Postpartum depression and infant feeding practices in a low income urban settlement in Nairobi-Kenya

Risk factors for undernutrition and poor growth during the first 6 months of life in sub-Saharan Africa: A scoping review

BACKGROUND & AIMS

Early infant undernutrition and suboptimal growth represent significant public health challenges in many low- and middle-income countries, yet information regarding the risk factors for poor growth remains limited. A scoping review was conducted to map the existing evidence on indicators of undernutrition and poor growth and related risk factors among infants aged 0-6 months in sub-Saharan Africa.

METHODS

This scoping review was conducted in accordance with the Joanna Briggs Institute framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. MEDLINE, Embase, and Scopus were systematically searched for eligible studies, with no restrictions on time or language.

RESULTS

A total of 50 studies met the inclusion criteria for this review. The most frequently reported indicator of undernutrition was stunting, followed by underweight and wasting. Sex, feeding, illness, and birth size were the most studied infant risk factors for poor growth. The maternal risk factors most frequently investigated included age, education, human immunodeficiency virus infection, and occupation. Socioeconomic status and factors related to water, sanitation, and hygiene were the most studied household risk factors.

CONCLUSIONS

Several indicators of undernutrition and poor growth were identified, with stunting being the most frequently reported. Associated risk factors included multiple infant-, maternal-, and household factors, highlighting the need for complex multilayered interventions to address undernutrition and poor growth among these vulnerable infants.

Predictors of depression among caregivers of children with malnutrition in Gedeo zone public hospitals, Southern Ethiopia: case-control study

BACKGROUND

Depression is a leading cause of disability worldwide, significantly impacting global health, particularly for women. It accounts for 4.3% of the total disability-adjusted life years (DALYs), making it a major contributor to global disability. The high rate of depression in developing nations, the caregiving responsibilities of caregivers, their susceptibility to depression, and maternal mental health in these nations may significantly impact childhood development. Therefore, the study aimed to identify the predictors of depression among caregivers of children with malnutrition in Gedeo Zone public hospitals.

METHODS

A facility-based unmatched case-control study was conducted. A systematic sampling technique was used to select 226 caregivers (113 cases and 113 controls). Depression of caregivers was assessed using a patient health questionnaire (PHQ-9). Data were analyzed using SPSS version 20. Bivariate and multivariate logistic regression analysis was conducted to identify predictors, and the association was presented with an adjusted odds ratio and a 95% confidence interval.

RESULTS

In this study, not attended formal education [AOR = 2.9(95%CI: 1.0-8.1)], unemployment [AOR = 3.7, (95% CI: 1.4-9.7)], low socioeconomic status [AOR = 3.3 (95% CI: 1.2-9.4)], physical abuse [AOR = 2.3(95% CI = 1.2-3.3)], poor social support [AOR = 2.6(95% CI: 1.0-6.5)], and stunting [AOR = 2.5, 95% CI: 1.3-3.4] were a significant positive predictors of depression.

CONCLUSION AND RECOMMENDATION

Nearly half of the study participants had a significant burden of depression among caregivers of malnourished children; particularly those facing not attended formal education, unemployment, low socioeconomic status, physical abuse, poor social support, and having a stunted child. Therefore, implementing early depression screening and interventions is crucial. Additionally, enhancing caregiver education, reducing unemployment, strengthening social support systems, preventing stunted physical growth, and boosting parents' financial stability with malnourished children are essential strategies for sustainable improvement.

Exploring care-seeking practices within a family mid-upper arm circumference approach in South Sudan: a mixed-methods prospective study

BACKGROUND

Despite the growing adoption of the Family Mid-Upper Arm Circumference (MUAC) approach to empower caregivers in detecting child malnutrition, limited evidence exists on whether caregivers act on identified cases by seeking care and factors influencing their decisions. Most research has focused on the accuracy of caregiver MUAC measurements, leaving a gap in understanding behavioral, social, emotional, and contextual barriers to care-seeking. Addressing this gap is critical for informing interventions to ensure early detection translates into timely treatment. This study aimed to explore the barriers and facilitators influencing care-seeking practices within a Family MUAC program in South Sudan.

METHODS

We conducted a mixed-methods, prospective, non-randomized study in Central Equatoria and Warrap States, South Sudan, between March 2022 and January 2023. We enrolled 2,893 children aged 5-53 months and trained their caregivers on using MUAC tapes. Caregivers were followed for 8 months, including three monitoring visits and baseline/endline surveys, capturing self-reported care-seeking practices. Qualitative data were obtained through 20 focus group discussions (FGDs) with caregivers, using the Health Belief Model as a theoretical framework to explore perceptions, barriers, and enablers of care-seeking. A combined deductive and inductive coding approach was used for thematic analysis.

RESULTS

Among children identified with wasting using MUAC tapes, 86.5% of caregivers sought care, with significantly higher rates in Warrap (97.6%) than Central Equatoria (79.4%) (p < 0.008). Barriers to care-seeking included distance to health facilities (18.9%), transportation costs (11.3%), and treatment costs (9.4%). Qualitative findings revealed additional challenges such as social stigma, lack of knowledge about where to seek care, and negative experiences with health workers. Despite some caregivers reporting a lack of encouragement, most valued the MUAC tapes, used them weekly, and were confident in their ability to take accurate measurements.

CONCLUSIONS

Policies and programmatic interventions should consider integrating Family MUAC programs with community-based financial initiatives like savings groups to address financial barriers. Tailoring interventions to rural and urban contexts through formative research can enhance program effectiveness, while training health workers in compassionate care may improve caregiver trust and increase care-seeking rates. Strengthening these areas can maximize the impact of Family MUAC and improve child health outcomes.

TRIAL REGISTRATION

N/A.

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.

Association between infant feeding practices, COVID-19 related cognitive factors, and postpartum depression during the COVID-19 pandemic: a cross-sectional online study in Thailand

BACKGROUND

Maternal beliefs towards COVID-19 vaccine safety may be associated with infant feeding practice and postpartum depression (PPD). Since there is a paucity of studies, this study aims to identify associations of COVID-19-related cognitive factors (e.g., COVID-19-vaccination-related belief and COVID-19-related knowledge and attitude) with infant feeding practices and their associations with PPD during the COVID-19 pandemic in Thai postpartum mothers.

METHODS

A cross-sectional online survey was conducted among 840 postpartum mothers whose infants were less than or equal to 6 months old. Mothers with a score ≥ 13 using the Edinburgh Postnatal Depression Scale (EPDS) were considered to have PPD. Student t-tests were used to measure the association between infant feeding practices and COVID-19-related cognitive factors, and Chi-square tests were used to assess their associations with PPD. Significant variables (p < 0.05) from the chi-square test were included in the logistic regression analysis. Multivariable logistic regression analyses were performed to identify factors associated with PPD. The associations were reported in adjusted odds ratio at 95% confidence interval.

RESULTS

This study showed one-third of the participants (32.4%) were at risk of having PPD. Mothers who fed expressed breastmilk had positive beliefs towards COVID-19 vaccination and higher scores on COVID-19 knowledge and attitude, while mothers who fed infant formula or solid, semi-solid, or soft food had negative beliefs towards the vaccination compared to their counterparts. Multivariable logistic regression showed women who fed their infant with solid, semi-solid, and soft foods (AOR = 3.28; 95% CI = 1.35-10.92) had significantly higher odds of PPD. Among COVID-19-related cognitive factors, negative or moderate COVID-19-related attitudes were associated with higher odds of PPD (1.91; 1.19-3.07 and 1.85; 1.20-2.86, respectively). Socio-demographic factors associated with PPD included living in urban areas, residing outside the Southern region, having food insecurity during the pandemic, having unintended pregnancy, and having health problems during the perinatal period.

CONCLUSIONS

The association of COVID-19-related cognitive factors and feeding practices with PPD may suggest that proper education on prevention, control, and vaccination of emerging infectious diseases such as COVID-19, as well as support for appropriate infant feeding practices, should be provided to postpartum mothers, which ultimately contributes to improving their mental health.

Association between maternal mental health and early childhood development, nutrition, and common childhood illnesses in Khwisero subcounty, Kenya

BACKGROUND

Despite the significant public health burden of maternal mental health disorders in sub-Saharan Africa (SSA), limited data are available on their effects on early childhood development (ECD), nutritional status, and child health in the region.

AIMS

This study investigated the association between maternal mental health and ECD, nutritional status, and common childhood illnesses, while controlling for biological, social, financial, and health-related factors and/or confounders.

METHOD

As part of the Innovative Partnership for Universal and Sustainable Healthcare (i-PUSH) program evaluation study, initiated in November 2019, a cohort of low-income rural families, including pregnant women or women of childbearing age with children under five, was recruited for this study. A total of 24 villages were randomly selected from a list of villages near two health facilities. Following a census to identify eligible households, 10 households per village were randomly selected. Data collection included maternal mental health, assessed using Centre for Epidemiological Studies Depression (CES-D) scale, ECD, nutritional status (anthropometric measurements), and common childhood illnesses, their symptoms, and healthcare utilization. This study presents a cross-sectional analysis of the data drawn from endline survey of 299 target mothers and 315 children.

RESULTS

The majority of the mothers were aged between 25 and 34 years. The mean age of children was 3.2 years, with 53% being male. The overall maternal mental health score, as measured by the CES-D scale, was 28. Children of mothers with higher CES-D scores exhibited poorer ECD domains, lower nutritional status indicators, and increased incidence of ill-health in the previous two weeks, in both unadjusted and adjusted analyses. Individual, parental, and household factors-including maternal age, household wealth index, and decision-making regarding child healthcare-were significantly associated with children's development, nutrition status, and health outcomes.

