Antenatal depressive symptoms in Kenyan women living with HIV: contributions of recent HIV diagnosis, stigma, and partner violence

The epidemiology of maternal mental health in Africa: a systematic review

BACKGROUND

Despite a growing body of evidence on maternal mental health in Africa, significant gaps remain in understanding its overall landscape, risk factors/determinants, immediate and long-term effects, accessibility to healthcare and services, and availability of practicable/effective interventions. This paper provides a thorough review of both peer-reviewed and grey literature and makes key recommendations and directions for future research and development.

METHODS

We systematically reviewed extant evidence using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Peer-reviewed studies published in English between 2010, and June 2024 were included based on a priori criteria. The National Institutes of Health (NIH) and Critical Appraisal Skill Program (CASP) quality assessment tools were used to critically appraise the reliability, validity and overall quality of included articles. A qualitative narrative synthesis was perfomed to summarize the findings effectively.

RESULTS

A total of 206 full-text articles evaluated for eligibility and inclusion in the systematic review, predominantly observational studies with a minority employing randomized controlled trial (RCT) designs, were included, with 70%, 22%, and 8% of the articles rated as good, fair, and poor quality, respectively. Women in Africa experience a wide range of common perinatal mental disorders, including major depressive disorders and psychosis, either discretely or comorbid. Socioeconomic disadvantages and other intertwined poverty-related factors at the individual, family, social, and environmental levels are implicated in maternal mental health disorders. Currently, there is insufficient evidence regarding the short- and long-term health, development, and social impacts of maternal mental health. Addtionally, there is limited knowledge about the availability and accessibility of mental healthcare, evidence-based context-specific interventions, and healthcare-seeking behaviors of women in Africa, as well as their access to and utilization of mental health services.

CONCLUSION

The evidence base on maternal mental health in Africa suffers from considerable variability, inconsistency, and equivocal findings resulting from heterogeneity across the studies. This restricts generalizability and the ability to draw valid conclusions. Published studies also likely underestimate the scale and health impacts of perinatal mental disorders. Evidence from these studies are rarely used to inform policies and programs. The maternal mental health ecosystem in Africa needs to be better understood. More rigorous study designs should be implemented to focus on evidence generation and the evaluation of interventions, alongside robust integration of mental health services within health systems. Policy initiatives aimed at reducing socioeconomic disparities in maternal, newborn, and child health, particularly concerning maternal mental health, must be supported by these studies.

ARTICLE HIGHLIGHTS

• Women across Africa suffer from various mental health problems, including major depressive disorders, anxiety, and psychosis, occurring separately or in combination. • The evidence base on maternal mental health in Africa displays significant variability, inconsistency, and ambiguous findings, largely attributed to study heterogeneity. • Factors at the individual, familial, societal, and environmental levels contribute to poverty-related issues that can lead to or worsen maternal mental health disorders. • Current evidence has not been synthesized to improve our understanding of the short- and long-term health impacts, developmental consequences, and social implications of maternal mental health conditions, as well as the healthcare-seeking behaviors and access to mental health services. • Insufficient policy prioritization and funding for maternal mental health in Africa hinder the development, evaluation, and sustainability of interventions. • There is an urgent need to integrate mental health services into primary healthcare, particularly in resource-limited settings across Africa. This integration should be guided by evidence from rigorous research that uses longitudinal designs. It is also essential to emphasize the importance of investing in digital and community-based approaches to improve the accessibility to mental health services.

Determination of depression prevalence in pregnant women living with HIV aged 18 years and older: A meta-analysis study

BackgroundPregnant women living with HIV are known to be at higher risk of depression than pregnant women without HIV. Accompanied by a systematic literature review, the aim of this study was to determine the global prevalence of depression in pregnant women living with HIV.MethodsPubMed, Scopus, Google Scholar and Web of Science databases were searched. The references of the included publications and a similar meta-analysis study were also reviewed. The 19 included studies were assessed for quality using standard forms. Pooled prevalence was calculated using a random effects model. Heterogeneity and publication bias were assessed using various methods. Subgroup analyses and meta-regression were also performed.ResultsOf the 19 studies included in the review, six of the studies were published between 2008 and 2014, and 13 were published between 2017 and 2023. 15 studies were conducted in African countries. According to study type, eight studies were cross-sectional and seven were cohort studies. The pooled prevalence of depression was calculated to be 45%. The prevalence in African countries was 37.7%. The studies were found to be statistically significantly heterogeneous. Tests and funnel plots showed no publication bias in this meta-analysis. The variables place, study type and scale made the model significant in the meta-regression.ConclusionIn this meta-analysis, 6379 women aged 18 years and older were examined and their depression levels were found to be high. Taking steps to struggle with HIV and depression in people living with HIV seems important.

