Measurement of maternal functioning during pregnancy and postpartum: findings from the cross-sectional WHO pilot study in Jamaica, Kenya, and Malawi

Family concerns and relationship problems in anxious pregnant women and their associations with postnatal functional disability in Pakistan

OBJECTIVE

Expanding on existing research suggesting that strategies to reduce prenatal anxiety can decrease functional disability (e.g., difficulties in performing everyday activities and social participation), we examined if this effect varied by type of anxiety-producing problem (i.e., having family concerns and relationship problems versus other problems) reported during pregnancy. Further, we explored if perceived social support mediated this relationship.

METHODS

We used longitudinal data on 310 anxious Pakistani women who received any psychosocial intervention sessions as part of a program that was based on Cognitive Behavioral Therapy. The Psychological Outcome Profiles (PSYCHLOPS) was used to assess whether women had 'family concerns and relationship problems' or 'other problems.' The WHO Disability Assessment Schedule 2.0 assessed functional disability at six-weeks after delivery. Lack of support was measured using a 12-item Multi-dimensional Scale of Perceived Social Support. We employed linear regression to examine associations between types of problems reported during pregnancy and postnatal functional disability. Causal mediation analysis was used to assess whether postnatal social support mediated this relationship.

RESULTS

Of anxious pregnant women, 34% reported family concerns or relationship problems as primary problems in pregnancy. They were more likely to report higher functional disability at six-weeks after delivery than women who reported other problems (adjusted B = 2.40, 95% CI: 0.83-3.97). Lack of overall social support (Estimateindirect = 0.69, 95% CI: 0.04-1.38) and lack of support from friends (Estimateindirect = 0.62, 95% CI: 0.01-1.29) significantly mediated the relationship.

CONCLUSIONS

Findings suggest that complementing pre- and post-natal care with support programs and services that address family concerns and relationship problems, as well as enhancing social support is important to functional disability.

Maternal performance after childbirth and its predictors: a cross sectional study

BACKGROUND AND OBJECTIVES

Birthing parents need to use specialized skills as the first caregiver of the newborn. Several factors may affect performance. Yet there is a paucity of research in this area, and evidence remains inconsistent. Consequently, this study aimed to determine maternal performance after childbirth and its predictors.

METHODS

This cross-sectional study was conducted with those (n = 450) who had given birth (< two months) and been referred for the vaccination of their newborn. The multi-stage sampling method was carried out from April 2022 to February 2023. Participants who met the inclusion criteria completed a demographic and obstetric information questionnaire, along with the childbirth experience 2 (CEQ2), Barkin maternal performance and maternal self-efficacy scales. Multiple linear regression was used to investigate the predictive effect of the independent variables of childbirth experience, maternal self-efficacy, demographic and obstetric variables on the dependent variable of maternal performance.

RESULTS

The mean age of the participants was 26.78 and the mean total score of maternal performance was 91.04 (0-120). The highest and lowest scores related to the 'maternal competence' and the 'maternal needs' domains, with mean score calculated at 77.51 and 72.81 respectively. 'Childbirth experience' and 'maternal self-efficacy' domains had a statistically significant relationship with maternal performance (P < 0.05). Among the predictive factors of maternal performance, the results of our linear regression demonstrated the variables of birth experience (B = 0.63), maternal self-efficacy (B = 1.53), spouse's employment status (B = 5.78 for worker level, B = 3.99 for employee level), the number of previous childbirth experiences (B = -8.46), frequency of receiving antenatal care (B = -6.68), length of stay in the birth suite (B = -2.22) and length of stay in the hospital (B = 2.84) remained in the model. 53.2% of changes in maternal performance can be explained by these independent variables.

CONCLUSION

The promotion of evidence-based, person-centered, and respectful perinatal care during pregnancy and childbirth are of paramount importance. Strategies to improve the experience of childbirth and self-efficacy are especially required to improve maternal performance in the postpartum period. Prenatal care aimed at improving maternal function after childbirth will be important in achieving this overall.