CONCLUSION

Children of mothers with low mental health scores demonstrated suboptimal developmental outcomes, nutritional status, and overall well-being, particularly for those from impoverished households. These findings suggest that improving the socioeconomic conditions of low-income households is essential for promoting children's development, nutritional status, and well-being. Longitudinal studies are needed to further investigate the impact of maternal mental health on child development, nutrition, and health outcomes, considering additional factors across the maternal, newborn, and child health continuum.

TRIAL REGISTRATION FOR THE PARENT AND NESTED STUDY

ClinicalTrials.gov (NCT04068571), AEA Registry (AEARCTR-0006089) and PACTR (PACTR202204635504887).

Maternal postpartum depression and children's emotional overeating: The mediating role of executive function

OBJECTIVES

The literature shows connections between maternal depression, children's executive function (EF), and emotional overeating (EOE). This study examined the interplay between maternal postpartum depression, EF, and EOE. We hypothesized that higher levels of postpartum depression would lead to lower inhibition and emotional control and higher levels of EOE. We also explored whether inhibition and emotional control mediate the relationship between postpartum depression and EOE.

METHODS

The analysis included 297 families (49 % of children were female at birth; 82 % of caregivers were White) from a longitudinal birth cohort study in the US Midwest (N = 468). Maternal self-reports assessed postpartum depression at six weeks using the Edinburgh Postnatal Depression Scale. Children's EF at 24 months was measured with the Behavior Rating Inventory of Executive Function-Preschool Version, and EOE at 48 months was assessed using the Child Eating Behavior Questionnaire.

RESULTS

While accounting for child gender, parent race, and education, there was a positive indirect effect of postpartum depression on EOE through children's inhibitory and emotional control difficulties. There was also a significant direct effect between postpartum depression and EOE. These results suggest that higher levels of postpartum depression in mothers may be associated with children's lower EF abilities (e.g., inhibition and emotional control), which may, in turn, lead to higher levels of EOE.

CONCLUSION

Early maternal depressive symptoms may have important implications for children's EF and EOE behaviors. The current findings stress the need to address symptoms of postpartum depression in mothers, even though symptoms may not reach clinical levels.

Perinatal depression and adverse child growth outcomes in low-income and middle-income countries (LMICs): A systematic review and meta-analysis

Perinatal depression (PND), which encompasses the antepartum and postpartum depression (APD and PPD), is a neglected crisis in low-income and middle-income countries (LMICs). We aimed to systematically search and meta-analyze existing evidence to determine whether a mother's PND affects adverse growth outcomes in children in LMICs (PROSPERO protocol: CRD42021246803). We conducted searches, including nine databases (PubMed, EMBASE, Web of Science, CINAHL Plus, Global Health Database, Google Scholar, WHO Regional Databases, PsycINFO, and LILACS) from January 2000 to September 2023. We restricted studies that assessed PND using validated screening tools or clinical interviews during pregnancy or within 12 months postpartum. We included studies that reported four types of adverse child growth outcomes (stunting, wasting, underweight, and overweight/obesity) in children younger than 5 years. We assessed the quality using the Newcastle Ottawa Scale and pooled risk ratios (RRs) and odds ratios (ORs) between PND and each adverse growth outcome using random-effects models. In total, 27 studies met the inclusion criteria for systematic review, with 24 eligible for meta-analysis, spanning data from 15 countries and 26,261 mother-baby pairs. Based on the studies that reported ORs, children below the age of 3 years with mothers experiencing PND had higher odds for stunting (OR 1.63, 95% CI 1.32, 2.02, I2 = 56.0%) and underweight (OR 2.65, 95% CI 1.90, 3.68, I2 = 34.5%) compared to children of mothers without PND. The pooled RRs for stunting and underweight did not show significant differences between mothers with and without PND. Studies on wasting (n = 5) and overweight/obesity (n = 2) were limited, demonstrating inconsistent results across studies. The association between PND and adverse growth outcomes varied according to the measure of association, region, country, PND type, outcome timepoint, and study design. There were limited studies in diverse LMICs, particularly on wasting, or overweight/obesity as an outcome.

Depression and Intimate Partner Violence (IPV) in mothers 6 weeks to 12 months post-delivery in a rural setting in Kenya

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.

Imputation of ancient canid genomes reveals inbreeding history over the past 10,000 years

The multi-millenia long history between dogs and humans has placed them at the forefront of archeological and genomic research. Despite ongoing efforts including the analysis of ancient dog and wolf genomes, many questions remain regarding their geographic and temporal origins, and the microevolutionary processes that led to the diversity of breeds today. Although ancient genomes provide valuable information, their use is hindered by low depth of coverage and post-mortem damage, which inhibits confident genotype calling. In the present study, we assess how genotype imputation of ancient dog and wolf genomes, utilising a large reference panel, can improve the resolution provided by ancient datasets. Imputation accuracy was evaluated by down-sampling high coverage dog and wolf genomes to 0.05-2x coverage and comparing concordance between imputed and high coverage genotypes. We measured the impact of imputation on principal component analyses and runs of homozygosity. Our findings show high (R2>0.9) imputation accuracy for dogs with coverage as low as 0.5x and for wolves as low as 1.0x. We then imputed a dataset of 90 ancient dog and wolf genomes, to assess changes in inbreeding during the last 10,000 years of dog evolution. Ancient dog and wolf populations generally exhibited lower inbreeding levels than present-day individuals. Interestingly, regions with low ROH density maintained across ancient and present-day samples were significantly associated with genes related to olfaction and immune response. Our study indicates that imputing ancient canine genomes is a viable strategy that allows for the use of analytical methods previously limited to high-quality genetic data.

Prevalence and associated factors of maternal depression among mothers of children with undernutrition at comprehensive specialized hospitals in Northwest Ethiopia in 2023: a cross-sectional study

Background

Malnutrition is one of the most significant child health problems in developing countries, accounting for an estimated 53% of child deaths per year. Depression is the leading cause of disease-related disability in women and adversely affects the health and well-being of mothers and their children. Studies have shown that maternal depression has an impact on infant growth and nutritional status. However, evidence is scarce regarding the relationship between maternal depression and child malnutrition.

Objectives

The general objective of this study was to assess the prevalence and associated factors of maternal depression among mothers of undernourished children at comprehensive specialized hospitals in Northwest Ethiopia in 2023.

Methods

An institution-based cross-sectional study was conducted among 465 participants. Outcome variables were assessed using a Patient Health Questionnaire-9 (PHQ-9). Data were analyzed using SPSS-25. Bivariate and multivariable logistic regression analyses were conducted. Variables with a p-value less than 0.05 were considered statistically significant with a corresponding 95% confidence interval (CI).

Results

The prevalence of maternal depression among mothers of children with undernutrition was 36.4% (95% CI = 32%-41%). According to a multivariate analysis, lack of maternal education (adjusted odds ratio [AOR] = 2.872, 95% CI = 1.502-5.492), unemployment (AOR = 2.581, 95% CI = 1.497-4.451), poor social support (AOR = 2.209, 95% CI = 1.314-3.713), perceived stigma (AOR = 2.243, 95% CI = 1.414-3.560), and stunting (AOR = 1.913, 95% CI = 1.129-3.241) were factors significantly associated with maternal depression.

Conclusion

The overall prevalence of maternal depression was higher among mothers of children with undernutrition. This higher prevalence was associated with several factors, including lack of education, unemployment, poor social support, high perceived stigma, and stunted physical growth in the children themselves. To decrease maternal depression, we can address these factors by increasing the level of maternal education and employment opportunities, strengthening social support systems, reducing stigma, and providing interventions to reduce stunting.

Common Mental Disorders and Associated Factors During Pregnancy and the Postpartum Period in Indonesia: An Analysis of Data From the 2018 Basic Health Research

OBJECTIVES

A substantial proportion of women experience mental health challenges during pregnancy or the postpartum period. Common mental disorders (CMDs), including depression, anxiety, and obsessive-compulsive disorder, are prevalent. Identifying causes and associated risk factors is imperative for early intervention and the prevention of mental health issues.

METHODS

This study utilized data from the 2018 Basic Health Research, which was conducted nationwide in Indonesia, using a crosssectional approach. We focused on women aged 13-49 years who were currently or previously married, and had experienced pregnancy, including 8889 pregnant women and 77 012 women who had delivered between January 1, 2013 and August 31, 2018. The Self-Reporting Questionnaire-20 was employed to assess CMDs. Multivariate logistic regression was performed.

RESULTS

The prevalence of CMDs in pregnant women was 12.6%, while postpartum mothers exhibited a prevalence of 10.1%. Poor health status displayed the strongest impact on CMDs during both pregnancy (adjusted odds ratio [aOR], 12.23; 95% confidence interval [CI], 9.01 to 16.60) and the postpartum period (aOR, 16.72; 95% CI, 14.85 to 18.82). Additional significant factors for both group include young maternal age, lack of education, unemployment, history of hypertension, and smoking status. Among pregnant women, CMDs was also associated with first-trimester pregnancy, previous pregnancy complications, and small upper arm circumference. For postpartum mothers, significant factors include living in rural areas, history of abortion, unwanted pregnancy, pregnancy complications, lack of antenatal care, spontaneous delivery, postpartum complications and contraceptive use.

