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Jensen CL, Sanga E, Kitt H, PrayGod G, Kunzi H, Setebe T, Filteau S, Webster J, Gladstone M, Olsen MF. Developing a context-relevant psychosocial stimulation intervention to promote cognitive development of children with severe acute malnutrition in Mwanza, Tanzania. PLoS One 2024; 19:e0285240. [PMID: 38722956 PMCID: PMC11081340 DOI: 10.1371/journal.pone.0285240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/15/2024] [Indexed: 05/13/2024] Open
Abstract
More than 250 million children will not meet their developmental potential due to poverty and malnutrition. Psychosocial stimulation has shown promising effects for improving development in children exposed to severe acute malnutrition (SAM) but programs are rarely implemented. In this study, we used qualitative methods to inform the development of a psychosocial stimulation programme to be integrated with SAM treatment in Mwanza, Tanzania. We conducted in-depth interviews with seven caregivers of children recently treated for SAM and nine professionals in early child development. We used thematic content analysis and group feedback sessions and organised our results within the Nurturing Care Framework. Common barriers to stimulate child development included financial and food insecurity, competing time demands, low awareness about importance of responsive caregiving and stimulating environment, poor father involvement, and gender inequality. Caregivers and professionals suggested that community-based support after SAM treatment and counselling on psychosocial stimulation would be helpful, e.g., how to create homemade toys and stimulate through involvement in everyday chores. Based on the findings of this study we developed a context-relevant psychosocial stimulation programme. Some issues identified were structural highlighting the need for programmes to be linked with broader supportive initiatives.
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Affiliation(s)
- Cecilie L. Jensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Erica Sanga
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Heather Kitt
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - George PrayGod
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Happiness Kunzi
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Theresia Setebe
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jayne Webster
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Melissa Gladstone
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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Girma B, Bimer K, Kassaw C, Mengistu N, Zewdie A, Sewalem J, Madoro D. Common mental disorders and associated factors among mothers of children attending severe acute malnutrition treatment in Gedio Zone, Southern Ethiopia, 2022: a cross-sectional study. BMC Psychiatry 2024; 24:276. [PMID: 38609954 PMCID: PMC11010270 DOI: 10.1186/s12888-024-05741-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Common mental disorders describe the physical, mental, and social disturbances that are more prevalent in low and middle-income countries. Mothers are among the more vulnerable groups especially mothers having children with under-nutrition. However, there are limited studies about the magnitude of common mental disorders among mothers of undernourished children in Ethiopia. Therefore, we aimed to assess the magnitude of common mental disorders and associated factors among mothers of children attending severe acute malnutrition treatment in Gedio Zone, Southern Ethiopia. METHODS A cross-sectional study was employed on 405 systematically selected participants. The outcome variable was assessed by a self-reporting questionnaire (SRQ-20) which was applicable and validated in Ethiopia. Data were entered and analyzed by EPi data version 5 software and SPSS version 25 respectively. Model fitness was checked by Hosmer Lemeshow's test. Logistic regression was employed to identify significant determinants. A p-value < 0.05 was used to declare association and expressed by odds ratio with a 95% CI. RESULT In this study, the magnitude of common mental disorders was 33.16% (95% CI [28.5-38])). In multivariable analysis, six factors poor social support [AOR: 14.0, 95% CI (5.45, 35.9)], educational status [AOR: 1.95, 95% CI (1.07. 3.55)], cigarette smoking [AOR: 10.9, 95% CI (1.78, 67.01)], mother of a child with another chronic disease [AOR: 3.19, 95% CI (1.13, 8.99)], sexual violence [AOR: 4.14, 95% CI (1.38, 12.4)] and mothers with chronic disease [AOR: 3.44, 95% CI (1.72, 6.86)] were significantly associated with common mental disorders. CONCLUSION The magnitude of common mental disorders was high. Six factors were significantly associated with common mental disorders; social support, sexual violence, maternal chronic illness, educational status, smoking, and mother of child with other chronic disease. Community awareness regarding the effect of violence, substance use, and social support on mental health should be created by the local stakeholders.
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Affiliation(s)
- Bekahegn Girma
- Department of Nursing, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia.
| | - Kirubel Bimer
- Department of Nursing, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Chalachew Kassaw
- Department of Psychiatry, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Nebiyu Mengistu
- Department of Psychiatry, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Ashenafi Zewdie
- Department of Nursing, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Jerusalem Sewalem
- Department of Psychiatry, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Derebe Madoro
- Department of Psychiatry, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
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Vray M, Tondeur L, Hedible BG, Randremanana RV, Manirakiza A, Lazoumar RH, Platen CV, Vargas A, Briend A, Jambou R. Three-arm clinical trial of improved flour targeting intestinal microbiota (MALINEA). MATERNAL & CHILD NUTRITION 2024:e13649. [PMID: 38599819 DOI: 10.1111/mcn.13649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024]
Abstract
The main objective of this project was to compare in the field conditions two strategies of re-nutrition of children with moderate acute malnutrition (MAM) aged from 6 to 24 months, targeting the microbiota in comparison with a standard regimen. A three-arm, open-label, pragmatic randomised trial was conducted in four countries (Niger, CAR, Senegal and Madagascar). Children received for 12 weeks either fortified blended flour (FBF control) = arm 1, or FBF + azithromycin (oral suspension of 20 mg/kg/day daily given with a syringe) for the first 3 days at inclusion = arm 2 or mix FBF with inulin/fructo-oligosaccharides (6 g/day if age ≥12 months and 4 g if age <12 months) = arm 3. For each arm, children aged from 6 to 11 months received 100 g x 2 per day of flours and those aged from 12 to 24 months received 100 g × 3 per day of FBF. The primary endpoint was nutritional recovery, defined by reaching a weight-for-height z-score (WHZ) ≥ -1.5 within 12 weeks. Overall, 881 children were randomised (297, 290 and 294 in arm 1, arm 2 and arm 3, respectively). Three hundred and forty-four children were males (39%) and median/mean age were 14.6/14.4 months (SD = 4.9, IQR = 10.5-18.4). At inclusion, the three arms were comparable for all criteria, but differences were observed between countries. Overall, 44% (390/881) of the children recovered at week 12 from MAM, with no significant difference between the three arms (41.4%, 45.5% and 45.9%, in arm 1, arm 2 and arm 3, respectively, p = 0.47). This study did not support the true advantages of adding a prebiotic or antibiotic to flour. When using a threshold of WHZ ≥ -2 as an exploratory endpoint, significant differences were observed between the three arms, with higher success rates in arms with antibiotics or prebiotics compared to the control arm (66.9%, 66.0% and 55.2%, respectively, p = 0.005).