Extreme heat, pregnancy and women's well-being in Burkina Faso: an ethnographical study

Climate change is an increasing threat to the health of populations in Africa, with a shift in seasonal temperatures towards more extreme heat exposures. In Burkina Faso, like other countries in the Sahel, many women have little protection against exposure to high temperatures, either outside or inside the home or place of work. This paper investigates how women perceive the impacts of heat on their physical and mental health, in addition to their social relationships and economic activities. Qualitative methods (in-depth interviews and focus group discussions) were conducted with women, community representatives and healthcare professionals in two regions in Burkina Faso. A thematic analysis was used to explore the realities of participants' experiences and contextual perspectives in relation to heat. Our research shows extreme temperatures have a multifaceted impact on pregnant women, mothers and newborns. Extreme heat affects women's functionality and well-being. Heat undermines a woman's ability to care for themselves and their child and interferes negatively with breast feeding. Heat negatively affects their ability to work and to maintain harmonious relationships with their partners and families. Cultural practices such as a taboo on taking the baby outside before the 40th day may exacerbate some of the negative consequences of heat. Most women do not recognise heat stress symptoms and lack awareness of heat risks to health. There is a need to develop public health messages to reduce the impacts of heat on health in Burkina Faso. Programmes and policies are needed to strengthen the ability of health professionals to communicate with women about best practices in heat risk management.

Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda

INTRODUCTION

Women who deliver via cesarean section (c-section) experience short- and long-term disability that may affect their physical health and their ability to function normally. While clinical complications are assessed, postpartum functional outcomes are not well understood from a patient's perspective or well-characterized by previous studies. In Rwanda, 11% of rural women deliver via c-section. This study explores the functional recovery of rural Rwandan women after c-section and assesses factors that predict poor functionality at postoperative day (POD) 30.

METHODS

Data were collected prospectively on POD 3, 11, and 30 from women delivering at Kirehe District Hospital between October 2019 and March 2020. Functionality was measured by self-reported overall health, energy level, mobility, self-care ability, and ability to perform usual activities; and each domain was rated on a 4-point likert scale, lower scores reflecting higher level of difficulties. Using the four functionality domains, we computed composite mean scores with a maximum score of 4.0 and we defined poor functionality as composite score of ≤ 2.0. We assessed functionality with descriptive statistics and logistic regression.

RESULTS

Of 617 patients, 54.0%, 25.9%, and 26.8% reported poor functional status at POD3, POD11, and POD30, respectively. At POD30, the most self-reported poor functionality dimensions were poor or very poor overall health (48.1%), and inability to perform usual activities (15.6%). In the adjusted model, women whose surgery lasted 30-45 min had higher odds of poor functionality (aOR = 1.85, p = 0.01), as did women who experienced intraoperative complications (aOR = 4.12, 95% CI (1.09, 25.57), p = 0.037). High income patients had incrementally lower significant odds of poor physical functionality (aOR = 0.62 for every US$1 increase in monthly income, 95% CI (0.40, 0.96) p = 0.04).

CONCLUSION

We found a high proportion of poor physical functionality 30 days post-c-section in this Rwandan cohort. Surgery lasting > 30 min and intra-operative complications were associated with poor functionality, whereas a reported higher income status was associated with lower odds of poor functionality. Functional status assessments, monitoring and support should be included in post-partum care for women who delivered via c-section. Effective risk mitigating intervention should be implemented to recover functionality after c-section, particularly among low-income women and those undergoing longer surgical procedures or those with intraoperative complications.

Prevalence and correlates of internalized stigma among adults with HIV and major depressive disorder in rural Malawi

Internalized stigma is common among individuals with sexually transmitted infections such as HIV and among those with mental health conditions such as major depressive disorder (MDD). As part of a cluster randomized trial, we investigated the prevalence and correlates of internalized stigma among adults living with comorbid HIV and MDD in rural Malawi (n = 339). We found heightened stigma toward HIV and mental illness among those in the cohort: more than half of respondents (54%) endorsed negative perceptions associated with each health condition. Internalized HIV-related stigma was higher among those with no education (p = 0.04), younger adults (p = 0.03), and those with less social support (p = 0.001). Mental illness-related stigma was elevated among those with no source of income (p = 0.001), and it was also strongly associated with HIV-related stigma (p < 0.001). Our findings highlight potential avenues for reducing internalized stigma associated with high-prevalence health conditions in Malawi.Trial registration: ClinicalTrials.gov identifier: NCT04777006.