CONCLUSIONS

CMDs can impact in pregnant and postpartum women. Early diagnosis and management must be seamlessly integrated into primary healthcare practices.

Prevalence and predictors of postpartum depression and generalized anxiety symptoms among women who delivered at a tertiary hospital in Mwanza Tanzania: a cross-sectional study

BACKGROUND

Postpartum depression and anxiety are major public health concerns that affect 3-39% of women after childbearing and can adversely affect maternal and child health. Most studies have investigated postpartum depression and anxiety and their associated factors among women 4-12 weeks after delivery. There is a scarcity of research among women immediately after delivery from low- and middle-income countries, the gap this study aimed to fill.

METHODS

A descriptive cross-sectional study was conducted among 386 postpartum women within one week after delivery. The Edinburg Postnatal Depression Scale was used to assess depressive symptoms and the Generalized Anxiety Disorder - 7 scale was used to screen for symptoms of generalized anxiety disorder. Participants were systematically selected from the postnatal wards and interviewed by trained research assistants from November 2019 to March 2020.

RESULTS

Using standard cut points, the prevalence of depressive and anxiety symptoms was 25.39%, and 37.31% respectively. Having a baby with a weight of 2.5 kgs or more and having partner support were associated with decreased odds of both depression and anxiety symptoms. In contrast, complications during delivery, caesarian section, marital status, and partner violence, were associated with increased odds of depressive and anxiety symptoms post-delivery.

CONCLUSION

There was a high prevalence of postpartum depression and anxiety symptoms among the study participants in the first week post-delivery, with delivery complications and outcome and psychosocial supports identified as associated factors for depression and anxiety symptoms. These findings highlight the need for early screening to identify those at risk for appropriate intervention.

Association of intimate partner violence with offspring growth in 32 low- and middle-income countries: a population-based cross-sectional study

Intimate partner violence (IPV) against women presents a major public health challenge, especially in low-income and middle-income countries (LMICs), and its relationship with poor offspring growth is emerging but remains understudied. This study aimed to explore the impact of maternal exposure to IPV on offspring growth based on different approaches in LMICs. We conducted a population-based cross-sectional study using the most recent Demographic and Health Surveys from 32 LMICs; 81,652 mother-child dyads comprising women aged from 15 to 49 years with children aged 0 to 59 months were included. We applied logistic regression models to explore the independent and cumulative relationship between IPV, including emotional, physical, and sexual IPV, with poor child growth status, including stunting and wasting; 52.6% of mothers were under the age of 30 years with a 36% prevalence of any lifetime exposure to IPV. Maternal exposure to any IPV increased the odds of stunting, but only physical and sexual IPV were independently associated with an increased risk of stunting. Three different types of IPV exhibited a cumulative effect on stunting. Maternal exposure to physical IPV was significantly associated with an increased risk of wasting. Significant associations between maternal exposure to emotional IPV with offspring stunting and physical IPV with wasting were only observed in children aged 0 to 36 months. IPV against women remains high in LMICs and has adverse effects on offspring growth. Policy and program efforts are needed to prioritize the reduction of widespread physical and sexual IPV and to mitigate the impact of such violence.

Longitudinal pathways between maternal depression, parenting behaviors, and early childhood development: a mediation analysis

Maternal depression is a global public health concern with far-reaching impacts on child development, yet our understanding of mechanisms remains incomplete. This study examined whether parenting mediates the association between maternal depression and child outcomes. Participants included 841 rural Pakistani mother-child dyads (50% female). Maternal depression was measured at 12 months postpartum, parenting behaviors (warmth, stimulation, and harsh parenting) were measured at 24 months, and child outcomes (mental health, socioemotional development, and cognitive skills) were measured at 36 months. Maternal depression predicted increased harsh parenting, child mental health difficulties, and child socioemotional concerns; however, there was little evidence for parenting as a mediator between maternal depression and child outcomes. Sex-stratified results are discussed, and findings are situated in context.

Validating the Edinburgh Postnatal Depression Scale Against the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition for Use in Uganda

Background

The Edinburgh Postnatal Depression Scale (EPDS) is a widely acknowledged screening tool for postpartum depression (PPD) globally, but its validation in Uganda has been lacking. This study aimed to assess the EPDS's accuracy as a PPD screening tool in Uganda compared to the Mini-International Neuropsychiatric Interview (MINI 7.0.2) based on the DSM-5.

Methods

This was a descriptive cross-sectional study conducted at a referral hospital and two peri-urban primary care postpartum clinics in rural southwestern Uganda. We enrolled 287 mothers aged 18 to 49 at their six-week postpartum visit. The EPDS was used for initial screening, and the MINI 7.0.2 was employed for clinical diagnosis. The study used the Runyankore-Rukiga language version of the EPDS and collected data from November 11, 2019, to June 10, 2020, with the MINI 7.0.2 as the reference standard.

Results

The overall PPD prevalence was 29.5%, as opposed to 26.5% with EPDS and MINI 7.0.2 DSM-5 criteria (p = 0.239). The EPDS demonstrated a sensitivity of 86.8%, specificity of 92.1%, positive predictive value of 80.5%, and negative predictive value of 94.9%. A cutoff score of ≥10 was found to be the most effective acceptable point after drawing the AUC of ROC and determining the most appropriate point using Youden's index. The area under the ROC curve, indicating the scale's overall performance against MINI 7.0.2, was 0.89 for Bwizibwera HCIV, 0.97 for Kinoni HCIV, and 0.84 for MRRH. In conclusion, the EPDS can effectively screen for postpartum depression in southwestern Uganda using a cutoff score of ≥10. It exhibits strong diagnostic performance in correctly identifying PPD in postpartum mothers.

Postpartum depression and associated factors in Afar Region, northeast Ethiopia

Background

To effectively address the burden of postpartum depression (PPD), it is crucial to gain a comprehensive understanding of its magnitude and the factors associated with it in the pastoral and hot region of the Afar Region. This will help identify the progress made thus far and highlight areas that require further attention to accelerate efforts toward reducing the impact of PPD. Notably, no previous study has examined the prevalence and associated factors of PPD specifically in pastoral communities within Ethiopia, including the Afar Region. Accordingly, we investigated the prevalence and associated factors of PPD among postpartum women in the Afar Region, Northeast Ethiopia.

Methods

An institution-based cross-sectional study was conducted in the Awsi Rasu Zone of Afar Regional State from June to July 2021. The study employed a systematic random sampling method to select a total of 302 postpartum mothers who had visited the Expanded Program of Immunisation (EPI) clinics in public health facilities within the Awsi Rasu Zone of the Afar Region. The measurement of PPD was performed using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable binary logistic regression modelling was used to investigate associations between sociodemographic, obstetric and health service, and psychosocial factors with PPD.

Results

The overall prevalence of PPD was 37.4% with a 95% confidence interval (CI) from 32.0% to 43.0%. Postpartum women who attained high school education were associated with a lower odds of PPD compared to those who did not attain formal schooling (adjusted odds ratio [AOR] = 0.31; 95% CI: 0.12, 0.82). Postpartum women with a family history of mental illness (AOR = 2.34; 95% CI: 1.24, 4.41), those who had trouble in infant feeding (AOR = 4.26; 95% CI: 2.32, 7.83), and those who experienced intimate partner violence (AOR = 3.09; 95% CI: 1.58, 6.04) were positively associated with PPD.

Conclusion

The results of our study revealed that the prevalence of PPD in the Awsi Rasu Zone of the Afar Region is higher than both the national and global averages. The findings also highlighted the need for targeted interventions addressing the needs of pastoral postpartum women who experience various stressors, such as feeding difficulties and intimate partner violence.

Maternal depression and child feeding practices: Determinants to malnutrition among young children in Malaysian rural area

BACKGROUND

Maternal depression may affect child feeding practices and growth.

OBJECTIVE

The objective of this study is to determine the relationship between child feeding practices and current maternal depression with malnutrition among young children in a rural community.

METHODS

This is a case-control study consisting of 52 Malay mothers of malnourished children (case) and 50 Malay mothers of well-nourished children (control) in Kuala Langat, Selangor, Malaysia. Structured questionnaires on child feeding practices and Beck Depression Inventory: Second Edition questionnaire were distributed to mothers.

RESULTS

Depressed mothers stopped exclusive breastfeeding (2.8 ± 2.1 months) earlier than non-depressed mothers (3.7 ± 2.0 months; p = 0.045). Binary logistic regression analysis showed current maternal depression was a primary contributor associated with risk of malnutrition in children (adjusted odds ratio: 2.5, 95% confidence interval: 1.08-6.09), and followed by the number of children (adjusted odds ratio: 1.3, 95% confidence interval: 1.02-1.77).

CONCLUSION

Mothers who experienced depression were twice as likely to have malnourished children. Each additional child in the family will increase the risk of malnutrition by 1.3 times. Maternal depression is associated with child feeding practices and malnutrition among young children in the studied population. Preliminary screening to identify depression symptoms should be conducted to all mothers as early as the first trimester to prevent the incidence of malnutrition in children.

Exploring the influence of postnatal depression on neonatal care practices among mothers in Western Kenya: A qualitative study

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.

The feasibility and acceptability of a task-shifted intervention for perinatal depression among women living with HIV in Malawi: a qualitative analysis

BACKGROUND

Perinatal depression (PND) is prevalent and negatively impacts HIV care among women living with HIV (WLHIV), yet PND remains under-identified in Malawian WLHIV. Accordingly, this formative study explored perceptions of the feasibility and acceptability of an integrated, task-shifted approach to PND screening and treatment in maternity clinics.