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Affiliation(s)
- Muriel Vray
- Emerging Diseases Epidemiology Unit, Institut de Pasteur, Université Paris-Cité, Paris, France
| | - Laura Tondeur
- Emerging Diseases Epidemiology Unit, Institut de Pasteur, Université Paris-Cité, Paris, France
| | - Boris G Hedible
- CERPOP UMR1295 Inserm, University of Toulouse, Toulouse, France
| | | | - Alexandre Manirakiza
- Epidemiology and Clinical Research Unit, Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Ramatoulaye Hamidou Lazoumar
- Unit of Epidemiology-Health-Environment-Climate, Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
| | - Cassandre Van Platen
- Center for Translational Science, Clinical Core, Institut Pasteur, Paris, France
| | - Antonio Vargas
- Nutrition and Health Unit, Action Against Hunger, Madrid, Spain
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Ronan Jambou
- Direction Scientifique, Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
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Mutiso VN, Musyimi CW, Gitonga I, Tele A, Ndetei DM. Depression and Intimate Partner Violence (IPV) in mothers 6 weeks to 12 months post-delivery in a rural setting in Kenya. Transcult Psychiatry 2024:13634615231187259. [PMID: 38500372 DOI: 10.1177/13634615231187259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Using a cohort of 544 postpartum mothers, 6 weeks to 12 months post-delivery in the largely rural Makueni County in Kenya, we aimed to determine: (1) the prevalence of postpartum depression (PPD) and the prevalence of each of the four domains of intimate partner violence (IPV), that is physical violence, sexual violence, emotional violence, and controlling behavior; (2) the co-occurrence of PPD and IPV; (3) risk factors and associations between sociodemographic variables and IPV, PPD and IPV and PPD co-occurring. We concurrently administered a researcher-designed sociodemographic ad hoc questionnaire, the WHO Intimate Partner Violence questionnaire and the Mini-International Neuropsychiatric Interview for adults (MINI Plus) for DSM-IV/ICD10 depression. The prevalence of PPD was 14.5%; Emotional violence 80.3%; Controlling behavior 74.4% (a form of emotional violence); Physical violence 40.3%; Sexual violence 28.9%. We found the following overlaps: 39% of participants reported both physical and emotional violence; 39% had both sexual and emotional violence; 15% experienced physical and sexual violence; and 15% of participants reported physical, sexual, and emotional violence. Postpartum depression was associated with physical violence during pregnancy, self-employed status, history of mood disorders and medical problems in the child. Further, we report associations between various types of IPV and history of depression, physical violence during pregnancy, low education level, marital status, and current depression diagnosis. IPV and PPD were highly prevalent in our population of postpartum mothers. Various types of IPV were significantly associated with various sociodemographic indicators while only sexual violence was significantly associated with PPD. Based on our results, we provide suggestions for potential interventions in the Kenyan setting.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Ritter C, Abdullahi SU, Gambo S, Murtala HA, Kabir H, Shamsu KA, Gwarzo G, Banaei Y, Acra SA, Stallings VA, Rodeghier M, DeBaun MR, Klein LJ. Impact of maternal depression on malnutrition treatment outcomes in older children with sickle cell anemia. BMC Nutr 2024; 10:18. [PMID: 38268013 PMCID: PMC10809526 DOI: 10.1186/s40795-024-00826-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Malnutrition and sickle cell anemia (SCA) result in high childhood mortality rates. Although maternal depression is an established risk factor for malnutrition in younger children, little is known about its impact on treatment response in children with malnutrition. We aimed to determine the relationship, if any, between maternal depression scores and malnutrition treatment outcomes in older children with SCA. METHODS We conducted a planned ancillary study to our randomized controlled feasibility trial for managing severe acute malnutrition in children aged 5-12 with SCA in northern Nigeria (NCT03634488). Mothers of participants completed a depression screen using the Patient Health Questionnaire (PHQ-9).We used a multivariable linear regression model to describe the relationship between the baseline maternal PHQ-9 score and the trial participant's final body mass index (BMI) z-score. RESULTS Out of 108 mother-child dyads, 101 with maternal baseline PHQ-9 scores were eligible for inclusion in this analysis. At baseline, 25.7% of mothers (26 of 101) screened positive for at least mild depression (PHQ-9 score of 5 or above). The baseline maternal PHQ-9 score was negatively associated with the child's BMI z-score after 12 weeks of malnutrition treatment (β=-0.045, p = 0.041). CONCLUSIONS Maternal depressive symptoms has an impact on malnutrition treatment outcomes. Treatment of malnutrition in older children with sickle cell anemia should include screening for maternal depression and, if indicated, appropriate maternal referral for depression evaluation and treatment. TRIAL REGISTRATION The trial was registered at clinicaltrials.gov (#NCT03634488) on January 30, 2018, https://clinicaltrials.gov/study/NCT03634488 .
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Affiliation(s)
| | - Shehu U Abdullahi
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Safiya Gambo
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Hassan Adam Murtala
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Halima Kabir
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Khadija A Shamsu
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Garba Gwarzo
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Sari A Acra
- Department of Pediatrics, D. Brent Polk Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Virginia A Stallings
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | | | - Michael R DeBaun
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Institute for Global Health, Nashville, TN, USA
| | - Lauren J Klein
- Department of Pediatrics, D. Brent Polk Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
- Vanderbilt Institute for Global Health, Nashville, TN, USA.