The Childbirth Experience of Pregnant Women Living with HIV Virus

Objective: The aim of this study was to examine the childbirth satisfaction of pregnant women living with HIV virus (PWLWHIV) and its association with selected variables in order to improve it. Methods: A total of 82 PWLWHIV were interviewed at an Institute in Rio de Janeiro. Maternal satisfaction was measured using the Brazilian version of the Mackey Childbirth Satisfaction Rating Scale, which was translated to Brazilian Portuguese by Lopes, who validated the translated version. The Mackey scale is divided into six subscales: self-evaluation, partner, baby, midwives, doctors, and overall satisfaction. Results: The PWLWHIV experienced a good total childbirth satisfaction (score 133 out of 165) and good overall childbirth satisfaction (score 12 out of 15). The PWLWHIV also experienced a good self-satisfaction (score 37.3 out of 45), good satisfaction with partner (score 8.96 out of 10), good satisfaction with midwives (score 35.1 out of 45), and good satisfaction with doctors (score 31.2 out of 45). The PWLWHIV also experienced satisfaction with their babies (score 8.48 out of 10). Significant associations were found through univariable and multiple regression analysis, regarding complications with baby at birth (p < 0.001) on the total, overall, self, partner, midwife, and doctor subscales. Conclusions: PWLWHIV had a positive experience at childbirth in the public maternities units of Rio de Janeiro. Our findings indicate that complications regarding baby health at birth were the main factor associated with a negative experience.

Antenatal depression and its predictors among HIV positive women in Sub-Saharan Africa; a systematic review and meta-analysis

Background

Antenatal depression in Human Immunodeficiency Virus (HIV) positive pregnant women can have significant adverse effects on both the mother and newborns, yet it is often overlooked in pregnancy care in Sub-Saharan Africa (SSA). Despite this, there is limited data on the combined prevalence of antenatal depression and its predictors among HIV-positive women in the region.

Objective

To assess the pooled prevalence of antenatal depression and its associated factors among HIV-positive women in SSA.

Methods

All primary cross-sectional studies published before 1st January/2024, were included. We conducted searches in relevant databases; PubMed, HINARI, Web of Science, PsycINFO, Psychiatry Online, ScienceDirect, and Google Scholar. The Joanna Briggs Institute checklist was used to critically appraise the selected studies. To assess heterogeneity among the studies, we utilized the I2 test. Publication bias was evaluated using a funnel plot and Egger's test. The forest plot was used to present the combined proportion of antenatal depression and odds ratio, along with a 95% confidence interval.

Results

The pooled prevalence of antenatal depression among HIV-positive women in Sub-Saharan Africa was found to be 30.6% (95% CI, 19.8%-41.3%). Factors significantly associated with antenatal depression among HIV-positive women in SSA included being unmarried (AOR: 3.09, 95% CI: 1.57 - 6.07), having a previous history of depression (AOR: 2.97, 95% CI: 1.79 - 4.91), experiencing intimate partner violence (IPV) (AOR: 2.11, 95% CI: 1.44 - 3.09), and experiencing stigma (AOR: 1.36, 95% CI: 1.05 - 1.76).

Conclusion

High prevalence of antenatal depression among HIV-positive women in SSA underscores the need for prioritizing identification and management. Interventions addressing factors like IPV and stigma, along with training for healthcare providers in recognizing symptoms and providing support, are recommended.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024508236.

Evaluation of a two-way SMS messaging strategy to reduce neonatal mortality: rationale, design and methods of the Mobile WACh NEO randomised controlled trial in Kenya

INTRODUCTION

Globally, approximately half of the estimated 6.3 million under-5 deaths occur in the neonatal period (within the first 28 days of life). Kenya ranks among countries with the highest number of neonatal deaths, at 20 per 1000 live births. Improved identification and management of neonates with potentially life-threatening illness is critical to meet the WHO's target of ≤12 neonatal deaths per 1000 live births by 2035. We developed an interactive (two-way) short messaging service (SMS) communication intervention, Mobile Solutions for Neonatal Health (Mobile women's and children's health (WACh) NEO), focused on the perinatal period. Mobile WACh NEO sends automated tailored SMS messages to mothers during pregnancy and up to 6 weeks post partum. Messages employ the Information-Motivation-Behaviour Skills framework to promote (1) maternal implementation of essential newborn care (ENC, including early, exclusive breast feeding, cord care and thermal care), (2) maternal identification of neonatal danger signs and care-seeking, and (3) maternal social support and self-efficacy. Participants can also send SMS to the study nurse, enabling on-demand remote support.

METHODS AND ANALYSIS

We describe a two-arm unblinded randomised controlled trial of the Mobile WACh NEO intervention. We will enrol 5000 pregnant women in the third trimester of pregnancy at 4 facilities in Kenya and randomise them 1:1 to receive interactive SMS or no SMS (control), and conduct follow-up visits at 2 and 6 weeks post partum. Neonatal mortality will be compared between arms as the primary outcome. Secondary outcomes include care-seeking, practice of ENC and psychosocial health. Exploratory analysis will investigate associations between maternal mental health, practice of ENC, care-seeking and SMS engagement.

ETHICS AND DISSEMINATION

This study received ethical approval from the University of Washington (STUDY00006395), Women and Infants Hospital (1755292-1) and Kenyatta National Hospital/University of Nairobi (P310/04/2019). All participants will provide written informed consent. Findings will be published in peer-reviewed journals and international conferences.

TRIAL REGISTRATION NUMBER

NCT04598165.