METHODS

We completed consecutive PND screenings of HIV+ women attending pre- or post-natal appointments at 5 clinics in Lilongwe district, Malawi. We conducted in-depth interviews with the first 4-5 women presenting with PND per site (n = 24 total) from July to August 2018. PND classification was based on a score ≥ 10 on the Edinburgh Postnatal Depression Scale (EPDS). We conducted 10 additional in-depth interviews with HIV and mental health providers at the 5 clinics.

RESULTS

Most participants endorsed the feasibility of integrated PND screening, as they believed that PND had potential for significant morbidity. Among providers, identified barriers to screening were negative staff attitudes toward additional work, inadequate staffing numbers and time constraints. Suggested solutions to barriers were health worker training, supervision, and a brief screening tool. Patient-centered counselling strategies were favored over medication by WLHIV as the acceptable treatment of choice, with providers supporting the role of medication to be restricted to severe depression. Providers identified nurses as the most suitable health workers to deliver task-shifted interventions and emphasized further training as a requirement to ensure successful task shifting.

CONCLUSION

Improving PND in a simple, task-shifted intervention is essential for supporting mental health among women with PND and HIV. Our results suggest that an effective PND intervention for this population should include a brief, streamlined PND screening questionnaire and individualized counselling for those who have PND, with supplemental support groups and depression medication readily available. These study results support the development of a PND intervention to address the gap in treatment of PND and HIV among WLHIV in Malawi.

Patterns and predictors of fear of childbirth and depressive symptoms over time in a cohort of women in the Pwani region, Tanzania

BACKGROUND

Fear of childbirth (FoB) and depressive symptoms (DS) are experienced by many women and can negatively affect women during and after pregnancy. This study assessed patterns of FoB and DS over time and associations of postpartum FoB and DS with sociodemographic and obstetric characteristics.

METHODS

We conducted a longitudinal study at six health facilities in Tanzania in 2018-2019. Pregnant women were consecutively assessed for FoB and DS before and after childbirth using the Wijma Delivery Expectancy/Experience Questionnaire versions A & B and the Edinburgh antenatal and postnatal depressive scale. This paper is based on 625 women who completed participation.

RESULTS

The prevalence rates of FoB and DS during pregnancy were 16% and 18.2%, respectively, and after childbirth, 13.9% and 8.5%. Some had FoB (6.4%) and DS (4.3%) at both timepoints. FoB was strongly associated with DS at both timepoints (p < 0.001). Both FoB (p = 0.246) and DS (p < 0.001) decreased after childbirth. Never having experienced obstetric complications decreased the odds of postpartum and persisting FoB (adjusted odds ratio (aOR) 0.44, 95% confidence interval (CI) 0.23-0.83). Giving birth by caesarean section (aOR 2.01, 95% CI 1.11-3.65) and having more than 12 hours pass between admission and childbirth increased the odds of postpartum FoB (aOR 2.07, 95% CI 1.03-4.16). Postpartum DS was more common in women with an ill child/stillbirth/early neonatal death (aOR 4.78, 95% CI 2.29-9.95). Persisting DS was more common in single (aOR 2.59, 95% CI 1.02-6.59) and women without social support from parents (aOR 0.28, 95% 0.11-0.69).

CONCLUSIONS

FoB and DS coexist and decrease over time. Identifying predictors of both conditions will aid in recognising women at risk and planning for prevention and treatment. Screening for FoB and DS before and after childbirth and offering psychological support should be considered part of routine antenatal and postnatal care. Furthermore, supporting women with previous obstetric complications is crucial. Using interviews instead of a self-administered approach might have contributed to social desirability. Also, excluding women with previous caesarean sections could underestimate FoB and DS prevalence rates.

Low husband involvement in maternal and child health services and intimate partner violence increases the odds of postpartum depression in northwest Ethiopia: A community-based study

Background

Depression is the most common mental health problem that affects women during pregnancy and after child-birth. Postpartum depression, in particular, has both short and long-term effects on the lives of mothers and children. Women’s health is a current global concern, but postpartum depression is a neglected issue in the maternal continuum of care and is rarely addressed. Therefore, this study aimed to assess postpartum depression and associated factors in Gondar city, northwest Ethiopia.

Methods

A community-based cross-sectional study was conducted from August 1^st to 30^th, 2021 in Gondar city. A cluster sampling technique was employed to select 794 postpartum women. Data were entered by EPI DATA version 4.6 and exported to SPSS version 25 for further analysis. The multivariable logistic regression analysis was carried out to identify factors associated with postpartum depression. The adjusted odds ratio with its 95% confidence interval at a p-value of ≤ 0.05 was used to declare the level of significance.

Results

A total of 794 women were included in the analysis, giving a response rate of 98.5%. The prevalence of postpartum depression was 17.25% (95% CI: 14.5, 20.2). Younger maternal age (AOR = 2.72, 95% CI: 1.23, 5.85), low average monthly income (AOR = 2.71, 95% CI: 1.24, 5.91), low decision-making power (AOR = 2.04, 95%CI: 1.31, 3.18), low husband/partner involvement in MNCH care service (AOR = 2.34, 95%CI: 1.44, 3.81), unplanned pregnancy (AOR = 3.16 95% CI: 1.77, 5.62), and experience of intimate partner violence (AOR = 3.13; 95% CI: 1.96, 4.99) were significantly associated with increased odds of postpartum depression.

Conclusion

In this study, nearly 1/5^th of the study participants had postpartum depression. Thus, it is important to integrate maternal mental health services with the existing maternal health care services. It is also crucial to advocate the need for husband’s involvement in MNCH care services and ensure women’s decision-making power in the household. Moreover, community-based sexual and reproductive health education would be better to reduce risk factors of postpartum depression.

Perinatal depression and its impact on infant outcomes and maternal-nurse SMS communication in a cohort of Kenyan women

BACKGROUND

Perinatal depression is broadly defined as depressive symptoms during pregnancy or within the 12 months following delivery, affecting approximately 20-25% of pregnant and postpartum women in low- and middle-income countries. The wide accessibility of mobile phones allows mobile health (mHealth) interventions to be considered a solution to identify perinatal depression and provide appropriate referrals for treatment. This study, nested in a larger SMS communication project, examined the prevalence and correlates of perinatal depression, determined the association between antenatal depression and infant morbidity and mortality, and compared SMS communication patterns between women with and without perinatal depression.

METHODS

This was a prospective longitudinal cohort study of pregnant women seeking antenatal services at two public sector health clinics in Kenya. SMS messages were sent to participants with educational content related to their pregnancy and infant health and two-way SMS communication occurred with a nurse. Sociodemographic and obstetric characteristics, SMS messaging behaviors, infant health status, and depressive symptoms were assessed by a standardized questionnaire administered at enrollment (30-36 weeks gestation) and follow-up (14 weeks postpartum). Generalized estimating equation (GEE) with Poisson link was used to evaluate correlates of perinatal depressive symptoms, infant outcomes, and frequency of SMS messaging.

RESULTS

Of the 572 women with complete follow-up information, 188 (32.9%) screened positive for elevated depressive symptoms (≥10 by EPDS scale) at some time point during pregnancy or postpartum. The strongest predictors of any depressive symptoms included interpersonal abuse during pregnancy, fewer years of schooling, and maternal unemployment. Antenatal depressive symptoms were associated with an increased risk of infant illness or hospitalization (RR = 1.12, 95% CI: 1.11, 1.13). Women with antenatal or persistent perinatal depressive symptoms sent fewer SMS messages during the study period than their counterparts without depression.

CONCLUSIONS

Prevalence of elevated perinatal depressive symptoms was high in this cohort of Kenyan women. Our findings highlight the importance of screening perinatal women for experiences of symptoms of depression as well as abuse. Differences in messaging frequency between women with vs. without depressive symptoms presents an opportunity to provide more tailored support for those perinatal depression.

Effects of an evidence-based nursing intervention on prevention of anxiety and depression in the postpartum period

Postpartum depression has been one of the most common psychological disorders in patients during postpartum period. The constant anxiety and depression during this period seriously affect the physiological and psychological health of both the mother and infant. Evidence-based nursing has been widely applied in clinical practice and has achieved remarkable results. However, the effect of evidence-based nursing on postpartum depression remains unclear. Pregnant women who were not diagnosed with postpartum depression during hospitalisation (Edinburgh Postpartum Depression Scale [EPDS] ≤ 13 points) but prone to postpartum depression (EPDS scores of 9-13) were recruited into the study. They were randomly divided into the Intervention group (N = 60) and Control group (N = 60). Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), EPDS and Pittsburgh Sleep Quality Index (PSQI) were used to investigate the psychological outcomes of puerperae during and after the 6-week intervention. Both the intention-to-treat and per-protocol analyses showed that 6 weeks of evidence-based nursing intervention significantly reduced the incidence of postpartum depression. The application of the evidence-based nursing also improved the patients' satisfaction degree and effectively alleviated their anxiety according to both the intention-to-treat and per-protocol analyses. Evidence-based nursing intervention had positive effects against anxiety and depression in the postpartum period.