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Folayan MO, Oginni AB, El Tantawi M, Adeniyi A, Alade M, Finlayson TL. Association between maternal decision-making and mental health and the nutritional status of children under 6 years of age in sub-urban Nigeria. BMC Public Health 2023; 23:1159. [PMID: 37322502 PMCID: PMC10268393 DOI: 10.1186/s12889-023-16055-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 06/05/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND We assessed the association between decision-making power and mental health status of mothers and the nutritional status of their children less than 6 years old in Ile-Ife, Nigeria. METHODS This was a secondary data analysis of 1549 mother-child dyads collected through a household survey conducted between December 2019 and January 2020. The independent variables were maternal decision-making and mental health status (general anxiety, depressive symptoms, parental stress). The dependent variable was the child's nutritional status (thinness, stunting, underweight and overweight). Confounders were maternal income, age, and education status, and the child's age and sex. The associations between the dependent and independent variables were determined using multivariable binary logistic regression analysis after adjusting for confounders. The adjusted odds ratios (AORs) were determined. RESULTS Children of mothers with mild general anxiety had lower odds of stunting than children of mothers with normal anxiety (AOR: 0.72; p = 0.034). Mothers who did not make decisions on children's access to health care (AOR: 0.65; p < 0.001) had children with lower odds of being thin than those whose mothers made decisions on their access to health care. Children of mothers with clinically significant parenting stress levels (AOR: 0.75; p = 0.033), severe depressive symptoms (AOR: 0.70; p = 0.041) and who were not decision makers on the access of their children to health care (AOR: 0.79; p = 0.035) had lower odds of underweight. CONCLUSIONS Maternal decision-making status and mental health status were associated with the nutritional status of children less than 6 years in a sub-urban community in Nigeria. Further studies are needed to understand how maternal mental health is associated with the nutritional status of Nigerian preschool children.
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Affiliation(s)
| | | | - Maha El Tantawi
- Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Abiola Adeniyi
- Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
| | - Michael Alade
- Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Osun State, Nigeria
| | - Tracy L Finlayson
- School of Public Health, San Diego State University, San Diego, CA, USA
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Elshafei A, Jemutai J, Tickell KD, Sukhtankar P, Bhat A, Molyneux S, Berkley JA, Walson JL, Collins PY. Depressive symptoms among mothers with hospitalized children in South Asia and sub-Saharan Africa. J Affect Disord 2023; 323:368-377. [PMID: 36436766 PMCID: PMC9843468 DOI: 10.1016/j.jad.2022.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/07/2022] [Accepted: 10/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Poor maternal mental health during childhood hospitalization is associated with post-discharge child mortality. We aimed to establish if maternal PHQ-9 scores during hospitalization are associated with acute stressors or longer trends in mental health status. METHOD Mothers of children admitted to nine hospitals in six countries completed a PHQ-9 assessment during hospitalization and 45-days post-discharge. Community participants were recruited from homes near the hospitalized children. The prevalence and correlates of high PHQ-9 scores among hospitalized and community mothers were compared. OUTCOMES Among 2762 mothers of hospitalized children, 514 (19 %) had PHQ-9 scores ≥10, significantly more than the 116 (10 %, p < 0·001) of 1159 community participants. Recruitment site and food insecurity were PHQ-9 correlates in both groups. Correlates of higher mean PHQ-9 scores among the hospitalized cohort included maternal illness (mean difference [MD]: 1·27, 95%CI: 0·77, 1·77), pregnancy (MD: 0·77, 95%CI: 0·27, 1·28), child HIV-infection (MD: 2·51. 95%CI: 1·55, 3·52), and lower child weight-for-height (MD: 0·21, 95%CI: 0·32, 0·11). Marriage (MD -0·92, 95%CI: -1·36, -0·48) and a positive malaria test (MD: -0·63, 95%CI: -1·15, -0·10) were associated with lower PHQ-9 scores among mothers of hospitalized children. Among mothers with PHQ-9 ≥10 during admission, 410 had repeat assessments 45-days after their child's discharge, and 108 (26 %) continued to meet the high PHQ-9 criterion. INTERPRETATION Among mothers of hospitalized children, there are subgroups with transient and persistent depressive symptoms. Interventions tailored to address acute stressors may improve post-discharge pediatric and maternal health outcomes. FUNDING Bill & Melinda Gates Foundation OPP1131320.
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Affiliation(s)
- Ahmed Elshafei
- Department of Psychiatry, Larkin Community Hospital, United States of America; Department of Global Health, University of Washington, United States of America.
