Recruitment Four antenatal clinics will be chosen to take part in the study based on three criteria: (1) availability of a local Kanyeleng group to deliver the intervention, (2) the language group predominantly spoken in the area (with at least one clinic being in a predominantly Wolof speaking area) and (3) the type of community the clinic serves (with at least one within an urban area). The health professionals working at the health centre will first approach participants for the study. If they meet the criteria, they will be given information about the study and asked if they would like to be referred to the RAs. They will then be put in contact with one of the RAs who will meet them privately face to face. The information sheet will be read out in their native language verbatim to ensure participants' ability to give informed consent. Consent will be taken orally by the RAs and recorded by signature or thumbprint. If participants do not choose to take part we will record their reason, if it is given, to help understand why women might not want or be able to participate. Incentive and participant retention Participants in both groups will be offered a total of 600 Dalasi (about 12 USD) for their time, 200 Dalasi for each of the three data collection time points (baseline, post, follow-up). All participants will be reminded of the data collection and the group-singing sessions by phone call. Calls will be made by the RAs 3 days and 1 day before as well as on the day of these appointments. Where possible, a record will be kept of the reasons women give for failing to join the intervention or data collection session. Sample size As this is a feasibility study, it is not designed to assess the efficacy of the intervention, although pilot data on this will be collected. We will evaluate the feasibility of study design, data collection and whether the intervention is deliverable and acceptable to the participants. In the study, we will gather information to be used in the design of the future definitive study including an estimate of the standard deviation of potential primary outcomes to inform the sample size. We aim to collect data from a total of 120 pregnant women, 60 in the control condition and 60 in the intervention condition [27]. This number will be sufficient to provide estimates of binary feasibility outcomes with precision of at least ± 9 percentage points for the 95% confidence interval. Trial schedule This trial design involves a sequential crossover of clusters whereby each cluster (antenatal clinic) receives the control condition followed by the intervention condition. The four chosen clinics will be randomised to two sequences of a 12-week phase. A separate cohort of participants will be recruited to the control group and the intervention (singing) group. Each cohort will be recruited around 4–6 months into their pregnancy. The 12-week phase for both the control and intervention cohort will include data collection at week 1 ("baseline") and week 7 ("post") after either group-singing (intervention) or standard care (control) as well as at week 11 ("follow-up"), 4 weeks after the intervention finished. Contamination will be avoided by having data for the control group collected before the intervention groups start at each clinic. See Fig. 1 for a schematic for the study. Fig. 1 figure1 Schematic of the study Full size image Assessment and management of risk There are no high risks within our study compared to standard care. We have identified three areas of ethical concern and have outlined how each of these issues will be managed. 1. Mothers may experience an adverse effect such as a miscarriage, difficult birth, still birth, a sudden drastic change in physical or mental health, infant health problems or even a serious adverse effect such as death during the intervention. It is possible that a participant experiencing such an adverse event may attribute a causal link between the adverse event and their involvement in the study. We will mitigate this association being made, firstly, by clearly explaining the nature of the intervention and any possible risks to the women when they are recruited into the study. If, despite this, an association of this nature was still made, we would enlist the help of the Ministry of Health & Social Welfare (our partner on the project) to disseminate information to the women and the community concerning the incidence of such events occurring in the general population in an attempt to reassure those concerned that such adverse events should not be attributed to involvement in the study. 2. It is possible that some of the themes involved in questionnaires could lead to the women revealing episodes of self-harm. If this is the case, the woman will receive in the moment front-line counselling to talk through these issues with the RAs who are trained psychiatric nurses. Then, if needed, she will be referred on to the community mental health team (CMHT) for further management. If the CMHT deems it appropriate, they may then refer her on to the psychiatric team. 3. It is possible that some of the themes involved in questionnaires may also lead the women to reveal domestic abuse. If this is the case, the woman will receive in the moment front-line counselling to talk through these issues with the RAs. For emergencies and cases that require immediate intervention, the RAs will connect with the Gender-Based Violence focal person. For other cases, the RAs will refer the woman to the One Stop Center at Serekunda General Hospital or Edward Francis Small Teaching Hospital. 4. Women throughout the study will be monitored by the RAs, both trained psychiatric nurses. If the RAs feel that at any point a woman's score indicates a high level of symptoms and/or the women reveal that they are particularly struggling, the RAs will refer the woman on to the Community Mental Health Team (CMHT) for further management. If the CMHT deems it appropriate, they may then refer her on to the psychiatric team. Data management All consent forms will be stored in a master file, which will be kept in a locked drawer where only members of the research team have access. All case report forms will not be linked to names, just a participant number, and kept in a separate locked cabinet where only the research team has access. All data, including video and audio recordings, will be held on an encrypted hard drive only members of the research team can access. Data will be stored for 5 years after the study and will then be deleted or destroyed. Analysis All data will be entered into a database by an RA and verified by the second RA using double data entry to ensure data quality. As this is a feasibility study, we will examine missing data as an outcome. Descriptive statistics will be summarised to understand the demographic variables relating to the recruited population. Descriptive statistics and plots will be used to assess the distribution of the measurement tools, repeated at baseline and follow-up and by each arm. We will also examine the distributions of scores in the different language groups to see to what extent item scores and overall distributions differ or are similar. Correlations between our two measurement tools will be calculated. To determine if the intervention is deliverable, we will record the number of sessions that the Kanyeleng groups delivered, aiming to deliver two thirds of the sessions, and the duration of each session, aiming to last between 45 and 75 min. We