"If it weren't for my traditional healer, I would be dead": Engaging traditional healers to support people living with HIV in rural Mozambique

Across rural sub-Saharan Africa, people living with HIV (PLHIV) commonly seek out treatment from traditional healers. We report on the clinical outcomes of a community health worker intervention adapted for traditional healers with insight into our results from qualitative interviews. We employed a pre-post intervention study design and used sequential mixed methods to assess the impact of a traditional healer support worker intervention in Zambézia province, Mozambique. After receiving a positive test result, 276 participants who were newly enrolled in HIV treatment and were interested in receiving home-based support from a traditional healer were recruited into the study. Those who enrolled from February 2016 to August 2016 received standard of care services, while those who enrolled from June 2017 to May 2018 received support from a traditional healer. We conducted interviews among healers and participants to gain insight into fidelity of study activities, barriers to support, and program improvement. Medication possession ratio at home (based on pharmacy pick-up dates) was not significantly different between pre- and post-intervention participants (0.80 in the pre-intervention group compared to 0.79 in the post-intervention group; p = 0.96). Participants reported receiving educational and psychosocial support from healers. Healers adapted their support protocol to initiate directly observed therapy among participants with poor adherence. Traditional healers can provide community-based psychosocial support, education, directly observed therapy, and disclosure assistance for PLHIV. Multiple factors may hinder patients' desire and ability to remain adherent to treatment, including poverty, confusion about medication side effects, and frustration with wait times at the health facility.

Prevalence and Risk Factors Associated With Postpartum Depressive Symptoms Among Women in Vientiane Capital, Lao PDR

Postpartum depression (PPD), the onset of depressive episodes after childbirth, is the most common psychological condition following childbirth, and a global public health concern. If undiagnosed and/or untreated, postpartum depression can have negative effects on maternal and child health, however, there are few studies on the prevalence of postpartum depression in low- and middle-income countries. To contribute to filling this gap, this study examined the prevalence and risk factors associated with postpartum depressive symptoms among women after delivery in Vientiane Capital, Lao PDR. The study was a cross-sectional design, with multistage sampling used to identify women between 4 and 24 weeks after giving birth (N = 521). The Edinburgh Postnatal Depression Scale was used to identify women with postpartum depressive symptoms. Univariate and multivariate logistic regressions identified risk factors associated with postpartum depressive symptoms. The prevalence of postpartum depressive symptoms among participants was 21.3%. Associated factors were having at least 2-3 living children (AOR: 1.9, 95% CI: 1.1-3.0), experiencing mental health problems during pregnancy (AOR: 3.3, 95% CI: 1.4-7.6), experiencing conflicts with family members (AOR: 2.5, 95% CI: 1.5-4.0), the experience of intimate partner violence (AOR: 2.6, 95% CI: 1.3-5.5), and receiving moderate social support (AOR: 5.6, 95% CI: 3.2-10.0). In contexts where access to mental health specialists has severely constrained maternal and child healthcare providers at primary health care must be supported to develop the necessary skills to identify risk factors and symptoms and offer basic essential services for postpartum depressive symptom (PDS). The study identified a high proportion of mothers with postnatal depressive symptoms, highlighting the need to screen and treat mothers who present with PDS, as not doing so exposes mother and their children to a range of negative health and social outcomes. Addressing the stigma associated with mental health illness and mental health illness and domestic violence that prevents women from seeking healthcare, must also be developed, implemented, and evaluated.

Effect of perinatal depression on birth and infant health outcomes: a systematic review and meta-analysis of observational studies from Africa

Background

Antenatal depression is associated with intrauterine growth retardation, preterm birth, and low birth weight. Infants born to mothers with postnatal depression also may suffer from malnutrition and other health problems. Even though there are few single studies conducted so far, a systematic review of these studies is highly important to highlight the effect of antenatal and perinatal depression on adverse birth and infant health outcomes in Africa.

Methods

We used the Preferred Report Items for Systematic Review and Meta-analysis (PRISMA) when conducting this study. Databases like CINAHL (EBSCO), MEDLINE (via Ovid and PubMed), PsycINFO, Emcare, Psychiatry Online, and Scopus were searched. In addition, Google Scholar and references from a list of eligible studies were explored. We included good quality observational studies based on Newcastle Ottawa Scale which are published in the English language between 2007 and 2018.  Heterogeneity and publication bias were assessed. Meta-analysis with a random effect model was employed to determine the pooled effect sizes with a 95% confidence interval. The review protocol is registered in PROSPERO (CRD42018106714).

Result

We found three studies (1511 participants) and 11 studies (22,254 participants) conducted on the effect of antenatal depression on birth outcomes and perinatal depression on adverse infant health outcomes, respectively. The overall risk of having adverse birth outcomes was 2.26 (95% CI: 1.43, 3.58) times higher among pregnant mothers with depression. The risk of preterm birth and low birth weight was 1.77 (95% CI: 1.03, 3.04) and 2.98 (95% CI: 1.60, 5.55) respectively. Similarly, the risk of having adverse infant health outcomes namely malnutrition and febrile illness was 1.61 (95% CI: 1.34, 1.95) times higher among mothers who had perinatal depression.

Conclusions

We have found a significant association between antenatal depression and adverse birth outcomes, low birth weight and preterm birth. Similarly, a significant effect of perinatal depression on adverse infant health outcomes namely, malnutrition, and febrile illnesses was observed. The findings highlight that it is time to integrate mental health services with routine maternal health care services to improve birth outcomes and reduce infant morbidity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00792-8.

Characterization and stratification of the correlates of postpartum depression in sub-Saharan Africa: A systematic review with meta-analysis

Postpartum depression (PPD) is a common mental health challenge in resource-constrained sub-Saharan Africa (SSA). Characterizing its correlates will aid prediction, early detection, and pre-emptive interventions. This review aimed to systematically synthesize and stratify PPD correlates in sub-Saharan Africa. The review was structured as per the Preferred Reporting Item for Systematic Reviews and Meta-Analyses. We included studies that reported the correlates of PPD in SSA. We searched PubMed, Medline, CINAHL, Academic Search Complete, and PsycINFO for relevant peer-reviewed literature. The correlates of PPD constituted the primary outcome. A random effect model was fitted to estimate the pooled correlation coefficient per correlate. The clinical relevance of correlates was stratified based on strength of correlation (r) and recurrence (f). The mean age of the participants was 27.0 ± 6.0 years, and 68.6% of participants had completed at least secondary education. The correlates of PPD in SSA were intimate partner violence (IPV) ((risk weight (rw) = 2.8; r = 0.212 (confidence interval (CI): 0.11-0.31), poor social support (PSS) (rw = 1.9; r = 0.250 (0.133-0.361)), unwanted pregnancy (UP) (rw = 1.6; r = 0.279 (CI: 0.14-0.41); I2 = 95.89), and maternal age (MA) (rw = 0.96; r = 0.27 (CI: 0.154-0.37)), among others. A cumulative risk weight of ⩾0.95 was predictive of PPD and marks the critical point at which preemptive interventions should be instituted. The stratification of risk PPD factors and computation of risk stability index are useful in identifying the clinical significant risk factors. The provision of critical risk point will simplify early detection thus facilitating cost-effectiveness. Of the correlates of PPD in SSA, IPV, PSS, UP, and MA are the most important. Targeted screening and pre-emptive interventions for women with high risk weight may be a reasonable strategy both in the short and long term.

A meta-analysis on burden of postpartum depression and its predictors among lactating women in East African countries from 1998 up to 2018

Objective:

Postpartum depression is a common mental illness that affects lactating women. This not only makes daily activities difficult for them, but it also affects child’s future lives. There is little evidence of about postpartum depression and its factors in East African countries, which piqued the authors’ interest in conducting a study on this matter for future decision- and policy-making.

Methods:

The protocol for Preferred Reporting Items for Systematic Reviews and Meta-Analyses was followed. To identify published articles, all major databases such as PubMed/MEDLINE, WHOLIS, Cochrane Library, Embase, PsycINFO, ScienceDirect, Web of Science, and reference lists were used. In addition, shelves, author contact, Google and Google Scholar were also used to identify unpublished studies. Joanna Briggs Institute—Meta-Analysis of Statistical Assessment and Review Instrument was used for critical appraisal of studies. STATA software version 14 was used for the analysis. The random-effect model was used to estimate postpartum depression with 95% confidence interval, while subgroup analysis and meta-regression were used to identify potential sources of heterogeneity and associated factors, respectively. Furthermore, Egger’s test and trim-and-fill analysis were used to check for publication bias.

Results:

Postpartum depression was found in 24% of lactating women in East African countries (95% confidence interval: 17.79–30.20). Postpartum depression was associated with being married (odds ratio = 2; 95% confidence interval: 1.05–3.81), domestic violence (odds ratio = 6.34; 95% confidence interval: 4:11–9.78), a lack of support (odds ratio = 6.59; 95% confidence interval: 1.98–21.89), and a lack of empowerment (odds ratio = 2.79; 95% confidence interval: 1.12–6.92).

Conclusion:

In East Africa, the prevalence of postpartum depression among lactating women is high and rising, as per global postpartum depression estimates. Therefore, the primary focus should be on women’s domestic violence prevention mechanisms. Existing national policies and development agendas must prioritize strategies for women’s support and empowerment. Future research into the relationship between marriage and postpartum depression is required.

