Manuscript Title: Maternal Mental Health in Sub-Saharan Africa: A Systematic Review of Interventions for Common Perinatal Mental Health Disorders

Introduction Common Perinatal Mental Disorders affect women and children across the world. Rates are high in sub-Saharan Africa, however studies on interventions are limited. Highlighting existing and upcoming practice to support maternal mental health services is imperative. Method We conducted a systematic review, yielding a large array of papers covering 32 low- and lower-middle income countries across sub-Saharan Africa. No time limit was placed on publication and study protocols and results papers were included. Results Twelve articles from 8 different countries were included in our review; Gambia, Ghana, Kenya, Malawi, Nigeria, Tanzania, Uganda and Zimbabwe. Most interventions took a psychotherapeutic approach, two included a pharmaceutical component. Half the studies detailed adapted approaches to ensure cultural acceptance. Effectiveness was limited; 3 studies showed a significant impact, only one of which had a large effect size. Conclusion Evidence remains limited and efforts should be made to support the implementation and generation of evidence in a wide variety of countries and contexts. Task-shifting was a common approach, though services were delivered at health facility level rather than in communities. Scaling-up effective holistic approaches to maternal mental health and child wellbeing remains an area of need.