| | - Julie Jemutai
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kenya
| | - Kirkby D Tickell
- Department of Global Health, University of Washington, United States of America
| | - Priya Sukhtankar
- Nuffield Department of Medicine, University of Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America
| | - Sassy Molyneux
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kenya; Nuffield Department of Medicine, University of Oxford, United Kingdom of Great Britain and Northern Ireland
| | - James A Berkley
- Nuffield Department of Medicine, University of Oxford, United Kingdom of Great Britain and Northern Ireland; Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kenya
| | - Judd L Walson
- Department of Global Health, University of Washington, United States of America
| | - Pamela Y Collins
- Department of Global Health, University of Washington, United States of America; Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America
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Gribbin C, Achieng F, K’Oloo A, Barsosio HC, Kwobah E, Kariuki S, Nabwera HM. Exploring the influence of postnatal depression on neonatal care practices among mothers in Western Kenya: A qualitative study. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231189547. [PMID: 37551659 PMCID: PMC10411280 DOI: 10.1177/17455057231189547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/23/2023] [Accepted: 07/05/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Postnatal depression (PND) is associated with adverse infant neurodevelopmental outcomes. Evidence is limited on how PND influences neonatal (<28 days old) outcomes in low- and middle-income countries, such as Kenya, which bear the global burden of neonatal morbidity and mortality. OBJECTIVES To explore how PND influences neonatal feeding and care practices among women in the early postnatal period in rural Western Kenya. DESIGN A cross-sectional study. METHODS Semi-structured interviews were conducted at 2-weeks postpartum among mothers of newborn infants identified <72 h old from the postnatal wards and clinics across five health facilities in Kisumu County of Western Kenya. They were all screened for features suggestive of postnatal depression using the Edinburgh Postnatal Depression Scale. RESULTS Twenty-four mothers were interviewed, 13 of whom had features suggestive of PND. All mothers experienced health or socio-economic adversities in the perinatal period, including traumatic deliveries, financial constraints, and challenging relationships with partners/other family members. Feeding difficulties due to perceived insufficient breastmilk were a particular challenge for mothers with features of PND, who were more likely to introduce complementary feeds. Maternal health-seeking decisions were influenced by high financial cost, long waiting times and poor interactions with health care providers that induced stress and fear among mothers. Maternal caregiving capacity was influenced by her ability to juggle other household duties, which was difficult for mothers with features suggestive of PND. Support from friends and relatives positively impacted maternal mood and caregiving ability. CONCLUSION Mothers experienced many stress-inducing events in the perinatal period which potentially exacerbated features of PND in the immediate postnatal period. Women with features of PND were particularly vulnerable to these stressors that influenced infant caregiving practices. Addressing the socio-economic challenges and health system gaps that include scale up of compassionate and respectful care for women during pregnancy and childbirth, as well as early screening and intervention of PND, through enhanced referral pathways between health facilities and community support structures, could mitigate against the impact of PND on neonatal caregiving.
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Affiliation(s)
- Catherine Gribbin
- Liverpool School of Tropical Medicine, Liverpool, UK
- King’s Mill Hospital, Sutton-in-Ashfield, UK
| | - Florence Achieng
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Alloys K’Oloo
- Liverpool School of Tropical Medicine, Liverpool, UK
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Hellen C Barsosio
- Liverpool School of Tropical Medicine, Liverpool, UK
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Edith Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
- Department of Psychiatry, Moi University, Eldoret, Kenya
| | - Simon Kariuki
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Helen M Nabwera
- Liverpool School of Tropical Medicine, Liverpool, UK
- The Aga Khan University, Nairobi, Kenya
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Kariuki EW, Kuria MW, Were FN, Ndetei DM. Predictors of postnatal depression in the slums Nairobi, Kenya: a cross-sectional study. BMC Psychiatry 2022; 22:242. [PMID: 35382788 PMCID: PMC8981836 DOI: 10.1186/s12888-022-03885-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postnatal depression (PND) is a universal mental health problem that prevents mothers' optimal existence and mothering. Although research has shown high PND prevalence rates in Africa, including Kenya, little research has been conducted to determine the contributing factors, especially in low-resource communities. OBJECTIVE This study aimed to investigate the PND risk factors among mothers attending Lang'ata and Riruta Maternal and Child Health Clinics (MCH) in the slums, Nairobi. METHODS This study was cross-sectional. It is part of a large study that investigated the effectiveness of a brief psychoeducational intervention on PND. Postnatal mothers (567) of 6-10 weeks postanatal formed the study population. Depression rate was measured using the original 1961 Beck's Depression Inventory (BDI). In addition, a sociodemographic questionnaire (SDQ) was used to collect hypothesized risk variables. Multivariable logistic regression analysis was used to explore predictors of PND. RESULTS The overall prevalence of PND in the sample of women was 27.1%. Women aged 18-24 (β = 2.04 95% C.I.[0.02; 4.05], p = 0.047), dissatisfied with body image (β = 4.33 95% C.I.[2.26; 6.41], p < 0.001), had an unplanned pregnancy (β = 2.31 95% C.I.[0.81; 3.80], p = 0.003 and felt fatigued (β = - 1.85 95% C.I.[- 3.50; 0.20], p = 0.028) had higher odds of developing PND. Participants who had no stressful life events had significantly lower depression scores as compared to those who had stressful life events (β = - 1.71 95% C.I.[- 3.30; - 0.11], p = 0.036) when depression was treated as a continuous outcome. Sensitivity analysis showed that mothers who had secondary and tertiary level of education had 51 and 73% had lower likelihood of having depression as compared to those with a primary level of education (A.O.R = 0.49 95% C.I.[0.31-0.78], p = 0.002) and (A.O.R = 0.27 95% C.I.[0.09-0.75], p = 0.013) respectively. CONCLUSION This study reveals key predictors/risk factors for PND in low-income settings building upon the scanty data. Identifying risk factors for PND may help in devising focused preventive and treatment strategies.
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Affiliation(s)
- Esther W. Kariuki
- grid.10604.330000 0001 2019 0495Department of Psychiatry, School of Medicine, The University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
| | - Mary W. Kuria
- grid.10604.330000 0001 2019 0495Department of Psychiatry, School of Medicine, The University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
| | - Fredrick N. Were
- grid.10604.330000 0001 2019 0495Department of Psychiatry, School of Medicine, The University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
| | - David M. Ndetei
- grid.10604.330000 0001 2019 0495Department of Psychiatry, School of Medicine, The University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
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10
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Jiang Q, Cohen N, Ohtori M, Gao J, Wang Q, Zhang E, Zhu S, Johnstone H, Guo Y, Dill SE, Zhou H, Rozelle S. Postnatal Mental Health, Hand Washing Practices, and Infant Illness in Rural China. Front Glob Womens Health 2021; 2:735264. [PMID: 34870276 PMCID: PMC8636699 DOI: 10.3389/fgwh.2021.735264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Maternal mental health problems play an important role in infant well-being. Although western countries have extensively studied the associations between maternal mental disorders, hygiene practices and infant health, little is known in developing settings. This study investigates the correlations between postnatal mental health problems, hand washing practices and infant illness in rural western China. Methods: A total of 720 mothers of infants aged 0–6 months from four poor counties in rural western China were included in the survey. Mental health symptoms were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Questions about infant illness and hand washing practices followed evaluative surveys from prior studies. Adjusted ordinary least squares regressions were used to examine correlations between postnatal mental health (depression, anxiety, and stress) symptoms, hand washing practices, and infant illness outcomes. Results: Maternal depression, anxiety and stress symptoms were significantly associated with reduced hand washing overall and less frequent hand washing after cleaning the infant's bottom. Mental health symptoms were also associated with a higher probability of infants showing two or more illness symptoms and visiting a doctor for illness symptoms. Individual hand washing practices were not significantly associated with infant illness; however, a composite measure of hand washing practices was significantly associated with reduced probability of infant illness. Conclusion: Postnatal mental health problems are prevalent in rural China and significantly associated with infant illness. Policy makers and practitioners should investigate possible interventions to improve maternal and infant well-being.