will also perform a qualitative evaluation, using the video and audio recordings, to determine intervention fidelity at the four sites. Both RAs will watch the video and audio recordings of the first and fourth group-singing sessions at each clinic and complete a checklist to determine if all the necessary elements—as outlined in the training workshops—were included in the intervention. Reliability of the fidelity measure will be ascertained by measuring inter-rater consistency. We will also calculate the proportion of clinics approached that consented, aiming to reach over 50% recruitment rate, and record any scheduling problems in keeping with the stepped wedge timeline. Recruitment, adherence and completeness of data will be calculated for both groups. We aim to achieve a 60% recruitment rate and no more than 30% attrition in both arms. To determine if the intervention was culturally appropriate and well received by the community and health workers, we will collect qualitative data from post-intervention interviews and perform a thematic analysis. Discussion The absence of mental health services in The Gambia, coupled with the stigma associated with mental illness in general, results in high levels of unmet need for pregnant women dealing with mental distress in The Gambia. The development of a low-cost, low-resource intervention, which is rooted in local health and cultural practices, is of high priority, and the feasibility study we intend to carry out will inform a full-scale trial to investigate efficacy of such an approach. By employing local research assistants and creating a partnership with governmental agencies, such as The Ministry of Health & Social Welfare and The National Centre for Arts and Culture, this study brings the understanding of existing health services and access to a network of primary healthcare workers throughout the country as well as the diversity of local musical practices and the meanings attached to them. This valuable knowledge will help us cope with the practical and operational issues that may arise. We hope to disseminate our findings within various scientific publications, during field days in various areas in The Gambia, and during a meeting in London which will bring together the researchers as well community members, academic colleagues and health professionals interested in hearing about this work. Trial status This article describes the protocol for a Community Health Intervention through Musical Engagement (CHIME) for perinatal mental health in The Gambia (version 1.0, 11/11/18). The sponsor for this trial is Goldsmiths, University of London. The project is funded by the MRC and the AHRC. Ethical approval was obtained from the Goldsmiths University Ethics Committee, the Research and Publication Committee (RePubliC) from the University of The Gambia and the Australian National University ethics committee. Availability of data and materials All of the data will be held by the principal investigator, and the research team has exclusive use of the data until the publication of the results. Abbreviations AHRC: Arts and Humanities Research Council CMHT: Community mental health team EPDS: Edinburgh Postnatal Depression Scale LMICs: Low- and middle-income countries MRC: Medical Research Council PACTR: Pan African Clinical Trial Registry RAs: Research assistants SRQ-20: Self-Reporting Questionnaire References 1. Fisher J, de Mello MC, Patel V, Rahman A, Tran T, Holton S, et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries : a systematic review. Bull World Health Organ. 2011;(90):139–49 Available from: https://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862012000200014. [cited 2019 Jan 22]. 2. O'Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. 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Funding The funders (MRC and AHRC) and sponsor (Goldsmiths) have no roles or responsibilities in the design, conduct, data analysis and interpretation, manuscript writing and dissemination of results. Author information Author notes Katie Rose M. Sanfilippo and Bonnie McConnell are joint first authors. Affiliations Goldsmiths, University of London, London, UK Katie Rose M. Sanfilippo & Lauren Stewart The Australian National University, Canberra, Australia Bonnie McConnell Imperial College London, London, UK Victoria Cornelius & Vivette Glover The Ministry of Health and Social Welfare, Banjul, The Gambia Buba Darboe, Hajara B. Huma & Malick Gaye The National Centre for Arts and Culture, Banjul, The Gambia Hajara B. Huma, Malick Gaye & Hassoum Ceesay University of Cambridge, Cambridge, UK Paul Ramchandani & Ian Cross Contributions LS is the principal investigator and obtained grant funding and conceived of the study. KRMS wrote the first draft of this publication manuscript, helped with the ethics and grant application, the intervention design, and the data monitoring and data collection plan. BM helped with the ethics and grant applications, translations of questionnaires, administration of focus groups and design of the intervention. VC obtained study funding, designed the study and statistical analysis plan, contributed to writing the manuscript. BD helped with the grant and ethics application, translations of questionnaires, administration of focus groups and design of the intervention. HBH and MG helped with the translation of the questionnaires, administration of the focus groups and design of the intervention. HC helped with planning the logistics for running the study as well as with the translation of the questionnaires. IC, VG and PR all helped with the grant application and advised on research and intervention design. All authors reviewed and had input into the final submission. All authors read and approved the final manuscript. Corresponding author Correspondence to Katie Rose M. Sanfilippo. Ethics declarations Ethics approval and consent to participate Ethical approval was obtained from the Goldsmiths University Ethics Committee, the Research and Publication Committee (RePubliC) from the University of The Gambia and the Australian National University ethics committee. Members of the research team will carry out the consenting and conduct of this study orally. It will be emphasised that any participant is able to withdraw from the study at any point without any consequences. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary information Additional file 1. SPIRIT Checklist. Rights and permissions Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Reprints and Permissions About this article Verify currency and authenticity via CrossMark Cite this article Sanfilippo, K.R.M., McConnell, B., Cornelius, V. et al. A study protocol for testing the feasibility of a randomised stepped wedge cluster design to investigate a Community Health Intervention through Musical Engagement (CHIME) for perinatal mental health in The Gambia. Pilot Feasibility Stud 5, 124 (2019) doi:10.1186/s40814-019-0515-5 Download citation Received 22 February 2019 Accepted 15 October 2019 Published 07 November 2019 DOI https://doi.org/10.1186/s40814-019-0515-5 Share this article Anyone you share the following link with will be able to read this content: Get shareable link Keywords Perinatal mental health Feasibility trial The Gambia Music Singing group Kanyeleng Comments By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Please note that comments may be removed without notice if they are flagged by another user or do not comply with our community guidelines.