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

Depression among pregnant women living with HIV (WLWH) in sub-Saharan Africa leads to poor pregnancy and HIV outcomes. This cross-sectional analysis utilized enrollment data from a randomized trial (Mobile WAChX, NCT02400671) in six Kenyan public maternal and child health clinics. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), stigma with the Stigma Scale for Chronic Illness, and intimate partner violence (IPV) with the Abuse Assessment Screen. Correlates of moderate-to-severe depressive symptoms ("depression", PHQ-9 score ≥10) were assessed using generalized estimating equation models clustered by facility. Among 824 pregnant WLWH, 9% had depression; these women had more recent HIV diagnosis than those without depression (median 0.4 vs. 2.0 years since diagnosis, p = .008). Depression was associated with HIV-related stigma (adjusted Prevalence Ratio [aPR]:2.36, p = .025), IPV (aPR:2.93, p = .002), and lower social support score (aPR:0.99, p = .023). Using population-attributable risk percent to estimate contributors to maternal depression, 81% were attributable to stigma (27%), recent diagnosis (24%), and IPV (20%). Integrating depression screening and treatment in prevention of mother-to-child HIV transmission programs may be beneficial, particularly in women recently diagnosed or reporting stigma and IPV.

"I Found Out I was Pregnant, and I Started Feeling Stressed": A Longitudinal Qualitative Perspective of Mental Health Experiences Among Perinatal Women Living with HIV

Globally, depressive symptoms among pregnant and postpartum (i.e., perinatal) women living with HIV (WLWH) are alarmingly high and associated with poor outcomes such as suboptimal adherence to antiretroviral therapy (ART), and early cessation of exclusive breastfeeding (EBF). Few qualitative studies have described the experience of perinatal depression among WLWH to identify the underlying social-structural determinants of poor mental health and potential strategies to intervene. We conducted a longitudinal qualitative study applying semi-structured interviews with 30 WLWH at three timepoints (28-38 weeks pregnant, 6-weeks postpartum and 5-7 months postpartum) to understand mental health experiences of perinatal WLWH in western Kenya. Financial insecurity emerged as the central theme impacting the mental health of women across time. Financial insecurity was often attributed to the loss of employment, related to pregnancy and the demands of breastfeeding and caring for an infant, as well as a lack of support from male partners. The loss of income and subsequent financial strain contributed to worsening levels of food insecurity and relationship stress and challenged engagement in HIV care. In this way, increased financial strain during the perinatal period negatively impacted the mental health of perinatal WLWH. Our findings suggest support to meet basic needs and remain engaged in HIV care during pregnancy and postpartum could improve perinatal mental health for WLWH in this setting.

Predictors of fear of childbirth and depressive symptoms among pregnant women: a cross-sectional survey in Pwani region, Tanzania

BACKGROUND

Many women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors.

METHODS

A cross-sectional study was conducted at six health facilities in two districts in Tanzania between 2018 and 2019. In total, 694 pregnant women with gestational age between 32 and 40 weeks and expecting vaginal delivery were consecutively recruited and assessed for FoB and DS. We collected data through interviews using 6 and 4-points Likert Scale of the Wijma Delivery Expectancy Questionnaire Version A and Edinburgh Postnatal Depression Scale, respectively. Women who scored ≥66 and ≥ 10 were categorised as having FoB and DS, respectively. We performed multivariable logistic regression to investigate the predictors of FoB and DS.

RESULTS

The prevalence rates of FoB and DS among pregnant women were 15.1 and 17.7%, respectively. FoB and DS were more likely in women aged above 30 years [Adjusted Odds Ratio (AOR) 6.29, 95%CI 1.43-27.84] and in single mothers (AOR 2.57, 95%CI 1.14-5.78). Women with secondary education and above (AOR 0.22, 95%CI 0.05-0.99) and those who had given birth previously (AOR 0.27, 95% CI 0.09-0.87) were less likely to have FoB in combination with DS Women who had previous obstetric complications, and those who did not receive any social support from male partners in previous childbirth were more likely to have FoB and DS. FoB was strongly associated with DS (AOR 3.42, 95%CI 2.12-5.53). DS only was more common in women who had inadequate income (AOR 2.35, 95%CI 1.38-3.99) or had previously experienced a perineal tear (AOR 2.32, 95%CI 1.31-4.08).

CONCLUSIONS

Not having a formal education, having only primary education, being aged above 30 years, being single, being nulliparous, having experienced obstetric complications, and having a lack of social support from a male partner during previous pregnancy and childbirth were predictors of FoB and DS during pregnancy. FoB and DS were strongly associated with each other. It is vital to identify at-risk women early, to offer support during pregnancy and childbirth.

Psychosocial challenges and individual strategies for coping with mental stress among pregnant and postpartum adolescents in Nairobi informal settlements: a qualitative investigation

BACKGROUND

This study was part of a project funded under the Grand Challenges Explorations initiative to engage adolescent girls living in the main slums of Nairobi. This involved an innovative co-creation initiative through jointly designing and testing the feasibility of a toolkit of information, skill, and confidence-building, and coping mechanisms that can effectively shield them and their peers against the risks of mental stress during pregnancy and early motherhood.

METHODS

Qualitative interviews and discussions from visual methodologies including Photovoice, digital storytelling, and public service announcements were conducted with 30 pregnant and adolescent mothers aged 14-19 years in four informal settlements either pregnant or having a child less than 2 years. The aims included; to generate an inventory of mental stressors during pregnancy and early motherhood; understand how mental stress affects the ability to seek care for themselves and their child, and understand individual coping strategies.

RESULTS

The psychosocial challenges identified in order of importance included: chased from home by the parents; economic hardship; neglect and abandonment by the person responsible for the pregnancy; stigmatization by family, friends, and the community; feelings of shattered dreams; and daily stress related to living in poor and unhygienic conditions. During the pregnancy and early motherhood, the participants experienced feelings of embarrassment, shame, hopelessness, and to the extreme, suicidal thoughts clouded their minds. Main coping strategies included social isolation for some, socializing with other pregnant and adolescent mothers, and negative behaviors like the uptake of illicit drugs and alcohol and risky sexual relationships.

CONCLUSION

The unpreparedness for early motherhood infused with inadequate psychosocial support led to increased mental stress and risk of depression. The interconnection between the triggers to mental stress showed the need to focus on a multifaceted approach to address the wellbeing of pregnant and adolescent mothers.

Nutritional Factors Associated With Maternal Depression Among Pregnant Women in Urban Low-Income Settlements in Nairobi, Kenya

BACKGROUND

Nutritional deficiencies are common during pregnancy and a year after childbirth. At the same time, maternal depression affects many women during pregnancy up to 1 year after childbirth. The objectives of this study were to determine the associations between nutrition status, dietary intake, and maternal depression among pregnant women.

METHODS

This was a cross-sectional study that included 262 pregnant women aged 15 to 49 years attending the antenatal clinic in 2 public health facilities in urban low-income settlements in Nairobi, Kenya. Maternal depression was assessed using Edinburgh Postnatal Depression Scale (EPDS). Mid-upper arm circumference (MUAC) was used to determine nutritional status. Dietary intake was assessed using the 24-hour recall, and brain essential nutrients were assessed through a questionnaire. Odds ratio was used to test the associations. All maternal characteristics with P < .001 in the univariable analysis were considered in the multivariable logistic regression, variables with P < .05 were considered significant.

RESULTS

Of the 262 pregnant women, 33.6% (95% CI: 27.9-40.7) had depressive illness as indicated by EPDS >13. About 9.9% of pregnant women had MUAC < 23 cm. The study established statistically significant association between poor nutrition by MUAC and maternal depression (P < .001). Maternal depression was statistically significantly associated with inadequate intake of brain food essential (P = .002). Maternal depression was statistically significantly associated with lower income (P < .001). In multivariable regression analysis, the main predictor of maternal depression was poor nutrition (P < .004).

CONCLUSION

These findings reveal an association between poor nutrition and maternal depression. These results suggest that nutritional deficiencies could be a contributing factor for maternal depression. Study recommends dietary interventions as cost-effective way to reduce deficiencies and improve mental health problems for pregnant women. Assessment of maternal depression and dietary intake be integrated as fundamental components of antenatal care.

Effectiveness of a brief psychoeducational intervention on postnatal depression in the slums, Nairobi: a longitudinal study

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.

Effect of perinatal depression on risk of adverse infant health outcomes in mother-infant dyads in Gondar town: a causal analysis

BACKGROUND

Approximately one-third of pregnant and postnatal women in Ethiopia experience depression posing a substantial health burden for these women and their families. Although associations between postnatal depression and worse infant health have been observed, there have been no studies to date assessing the causal effects of perinatal depression on infant health in Ethiopia. We applied longitudinal data and recently developed causal inference methods that reduce the risk of bias to estimate associations between perinatal depression and infant diarrhea, Acute Respiratory Infection (ARI), and malnutrition in Gondar Town, Ethiopia.

METHODS

A cohort of 866 mother-infant dyads were followed from infant birth for 6 months and the cumulative incidence of ARI, diarrhea, and malnutrition were assessed. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess the presence of maternal depression, the Integrated Management of Newborn and Childhood Illnesses (IMNCI) guidelines were used to identify infant ARI and diarrhea, and the mid upper arm circumference (MUAC) was used to identify infant malnutrition. The risk difference (RD) due to maternal depression for each outcome was estimated using targeted maximum likelihood estimation (TMLE), a doubly robust causal inference method used to reduce bias in observational studies.

RESULTS

The cumulative incidence of diarrhea, ARI and malnutrition during 6-month follow-up was 17.0% (95%CI: 14.5, 19.6), 21.6% (95%CI: 18.89, 24.49), and 14.4% (95%CI: 12.2, 16.9), respectively. There was no association between antenatal depression and ARI (RD = - 1.3%; 95%CI: - 21.0, 18.5), diarrhea (RD = 0.8%; 95%CI: - 9.2, 10.9), or malnutrition (RD = -7.3%; 95%CI: - 22.0, 21.8). Similarly, postnatal depression was not associated with diarrhea (RD = -2.4%; 95%CI: - 9.6, 4.9), ARI (RD = - 3.2%; 95%CI: - 12.4, 5.9), or malnutrition (RD = 0.9%; 95%CI: - 7.6, 9.5).