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Affiliation(s)
- Qi Jiang
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States.,School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Nourya Cohen
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Mika Ohtori
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Jie Gao
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qingzhi Wang
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Evelyn Zhang
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Sabrina Zhu
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Hannah Johnstone
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Yian Guo
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Sarah-Eve Dill
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
| | - Huan Zhou
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, United States
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Singh M, Stacey T, Abayomi J, Simkhada P. Maternal mental health and infant and young child undernutrition: protocol for a systematic review. BMJ Open 2021; 11:e044989. [PMID: 34518243 PMCID: PMC8438753 DOI: 10.1136/bmjopen-2020-044989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Mental health disorder, particularly depression, is one of the leading causes of 'disease related disability' in women that both affects the women but has adverse effect on their children. This can have an impact on mothers' capacity of child care which ultimately increases the risk of infection, malnutrition, impaired growth and behavioural problems in children that might extend to adulthood too. Diminished child growth has an irreversible effect both short and long terms, affecting physical growth, brain development, performance in education, working capacity and increased risks to non-communicable diseases. To date, the reviews conducted are only limited to few countries or maternal depression or certain age group of children. Our aim is to provide a global perspective focusing on all early childhood undernutrition (under 5 years) and to see if the association between maternal mental health and child undernutrition has yielded similar or different result. Furthermore, we intend to explore the risk factors associated with copresence of maternal mental health issues and undernutrition in children. METHODS AND ANALYSIS MEDLINE (PubMed), PsycINFO, CINAHL, Cochrane Library, Global Health Library Relevant reports from the WHO, United Nations of Children Education Fund and organisations working in maternal and child health will also be searched. Database of systematic reviews and database of abstracts of reviews of effects will also be searched for relevant literature. Papers published from 1995 to 2020 in English will be included. Title, abstract or both will be screened independently by reviewers. For data analysis and synthesis, we will present all the outcomes mentioned in the studies and a subgroup analysis for age and sex will be conducted. This study aims to conduct a meta-analysis. ETHICS AND DISSEMINATION Ethical approval is not required to conduct this review. PROSPERO REGISTRATION NUMBER CRD42020189315.
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Affiliation(s)
- Manisha Singh
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Tomasina Stacey
- Department of Nursing and Midwifery, University of Huddersfield, Huddersfield, UK
| | - Julie Abayomi
- Department of Allied Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - Padam Simkhada
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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12
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Coley EJL, Hsiao EY. Malnutrition and the microbiome as modifiers of early neurodevelopment. Trends Neurosci 2021; 44:753-764. [PMID: 34303552 DOI: 10.1016/j.tins.2021.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/23/2021] [Accepted: 06/11/2021] [Indexed: 01/16/2023]
Abstract
Malnutrition refers to a dearth, excess, or altered differential ratios of calories, macronutrients, or micronutrients. Malnutrition, particularly during early life, is a pressing global health and socioeconomic burden that is increasingly associated with neurodevelopmental impairments. Understanding how perinatal malnutrition influences brain development is crucial to uncovering fundamental mechanisms for establishing behavioral neurocircuits, with the potential to inform public policy and clinical interventions for neurodevelopmental conditions. Recent studies reveal that the gut microbiome can mediate dietary effects on host physiology and that the microbiome modulates the development and function of the nervous system. This review discusses evidence that perinatal malnutrition alters brain development and examines the maternal and neonatal microbiome as a potential contributing factor.
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Affiliation(s)
- Elena J L Coley
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095, USA.
| | - Elaine Y Hsiao
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095, USA
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13
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Alam MM, Haque T, Uddin KMR, Ahmed S, Islam MM, Hawlader MDH. The prevalence and determinants of postpartum depression (PPD) symptomatology among facility delivered mothers of Dhaka city. Asian J Psychiatr 2021; 62:102673. [PMID: 34052707 DOI: 10.1016/j.ajp.2021.102673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/08/2021] [Accepted: 05/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Postpartum depression (PPD) is among the top mental health issues and affects children's health and cognitive development. This study aimed to identify the prevalence of PPD symptomatology and possible determinants among facility delivered mothers of Dhaka city. METHOD A cross-sectional study was conducted among 291 mothers within the 12 months of postpartum during January to May 2019. RESULTS The prevalence of PPD symptomatology was 29.9 % among postpartum mothers. Multiple adjusted odds ratios of stepwise logistic regression analyses revealed, mothers age more than 30 years (AOR = 2.56:95 %CI = 1.21-5.39), being a mother for the first time (AOR = 2.08:95 %CI = 1.09-3.96), lost job or couldn't able to do paid work due to pregnancy (AOR = 2.60:95 %CI = 1.25-5.43), hypertension history (AOR = 2.48:95 %CI = 1.20-5.10), neonatal complication (AOR = 2.04:95 %CI = 1.05-3.95), and rare or no support from husband (AOR = 4.12:95 %CI = 2.14-7.95) were identified as significant predictors of PPD. However, having a household income of more than 50,000 Bangladeshi Taka per month (AOR = 0.36:95 %CI = 0.17-0.76) and passing less sedentary hours (AOR = 0.41:95 % CI = 0.23-0.75) were protective factors for PPD. CONCLUSION Our study has revealed a relatively high prevalence of PPD symptomatology; therefore, mental health counseling and proper management of cases are essential for bettering mothers and the next generation.