Impacts of childbirth on anxiety, disability, and depression: Results from a Brazilian cohort

Conditions such as violence, drug abuse, sexual satisfaction, anxiety, depression, and disability interfere with a healthy pregnancy and can also account for maternal morbidity. The instrument WOICE was built by WHO to measure it. We applied WOICE in a prospective cohort of 125 pregnant women, using a before-after approach, during the third trimester of pregnancy, and after 42 until 90 days of childbirth. 60% had anxiety during pregnancy, decreasing to 48.8% after delivery (p = 0.07), and depression scores decreased from 7.56 to 5.80 (p = 0.014). Disability affected 62.4% and 56, respectively. 9.6% used drugs during pregnancy, reducing to 4.0% after delivery (RR 0.69, IC 0.49 - 0.69).

A structural equation modelling of the direct and indirect factors associated with functional status over time as measured by WHODAS-32 items among postpartum women in Northwest Ethiopia

INTRODUCTION

Full functional status recovery which is a multidimensional concept, that includes personal care, infant and family care, social and occupational activities and adjusting to the role of motherhood may require several months to achieve. However, most study designs on postpartum maternal functional status were cross-sectional, providing limited insights into functional status patterns over time and the mediating relationships among variables associated with it during the postpartum period.

OBJECTIVE

To investigate the patterns of functional status over time and the mediating relationships among variables associated with functional status after childbirth.

METHODS

From October 2020 to March 2021, 775 women in Northwest Ethiopia participated in a community-based follow-up study that was linked to a health institution. Functional status was measured by the Amharic version of WHODAS 2.0 instrument. Structural equation modelling was used to determine the direct and indirect effects of predictor variables on individual domains of functional status as measured by WHODAS 2.0 instrument.

RESULTS

Higher fear of childbirth score, anxiety and PTSD score had a direct deleterious effect (increased risk of functional disability) on the overall functional status and six domains of WHODAS 2.0 (cognition, mobility, self-care, getting along with people, household life activities and community participation) at the first, second and third follow up periods. Higher social support had a direct protective effect (decreased risk of functional disability) on all domains of WHODAS 2.0 and the overall functional status at the three follow up periods. Higher social support had also an indirect protective effect through fear of birth on the six domains of WHODAS 2.0 and the overall functional status throughout the follow up period. Higher PTSD symptom score had also an indirect deleterious effect (increased risk of functional disability) through fear of birth on the overall functional status and six domains of WHODAS 2.0 (higher disability) throughout the follow up period. Complications of delivery management had a direct deleterious effect (increased disability score) on the domains of getting along with people, household life activities, mobility, self-care and community participation and on the overall functional status disability score.

CONCLUSION

Maternal functioning in the postpartum period is initially impaired, but improves over time. Despite improvement, maternal morbidities are correlated with worse functioning scores compared to women without these morbidities. Interventions should target on the mediating role of fear of child birth, life threatening event of health risk and PTSD with the deleterious effects of complications of delivery management, poor social support, vaginal mode of delivery, anxiety, poor physical and mental quality of life on functional status of postpartum women.

Longitudinal functional status trajectories and its predictors among postpartum women with and without maternal morbidities in Northwest Ethiopia: a group based multi-trajectory modelling

INTRODUCTION

Unlike physiological recovery, return to full functional status following childbirth takes longer than 6 weeks (42 days) of the traditionally defined postnatal period, and women with maternal morbidity usually require a longer period to recover. However, the extent to which this morbidity collectively impacts on women's functional status is not well investigated in Ethiopia. We aim to determine the distinct trajectories and predictors of functional status among postpartum women in Northwest Ethiopia.

METHODS

Health facility linked community-based follow-up study was conducted in Northwest Ethiopia from October 2020-March 2021. A sample of 779 delivering women was recruited after childbirth and before discharge using the criteria published by the WHO Maternal Morbidity Working Group. Functional status was measured by the Amharic version of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) instrument. The Stata Traj package was used to determine trajectories of functional status using group-based multi-trajectory modelling. The multinomial logistic regression model was used to identify predictors of trajectory group membership.

RESULTS

A total of 775 women participated at the first, second and third follow-up of the study (6th week, 12th week and 18th week of postpartum period). Three distinct functional status trajectory groups with different longitudinal patterns were identified across the six domains of WHODAS 2.0. Direct and indirect maternal morbidities, lower educational status, poor social support, vaginal delivery, stress, anxiety, posttraumatic stress disorder and fear of childbirth were found to be predictors of poor functioning trajectories.

CONCLUSION

Early diagnosis and treatment of maternal morbidities and mental health problems, developing encouraging strategies for social support and providing health education or counselling for women with less or no education are essential to improve functioning trajectories of postpartum women.