CONCLUSION

There was no evidence for an association between perinatal depression and the risk of infant diarrhea, ARI, and malnutrition amongst women in Gondar Town. Previous reports suggesting increased risks resulting from maternal depression may be due to unobserved confounding.

Perinatal depressive symptoms and breastfeeding behaviors: A systematic literature review and biosocial research agenda

BACKGROUND

Breastfeeding is recommended to improve maternal and infant health globally. Depression has been posited to negatively impact breastfeeding, although potential causal and bidirectional pathways between these two phenomena have not been sufficiently characterized. We therefore conducted a systematic review to critically evaluate available evidence on the relationship between perinatal depressive symptoms and breastfeeding behaviors; to identify knowledge gaps and propose a biosocial research agenda to advance our understanding of this topic.

METHODS

A systematic search strategy was applied across seven databases. Data were extracted and aggregated using the matrix method to provide a narrative synthesis of findings.

RESULTS

Thirty-eight studies from 20 countries spanning 1988 through 2018 fit the inclusion criteria. In general, methods across studies were heterogeneous. Fourteen different tools were used to measure perinatal depressive symptoms. Nearly half the studies did not provide breastfeeding definitions. No studies from low-income countries met inclusion criteria. More than half (63%) of studies demonstrated a negative association between depressive symptoms across the perinatal period and less exclusive breastfeeding and/or shorter breastfeeding durations.

LIMITATIONS

Heterogeneity in study design, definitions, assessment tools, and measurement time points limited the comparability of study findings. Causality cannot be assessed.

CONCLUSIONS

Available evidence suggests perinatal depressive symptoms negatively associated with breastfeeding exclusivity and duration, which can lead to suboptimal infant nutrition and detrimental impacts on maternal mental and physical health. To better understand this relationship, we propose including consistent operationalization and assessment of depression and breastfeeding globally and concurrent repeated measures of key biological and social factors.

Effect of postpartum depression on exclusive breast-feeding practices in sub-Saharan Africa countries: a systematic review and meta-analysis

BACKGROUND

Postpartum depression (PPD) is a serious mood disorder that affects behavioural, physical and mental health of women and newborn after childbirth. Although a wide range of research have been conducted on maternal and infant health outcomes, the effect of postpartum depression on exclusive breastfeeding practices remains ambiguous, and needs addressing. The aim of this study was to assess the effect of postpartum depression on exclusive breast feeding practices in sub-Saharan African countries.

METHODS

PubMed, Google Scholar, Science Direct and Cochrane Library were systematically searched for relevant articles published between 2001 and 2020. STATA version 14 was used to calculate the pooled odd ratio with 95% confidence intervals (95% CI). The DerSimonian and Laird random effects meta-analysis was used to measure the effect of postpartum depression on exclusive breast feeding practices. The heterogeneity and publication bias were assessed by using I² test statistics and Egger's test, respectively. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis.

RESULT

A total of 1482 published articles and gray literatures were retrieved from different databases. Additional articles were identified from the reference list of identified reports and articles. After assessment of obtained articles, studies not meeting the inclusion criteria were excluded. Twenty six studies involving 30,021 population met the inclusion criteria were included in this review. In sub Saharan Africa the overall estimated level of postpartum depression was 18.6% (95% CI: 13.8, 23.4). This review found that postpartum depression had no significant effect on exclusive breast feeding practices (OR = 0.46, 95% CI: 0.18, 1.14).

CONCLUSION

In Sub Saharan Africa, the prevalence of postpartum depression was lower than the report of World Health Organization for developing Country in 2020. This review reveled that maternal postpartum depression has no significant effect on exclusive breast feeding practices. Thus, the investigators strongly recommend the researchers to conduct primary studies using strong study design in sub-Saharan Africa.

A Study on Postpartum Depression and its Association with Infant Feeding Practices and Infant Nutritional Status among Mothers Attending the Anganwadi Centers of Valsad District, Gujarat, India

Background:

Systematic reviews on postpartum depression (PPD) suggest that PPD mothers are more likely to interrupt exclusive breastfeeding with inappropriate feeding practices resulting malnutrition in child. A community-based study was planned with the objective to find the risk factors associated with PPD and its possible association on infant feeding practices and infant nutritional status.

Materials and Methods:

This was a cross-sectional study conducted among 116 postpartum mothers attending Anganwadi centers under the Urban Health Training Centre and Rural Health Training Centre of Medical College. A purposive sampling technique was applied. Informed and written consent in local language was taken. Data were collected in predesigned, pretested, and semi-structured pro forma. The mothers were screened for possible PPD using the 10-item well-validated Edinburgh PPD Scale in Gujarati language. The cutoff point is score more than 10.5 based on previous studies. Infant's nutritional status and breastfeeding practices were assessed according to the WHO Growth Chart and Infant and Young Child Feeding guidelines.

Results:

(1) 6.8% of the prevalence of PPD was reported in the study; (2) sociodemographic factors such as relationship of mothers with in-laws/husbands, help at home in childcare, literacy status, age at marriage and first child, and own desired/in-laws of sex of child are found to be significantly associated with PPD. (3) The Association of PPD and poor nutritional status of child was statistically significant.

Conclusions:

The study highlights the need of screening for PPD in the community. The potential risk factors for PPD can be taken into consideration during routine antenatal/postnatal care and for planning of preventive strategies.

Risk factors and experiences of prepartum depression in urban- low-income settlement Nairobi Kenya: a mixed-method study

Background: Prepartum depression is common among pregnant women and has not been studied much in low and middle-income countries. Evidence shows that mental illnesses are prevalent in urban than in rural areas. The study objective was to determine the magnitude of prepartum depression, risk factors, and real-life experiences of depression among pregnant women.

Method: A mixed-method cross-sectional study was conducted. It included 262 pregnant women attending antenatal clinics in two public health facilities in urban low-income settlement Nairobi, Kenya. Edinburgh Postnatal Depression Scale (EPDS) with cut-off >13 was used to classify clinical depressive illness. Further, a focus group discussion was conducted with 20 women identified with depression. Univariable analysis with Odd's Ratio was used to test associations. Variables with a p<0.05 in multivariable regression were considered significant.

Result: Out of the 262 women, 33.6% were found to have clinical depression as indicated by EPDS score of >13. Women's gestational age was statistically significantly associated with prepartum depression [OR 4.27 (95% C.I. 2.08 - 8.79),  p<0.001]. Income level ≤ 5000 KES was statistically significantly associated with prepartum depression [OR 3.64 (95% C.I.1.25 -10.60), p=0.018]. Further, thematic analysis of qualitative indicated that poverty, lack of social support, domestic violence, and unfriendly health care were major contributors to prepartum depression.

Conclusion: Significant numbers of pregnant women were found to experience depression. This prevalence rate indicates a high disease burden of women who live with depression, which is not diagnosed because screening of depression is not done in primary health care centers. This study calls for a need and consideration for screening for perinatal depression in primary health care facilities, mainly in resource-poor areas. Interventions targeting means of resolving conflicts in families are highly needed. Such steps would help achieve key sustainable development goals where maternal and child health remains key priority.

The relationship between caregivers' feeding practices and children's eating behaviours among preschool children in Ethiopia

Preschool age is a time when distinct eating behaviours are formed. Eating behaviours have been associated with underweight and poor growth as well as with overweight. However, the relationship between caregivers' feeding practices and children's eating behaviours remains poorly understood in developing countries. This study aims to evaluate the association between caregivers' feeding practices and eating behaviours among preschool children in Ethiopia. We conducted a school-based cross-sectional study among 542 caregivers of children aged between three and six years old. We used the Children Eating Behaviour Questionnaire and the Child Feeding Questionnaire to measure eating behaviour and caregivers' feeding practices respectively. A multiple linear regression was fitted to determine the association between caregivers' feeding practices and the multiple scales of children's eating behaviour while adjusting for potential confounders. Children whose caregivers practice food restriction tended to be more food responsive (β = .23, p < .001), tend to emotionally overeat (β = .09, p < .01), enjoy food more (β = 0.23, p < .001) and have more desire to drink (β = .24, p < .001). Meanwhile, children whose caregivers practiced pressure to eat were fussier about food (β = .09, p < .001), were more satiety responsive (β = .13, p < .001) and tended to eat slower (β = .10, p < .01). In Ethiopia, where under- and over-nutrition coexist among pre-school children, the results from this study underscore the importance of investigating eating behaviours at an early age, as these eating styles may contribute to children's poor nutritional status. It is also essential to include appropriate child eating behaviour and specific feeding practices components, together with responsive feeding in national nutritional programmes to improve the nutritional status of children aged 24-59 months.

The magnitude of postpartum depression among mothers in Africa: a literature review

Introduction

postpartum depression (PPD) continues to become one of the major maternal health challenges across the globe but there is a paucity of recent data on its magnitude in Africa. This study was motivated by the need to update the current magnitude of PPD in Africa based on various assessment tools.

Methods

a total of 21 articles met the study criteria. Fifteen articles used the EPDS and six used other assessment tools. Postpartum depression among studies that used EPDS tool ranged from 6.9% in Morocco to 43% in Uganda and 6.1% in Uganda to 44% in Burkina Faso among studies that used other depression assessment tools. Sensitivity and specificity results of the EPDS ranged from 75%-100% and 87%-98% respectively.