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Affiliation(s)
- Mohammad Morshad Alam
- Department of Public Heath, North South University, Dhaka, Bangladesh; Health, Nutrition and Population (HNP) Global Practice, The World Bank, Dhaka, Bangladesh.
| | - Tahsin Haque
- Department of Public Heath, North South University, Dhaka, Bangladesh.
| | | | - Shakil Ahmed
- Department of Public Heath, North South University, Dhaka, Bangladesh.
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Mokwena KE. Neglecting Maternal Depression Compromises Child Health and Development Outcomes, and Violates Children's Rights in South Africa. CHILDREN-BASEL 2021; 8:children8070609. [PMID: 34356588 PMCID: PMC8303702 DOI: 10.3390/children8070609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022]
Abstract
The intention of the South African Children’s Act 38 of 2005 is to provide guarantees for the protection and promotion of optimum health and social outcomes for all children. These guarantees are the provision of basic nutrition, basic health care and social services, optimal family or parental care, as well as protection from maltreatment, neglect and abuse services. However, despite these guarantees, child and maternal mortality remain high in South Africa. The literature identifies maternal depression as a common factor that contributes to negative health and social outcomes for both mothers and their children. Despite the availability of easy-to-use tools, routine screening for maternal depression is not carried out in public health services, which is the source of services for the majority of women in South Africa. The results are that the mothers miss out on being diagnosed and treated for maternal depression, which results in negative child outcomes, such as malnutrition, as well as impacts on mental, social and physical health, and even death. The long-term impacts of untreated maternal depression include compromised child cognitive development, language acquisition and deviant behaviors and economic disadvantage in later life. The author concludes that the neglect of screening for, and treatment of maternal depression therefore violates the constitutional rights of the affected children, and goes against the spirit of the Constitution. The author recommends that maternal and child health services integrate routine screening for maternal depression, which will not only satisfy the Constitutional mandate, but also improve the health and developmental outcomes of the children and reduce child mortality.
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Affiliation(s)
- Kebogile Elizabeth Mokwena
- Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi Drive, Ga-Rankuwa, Pretoria 0204, South Africa
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15
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Effectiveness of a brief psychoeducational intervention on postnatal depression in the slums, Nairobi: a longitudinal study. Arch Womens Ment Health 2021; 24:503-511. [PMID: 33196927 DOI: 10.1007/s00737-020-01085-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022]
Abstract
Research has shown that postnatal depression (PND) is higher in low- and middle-income countries as compared to higher-income countries. Despite this, little is known about practical interventions in these poorly resourced countries. This research investigated the effectiveness of a brief, prophylactic and therapeutic psychoeducational intervention in a low-resourced community in Nairobi. Two closely similar Maternal and Child Health (MCH) clinics in urban slums in Nairobi were identified and randomly selected. A total of 567 mothers formed the study population. The experimental group (284) mothers received the intervention, which included psychoeducation on PND, coping skills, healthy way of mother/child interaction and infant stimulation in addition to routine treatment, while the control group (283) mothers received treatment as usual. Data was collected using a social-demographic questionnaire and the English version of Becks Depression Inventory (BDI) at baseline. At 6 months, we reassessed both groups using BDI only. Within group comparison, the percentage reduction of depression was 35.6% among the experimental as compared to 2.3% in the control group. Between group comparison, the mean BDI depression score was significantly low in the experimental arm compared to the control arm at endline (p = 0.025). When all variables were adjusted, using a generalized linear model, BDI depression score reduction among the participants was significantly associated with the intervention (p = 0.040). A brief, psychoeducational intervention that targets the mother and her infant may reduce PND even in poorly resourced environments. Therefore, it can be integrated into existing MCH services.
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16
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Akintunde TY, Chen S, Ibrahim E, Tassang AE. Maternal Self-rated Capability Status and Its Association with Under-Five Children Morbidity. J Prim Care Community Health 2021; 12:21501327211002102. [PMID: 33715503 PMCID: PMC7968025 DOI: 10.1177/21501327211002102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: Under-five morbidity is a significant public health concern in developing countries, and maternal intervention remains vital to achieving under-five optimal health. Objective: The study examined the influence of maternal self-rated capability status (SCS) on under-five morbidity in Ibadan North Local Government Area (LGA), Oyo State, Nigeria. Methods: The study interviewed 683 nursing mothers surveyed from 20 primary healthcare centers (PHCs) from 13th to 27th September 2018 in the LGA of study. We employed logistic regression models to examine the association of 4 domains of maternal SCS on under-five morbidity incidence controlling for the potential confounding effects of maternal, child, and household sociodemographic attributes. Results: Under-five children of mothers with poor status in the knowledge of child morbidity, experience-informed action, child morbidity exposure, and childcare vulnerability domains are, respectively, 497%, 323%, 400%, and 318% more likely to be at risk of morbidity than their peers born to mothers with good status. In addition, the odds of morbidity were lower for children born to women with more than 1 under-five children (AOR: 0.49, 95% CI: 0.27, 0.88), while the odds were higher for those from households that are food-insecure (AOR: 3.16, 95% CI: 1.31, 7.65) and dispose of wastes within the compound (AOR: 2.67, 95% CI: 1.31, 5.45) relative to children in the comparative categories. Conclusion: Our findings revealed the significance of maternal SCS as a crucial pathway for understanding and reducing under-five morbidity. Community interventions should prioritize empowering nursing mothers with prevention and care information necessary to reduce the under-five morbidity burden at the community level.
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Affiliation(s)
- Tosin Yinka Akintunde
- Department of Sociology, Hohai University, Nanjing, China.,Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Shaojun Chen
- Department of Sociology, Hohai University, Nanjing, China
| | - Elhakim Ibrahim
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.,Department of Demography, The University of Texas at San Antonio, San Antonio, TX, USA
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17
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Husain N, Kiran T, Shah S, Rahman A, Raza-Ur-Rehman, Saeed Q, Naeem S, Bassett P, Husain M, Haq SU, Jaffery F, Cohen N, Naeem F, Chaudhry N. Efficacy of learning through play plus intervention to reduce maternal depression in women with malnourished children: A randomized controlled trial from Pakistan ✰. J Affect Disord 2021; 278:78-84. [PMID: 32956964 DOI: 10.1016/j.jad.2020.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 05/14/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The risk factors and adverse outcomes related to maternal depression and child malnutrition are a leading cause of morbidity and mortality in low and middle-income countries (LMIC) including Pakistan. Above 25% of women suffer from maternal depression. Up to 50% children are under-nourished which contributes to 35% of all under-5 deaths in the country. AIM To determine the efficacy of Learning through Play Plus Thinking Healthy Program (LTP Plus) intervention to reduce maternal depression in mothers with undernourished children. METHODS In this randomised controlled trial, all eligible mothers presenting to the paediatric departments were invited to participate in the study. Out of the total 256 mothers screened, 107 were included, 54 of those were randomly allocated to LTP Plus group and 53 to treatment as usual (TAU). Edinburgh Postnatal Depression Scale (EPDS) was used to screen for depression. Hamilton Depression Rating Scale (HDRS), Maternal Attachment Inventory (MAI), Social Support Scale (OSLO-3) and the Euro-QoL (EQ-5D) were used to measure the severity of depression, mother-child attachment, level of support and health related quality of life dimensions. Assessments were completed at baseline, end of intervention (3 months from baseline) and at 6 months from baseline. RESULTS Mothers in the LTP Plus group significantly showed improvements in depression (p<0.001), social support (p = 0.02) and quality of life (p<0.001) at the end of the intervention (LTP Plus), as compared to the TAU group, which were sustained up to 6 months after baseline. CONCLUSION The outcomes of LTP Plus intervention for mothers of malnourished children show promising results in reducing maternal depression and improving child outcomes. A full trial with longer-term outcomes and cost-effectiveness needs to be conducted.
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Affiliation(s)
- Nusrat Husain
- University of Manchester United Kingdom; Lancashire Care NHS Foundation Trust.
| | | | - Sadia Shah
- Lancashire Care NHS Foundation Trust; Pakistan Institute of Living and Learning
| | | | | | | | | | | | | | | | | | | | - Farooq Naeem
- Centre for Addiction & Mental Health, Toronto, Canada
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18
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Kumar M, Huang KY, Othieno C, Wamalwa D, Hoagwood K, Unutzer J, Saxena S, Petersen I, Njuguna S, Amugune B, Gachuno O, Ssewamala F, McKay M. Implementing combined WHO mhGAP and adapted group interpersonal psychotherapy to address depression and mental health needs of pregnant adolescents in Kenyan primary health care settings (INSPIRE): a study protocol for pilot feasibility trial of the integrated intervention in LMIC settings. Pilot Feasibility Stud 2020; 6:136. [PMID: 32974045 PMCID: PMC7507720 DOI: 10.1186/s40814-020-00652-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Addressing adolescent pregnancies associated health burden demands new ways of organizing maternal and child mental health services to meet multiple needs of this group. There is a need to strengthen integration of sustainable evidence-based mental health interventions in primary health care settings for pregnant adolescents. The proposed study is guided by implementation science frameworks with key objective of implementing a pilot trial testing a full IPT-G version along with IPT-G mini version under the mhGAP/IPT-G service framework and to study feasibility of the integrated mhGAP/IPT-G adolescent peripartum depression care delivery model and estimate if a low cost and compressed version of IPT-G intervention would result in similar size of effect on mental health and family functioning as the Full IPT-G. There are two sub- studies embedded which are: 1) To identify multi-level system implementation barriers and strategies guided by the Consolidated Framework for Implementation Research (CFIR) to enhance perinatal mhGAP-depression care and evidence-based intervention integration (i.e., group interpersonal psychotherapy; IPT-G) for pregnant adolescents in primary care contexts; 2) To use findings from aim 1 and observational data from Maternal and Child Health (MCH) clinics that run within primary health care facilities to develop a mental health implementation workflow plan that has buy-in from key stakeholders, as well as to develop a modified protocol and implementation training manual for building health facility staff's capacity in implementing the integrated mhGAP/IPT-G depression care. METHODS For the primary objective of studying feasibility of the integrated mhGAP/IPT-G depression care in MCH service context for adolescent perinatal depression, we will recruit 90 pregnant adolescents to a three-arm pilot intervention (unmasked) trial study (IPT-G Full, IPT-G Mini, and wait-list control in the context of mhGAP care). Pregnant adolescents ages 13-18, in their 1st-2nd trimester with a depression score of 13 and above on EPDS would be recruited. Proctor's implementation evaluation model will be used. Feasibility and acceptability of the intervention implementation and size of effects on mental health and family functioning will be estimated using mixed method data collection from caregivers of adolescents, adolescents, and health care providers. In the two sub-studies, stakeholders representing diverse perspectives will be recruited and focus group discussions data will be gathered. For aim 2, to build capacity for mhGAP-approach of adolescent depression care and research, the implementation-capacity training manual will be applied to train 20 providers, 12 IPT-G implementers/health workers and 16 Kenyan researchers. Acceptability and appropriateness of the training approach will be assessed. Additional feedback related to co-located service delivery model, task-shifting and task-sharing approach of IPT-G delivery will be gathered for further manual improvement. DISCUSSION This intervention and service design are in line with policy priority of Government of Kenya, Kenya Vision 2030, World Health Organization, and UN Sustainable Development Goals that focus on improving capacity of mental health service systems to reduce maternal, child, adolescent health and mental health disparities in LMICs. Successfully carrying out this study in Kenya will provide an evidence-based intervention service development and implementation model for adolescents in other Sub-Saharan African (SSA) countries. The study is funded by FIC/NIH under K43 grant.