Results

a total of 21 articles met the study criteria. Fifteen articles used the EPDS and six used other assessment tools. Postpartum depression among studies that used EPDS tool ranged from 6.9% in Morocco to 43% in Uganda and 6.1% in Uganda to 44% in Burkina Faso among studies that used other depression assessment tools. Sensitivity and specificity results of the EPDS ranged from 75%-100% and 87%-98% respectively.

Conclusion

despite the limited dearth of literature, the magnitude of PPD in Africa remains high which suggests that PPD is still a neglected illness and calls for immediate interventions. EPDS is an effective tool with high sensitivity and specify in varying study contexts.

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

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.

Postnatal depression and its association with adverse infant health outcomes in low- and middle-income countries: a systematic review and meta-analysis

Background

Postnatal Depression (PND) is a mood disorder that steals motherhood and affects the health and development of a newborn. While the impact of PND on motherhood and newborn in developed countries are well described, its epidemiology and health consequences in infant is not well known in middle-and low-income countries. The objective of this review was to determine the burden and association of PND with adverse infant health outcomes in low-and middle- income countries.

Methods

We searched observational studies written in the English language and conducted in middle-and low-income countries between December 1st, 2007, and December 31st, 2017. The CINHAL, MEDLINE, Emcare, PubMed, Psych Info, and Scopus databases were searched for the following search terms: PND, acute respiratory infection, pneumonia, diarrhea, exclusive breastfeeding, common infant illnesses, and malnutrition. We excluded studies in which the primary outcomes were not measured following a standardized approach. We have meta-analyzed the estimates from primary studies by adjusting for possible publication bias and heterogeneity. The analysis was conducted in Stata 14. The study was registered in PROSPERO protocol number CRD42017082624.

Result

Fifty-eight studies on PND prevalence (among 63,293 women) and 17 studies (among 32,454 infants) on infant health outcomes were included. PND prevalence was higher in the low-income countries (Pooled prevalence (PP) = 25.8%; 95%CI: 17.9–33.8%) than in the middle-income countries (PP = 20.8%; 95%CI: 18.4–23.1%) and reached its peak in five to ten weeks after birth. Poor obstetric history and social support, low economic and educational status, and history of exposure to violence were associated with an increased risk of PND. The risk of having adverse infant health outcomes was 31% higher among depressed compared to non-depressed postnatal mothers (Pooled relative risk (PRR) = 1.31; 95%CI: 1.17–1.48). Malnutrition (1.39; 1.21–1.61), non-exclusive breastfeeding (1.55; 1.39–1.74), and common infant illnesses (2.55; 1.41–4.61) were the main adverse health outcomes identified.

Conclusions

One in four and one in five postnatal mothers were depressed in low and middle-income countries, respectively. Causes of depression could be explained by social, maternal, and psychological constructs. High risk of adverse infant health outcomes was associated with PND. Timely screening of PND and evidence-based interventions were a pressing need in low and middle-income countries.

Maternal depression is associated with child undernutrition: A cross-sectional study in Ethiopia

Child undernutrition is widespread in low- and middle-income countries (LMIC) and is associated with health and economic losses. Undernutrition is estimated to contribute to 3.1 million deaths per year in children less than 5 years of age. A complex causal and contextual factors contributing to child undernutrition have been assessed, but maternal depression, which could contribute to child undernutrition by interfering with the mother's child caring practice and ability, has been received little attention. The objective of this study was to assess the association between maternal postpartum depression symptoms and infant (5-10 months of age) stunting in northern Ethiopia. A community-based cross-sectional study was conducted among mother-infant pairs (n = 232) between March and April 2018. Through interviewer-administrated questionnaire, information on sociodemographic variables were collected, and maternal depression symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS≥13). Infants' length and weight were measured and converted to length and weight for age Z scores using the WHO growth standards. Breastfeeding was a norm, but the adequacy of complementary feeding practice was sub-optimal. Only 25% of the infants met the minimum meal frequency (MMF), less than 10% met the minimum dietary diversity (MMD; 9%) or minimum acceptable diet (7%). Maternal depression was prevalent (22.8%) and was significantly associated with inappropriate complementary feeding and stunting (P < .05). Improving complementary feeding practices is central to preventing stunting in this and other settings. However, such efforts should integrate interventions that address maternal depression to improve child feeding and caring practices to effectively prevent stunting.

The Relationship Between Postpartum Depression and Lower Maternal Confidence in Mothers with a History of Depression During Pregnancy

The objective of the present study is to evaluate the association of postpartum depression and low maternal confidence in a sample of women who had depression during pregnancy. Cross-sectional study performed from 2013 to 2015 with 346 postpartum women who had participated in an intervention to treat their depression during pregnancy. This study used the Maternal Confidence Questionnaire and the Patient Health Questionnaire 9-item scale. The prevalence ratio, adjusted and non-adjusted, and the 95% CI were calculated using Poisson regression with robust variance. Multivariate models estimated the Prevalence Ratios between postpartum depression and low maternal confidence adjusted for socio-demographic variables and maternal characteristics. Statistical analysis was performed with the STATA12. Among a sample of women who were depressed during pregnancy, only 19% had probably moderate to severe depression and nearly half, 48%, reported high maternal confidence in the postpartum period. In the fully adjusted model, women with moderate/severe probable depression showed increased risk of lower maternal confidence in comparison to women without probable depression Prevalence Ratio = 1.37 (95% CI 1.10-1.71). The results reinforce the importance of the evaluation of maternal confidence feelings in primary care particularly for women with more severe forms of depression.

Burden of HIV-Related Stigma and Post-Partum Depression: A Cross-Sectional Study of Patients Attending Prevention of Mother-to-Child Transmission Clinic at Kenyatta National Hospital in Nairobi

Background: We look at how various HIV-related stigma subtypes, especially internalizing types, interact with postpartum depression (PPD) among women living with HIV. Additionally, we identify key psychosocial risk factors that influence stigma and PPD among women attending Prevention of Mother-to-Child Transmission (PMTCT) clinics. Methods: In this cross-sectional design, 123 women living with HIV were recruited. Participants ages between 18 and 50, who were at least 8 weeks postpartum seeking PMTCT services at Kenyatta National Hospital (KNH), between June and September 2014 participated in the study. HIV/AIDS Stigma Instrument-PLWHA (HASI-P) was used to assesses stigma and Postpartum depression was assessed by Edinburgh Postnatal Depression Scale (EPDS). Bivariate and multivariate regression models were used to determine the individual characteristics associated with the HIV-related stigma Scale. Post survey a few in-depth-interviews were conducted to explore individuals' stigma and depression experiences. Results: The mean age was 31.2 years (SD = 5.2). Fifty-nine (48%) women screened positive for significant depressive symptoms. Post-partum depression was a significant predictor of internalized stigma, enacted, and total stigma (P < 0.05). Older age was associated with less internalized stigma. Living with a partner was associated with more internalized stigma. Having an income above 100 USD per month was protective against stigma. Having good family social support was protective against internalized stigma. A higher educational level was protective against enacted stigma. Being treated for STIs was a risk factor for both enacted and overall stigma. Conclusions: HIV-related stigma needs to be addressed through integrated mental health care programs in PMTCT. Postpartum depression requires comprehensive management to improve short- and long-term outcomes of women living with HIV.

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

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.

Postpartum depression and associated factors among mothers who gave birth in the last twelve months in Ankesha district, Awi zone, North West Ethiopia

BACKGROUND

Postpartum depression is the most common complication of childbearing age women and is a considerable public health problem. The transition into motherhood is a difficult period that involves significant changes in the psychological, social and physiological aspects, and has increased vulnerability for the development of mental illness. More than 1 in 10 pregnant women and 1 in 20 postnatal women in Ethiopia suffer from undetected depression.

METHODS

Community based cross sectional study was conducted among 596 postpartum mothers in Ankesha District, North West Ethiopia, from February 01 to March 2, 2018. One stage cluster sampling technique was employed to get the study participants. The objective was to assess the prevalence and associated factors of postpartum depression among mothers who gave birth in the last Twelve months in Ankesha District, Awi Zone, North West Ethiopia, 2018. The interviewer-administered questionnaire was used to collect data and Eden Burg Postpartum Depression Scale was used to assess postpartum depression with cutoff point ≥8. The data were entered into Epi data version 3.1 and exported to SPSS version 24 for analysis. All variables with P < 0.25 in the bivariate analysis were included in the final model and statistical significance was declared at P < 0.05.

RESULT

In this study, a total of 596 study participants were involved making a response rate of 97.4%, the prevalence of postpartum depression was 23.7% with 95%CI: 20.3-27.2. From the participant mothers who are divorced/widowed/unmarried (AOR = 3.45 95%CI: 1.35-8.82), unwanted pregnancy (AOR = 1.95 95%CI: 1.14-3.33), unpreferred infant sex (AOR = 1.79 95%CI: 1.13-2.86), infant illness (AOR = 2.08 95%CI: 1.30-3.34) and low social support (AOR = 3.16 95% CI: 1.55-6.43) was independent predictors of postpartum depression.

CONCLUSION

Almost a quarter (23.7%) of women suffers from postpartum depression. Marital status, unwanted pregnancy, unwanted infant sex, infant illness, and low social support were independent predictors of postpartum depression. Therefore, integration of mental illness with maternal and child health care is important, information communication education and behavioral change communications on postpartum depression are better been given attention.