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Affiliation(s)
- Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Keng-Yen Huang
- Department of Population Health, New York University School of Medicine, New York, USA
| | - Caleb Othieno
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, USA
| | - Jurgen Unutzer
- Department of Psychiatry, University of Washington, Seattle, USA
| | - Shekhar Saxena
- Department of Global Health and Population, Chan School of Public Health, Harvard University, Boston, USA
| | - Inge Petersen
- Department of Psychology, University of Kwa-Zulu Natal, Durban, South Africa
| | - Simon Njuguna
- Department of Mental Health, Ministry of Health, Nairobi, Kenya
| | | | - Onesmus Gachuno
- Department of Obstertrics and Gynacology, University of Nairobi, Nairobi, Kenya
| | - Fred Ssewamala
- Brown School at Washington University in St.Louis, St. Louis, USA
| | - Mary McKay
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
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Prevalence and Predictors of Being Overweight or Obese Among the Married Female Adolescents in Bangladesh: an Analysis of Bangladesh Demography and Health Survey 2014. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Hossain A, Niroula B, Duwal S, Ahmed S, Kibria MG. Maternal profiles and social determinants of severe acute malnutrition among children under-five years of age: A case-control study in Nepal. Heliyon 2020; 6:e03849. [PMID: 32420471 PMCID: PMC7218020 DOI: 10.1016/j.heliyon.2020.e03849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/09/2020] [Accepted: 04/21/2020] [Indexed: 11/27/2022] Open
Abstract
Background Addressing the determinants of severe acute malnutrition (SAM) among children remains a challenge in Nepal. This study investigated the effect of maternal and social determinants of SAM among under-five children of Nepal. Methods We conducted a hospital-based unmatched case-control study with 256 under-five children (128 cases and 128 controls). The children aged 6–59 months were taken, and the cases and controls were defined based on mid-upper arm circumference (MUAC). Results Backward Stepwise logistic regression analysis of 6–59 months children showed that the odds of SAM were lower among male children (AOR = 0.50, 95% CI = 0.27–0.92), mothers from high socioeconomic status (AOR = 0.469, 95% CI = 0.26–0.83), breastfeeding 6–12 months (AOR = 0.21, 95% CI = 0.05–0.68), breastfeeding ≥13 months (AOR = 0.18, 95% CI = 0.05–0.54) and optimal complementary feeding (AOR = 0.40, 95% CI = 0.22–0.70). SAM was significantly higher among children of the age group 6–24 months (AOR = 2.57, 95% CI = 1.30–5.22) and children with a history of diarrhea (AOR = 1.75, 95% CI = 0.92–3.39). Conclusions In order to reduce the children's SAM, it is necessary to scale up services to improve the socioeconomic status which includes the education, occupation, and monthly income of the mother. Girls of age group 6–24 months were more likely to develop SAM. Two contributing factors to decrease SAM are the importance of exclusive breastfeeding practices and the availability and usage of soap in hand washing, which are ideal for low cost interventions. To reduce SAM in Nepal, a focus on enhancing complementary feeding through increased affordability of nutritious foods is also needed.
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Affiliation(s)
- Ahmed Hossain
- Department of Public Health, North South University, Bashundhara, Dhaka 1229, Bangladesh.,Centre for Development Action, Dhaka 1216, Bangladesh
| | - Bhupendra Niroula
- Department of Public Health, North South University, Bashundhara, Dhaka 1229, Bangladesh.,Kathmandu University, Dhulikhel, Kathmandu 45200, Nepal
| | - Sangita Duwal
- Department of Public Health, North South University, Bashundhara, Dhaka 1229, Bangladesh.,Kathmandu University, Dhulikhel, Kathmandu 45200, Nepal
| | - Shakil Ahmed
- Department of Public Health, North South University, Bashundhara, Dhaka 1229, Bangladesh
| | - Md Golam Kibria
- Department of Public Health, North South University, Bashundhara, Dhaka 1229, Bangladesh.,Centre for Development Action, Dhaka 1216, Bangladesh
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21
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Mohammedahmed ASA, Koko AEA, Arabi AME, Ibrahim MA. Maternal depression, a hidden predictor for severe acute malnutrition in children aged 6-59 months: a case-control study at Omdurman Paediatrics Teaching Hospital, Sudan. Sudan J Paediatr 2020; 20:111-121. [PMID: 32817731 DOI: 10.24911/sjp.106-1590606922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Malnutrition remains one of the main disabling issues in child health, especially in developing countries. Maternal depression by its related disabilities has been linked with children undernutrition in the studies abroad. Unfortunately, not much is known regarding this issue in Sudan, so this study aims to examine the association between maternal depression and severe acute malnutrition (SAM) in children under 5 years of age. A matched case-control study was conducted in Omdurman Paediatrics Teaching Hospital. Children admitted with SAM were assigned as cases, whereas controls were age- and sex-matched children with normal weight and height admitted in the same hospital. Mothers of both cases and controls were assessed for depression utilising the Patient Health Questionnaire-9 tool. The prevalence of depression among mothers of malnourished children was high (41.5%) compared to the mothers of controls (19.1%). In multivariate logistic regression analyses, the adjusted odds ratio (AOR) of maternal depression were markedly higher in cases than in controls (AOR = 3.09, p = 0.002), as was the odds of below 1-year breastfeeding weaning (AOR = 18.60, p = 0.006) and mother illiteracy (AOR = 2.42 p = 0.031). Furthermore, the analysis found a significant negative association between the occurrence of malnutrition and exclusive breastfeeding (AOR = 0.43, p = 0.015). Maternal depression carries a significant burden in the mothers of children hospitalised with SAM. We strongly recommend routine screening and treatment for depression in childbearing age mothers in the available relative maternal and child health clinics.
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Affiliation(s)
- Arwa S A Mohammedahmed
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan.,Pediatrics and Child Health Specialty Council, Sudan Medical Specialization Board, Khartoum, Sudan
| | | | - Ali M E Arabi
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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