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Kabunga A, Tumwesigye R, Kigongo E, Musinguzi M, Acup W, Auma AG. Systematic review and meta-analysis of postpartum depression and its associated factors among women before and after the COVID-19 pandemic in Uganda. BMJ Open 2024; 14:e076847. [PMID: 39089714 PMCID: PMC11293379 DOI: 10.1136/bmjopen-2023-076847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/19/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVE This meta-analysis aimed to estimate the national prevalence of postpartum depression (PPD) in Uganda and identify predictors in both pre-COVID-19 and post-COVID-19 eras. DESIGN Used a systematic review and meta-analysis methodology. DATA SOURCES Reviewed papers were sourced from Medline/PubMed, PsycINFO, CINAHL/EBSCOhost, Google Scholar, ScienceDirect and African Journals Online. ELIGIBILITY CRITERIA FOR SELECTED STUDIES The review encompassed observational studies published on PPD in Uganda from 1 January 2000 to 30 November 2023. RESULTS 11 studies (involving 7564 participants) published from 1 January 2000 to 30 November 2023 were reviewed. The pooled prevalence of PPD in Uganda was 29% (95% CI 21% to 37%, I2=98.32%). Subgroup analysis indicated a similar prevalence before (29%, 95% CI 20% to 39%) and during (28%, 95% CI 22% to 32%) the COVID-19 period. Special groups exhibited a higher prevalence (32%, 95% CI 16% to 47%) than general postpartum women (28%, 95% CI 19% to 37%). Factors associated with PPD included poor social support (OR 1.19, 95% CI 1.17 to 1.22, I2=96.8%), maternal illness (OR 1.22, 95% CI 1.19 to 1.26, I2=96.9%), poor socioeconomic status (OR 1.43, 95% CI 1.40 to 1.46, I2=99.5%) and undergoing caesarean section (OR 1.15, 95% CI 1.12 to 1.17, I2=80.6%). Surprisingly, there was a marginal decrease in PPD during the COVID-19 period. Subgroup analysis highlighted a higher prevalence among mothers with HIV. CONCLUSION This study underscores the significant prevalence of PPD in Uganda, with sociodemographic factors increasing risk. Despite a slight decrease during the COVID-19 period, the importance of prioritising maternal mental health is emphasised, considering sociodemographic factors and pandemic challenges, to improve maternal and child health outcomes and overall well-being.
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Affiliation(s)
- Amir Kabunga
- Department of Psychiatry, Lira University, Lira, Uganda
| | | | - Eustes Kigongo
- Lira University, Lira, Uganda
- Public Health, Lira University, Lira, Uganda
| | | | - Walter Acup
- Public Health, Lira University, Lira, Uganda
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Goh HQ, Nelson LE, Teo WZ, Aidoo-Frimpong G, Ramos SR, Shorey S. Perspectives and thoughts of pregnant women and new mothers living with HIV receiving peer support: A mixed studies systematic review. J Adv Nurs 2024; 80:2715-2727. [PMID: 38093472 DOI: 10.1111/jan.16014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/31/2023] [Accepted: 11/26/2023] [Indexed: 06/13/2024]
Abstract
AIM The aim of this study was to systematically consolidate evidence on perspectives and thoughts of women living with HIV regarding the peer support they have encountered during pregnancy and after childbirth. DESIGN Mixed studies systematic review. DATA SOURCES PubMed, EMBASE, Cochrane, PsycINFO, CINAHL, Scopus and ProQuest were sourced from 1981 to January 2022. METHODS A convergent qualitative synthesis approach was used to analyse the data. Quality appraisal was performed using the Mixed Methods Appraisal Tool. RESULTS A total of 12 studies were included, involving 1596 pregnant women and 1856 new mothers living with HIV. An overarching theme, 'From One Mother to Another: The Supportive Journey of Pregnant Women and New Mothers Living with HIV', and two themes were identified: (1) Emotional support buddies and extended networks and (2) Link bridge to healthcare support and self-empowerment. CONCLUSION Peer support played an indispensable role in the lives of women living with HIV and served as a complementary support system to professional and family support. IMPACT What problem did the study address? Pregnant women and new mothers living with HIV face preconceived stigma and discrimination. What were the main findings? Peer support was perceived to be beneficial in enhancing emotional support among women living with HIV and was well-accepted by them. Where and on whom will the research have an impact? Healthcare providers and community social workers could develop or enhance peer support educational programmes tailored to pregnant women and new mothers living with HIV. Policymakers and administrators can leverage public awareness, advocacy and political will to formulate and implement policies and campaigns aimed at fostering awareness and receptivity towards peer support interventions. REPORTING METHOD Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Huang Qi Goh
- National Kidney Foundation, Singapore, Singapore
| | - LaRon E Nelson
- Yale School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Wei Zhou Teo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gloria Aidoo-Frimpong
- Yale AIDS Prevention Training Program, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - S Raquel Ramos
- School of Nursing, Yale University, Orange, Connecticut, USA
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
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Bridget Spelke M, Okumu E, Perry NR, Blette BS, Paul R, Schiller CE, Ncheka JM, Kasaro MP, Price JT, Meltzer-Brody S, Stringer JSA, Stringer EM. Acceptability of a Randomized Trial of Anti-depressant Medication or Interpersonal Therapy for Treatment of Perinatal Depression in Women with HIV. AIDS Behav 2024; 28:1123-1136. [PMID: 38353877 PMCID: PMC10940463 DOI: 10.1007/s10461-023-04264-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 03/16/2024]
Abstract
Postpartum depression (PPD) affects nearly 20% of postpartum women in Sub-Saharan Africa (SSA), where HIV prevalence is high. Depression is associated with worse HIV outcomes in non-pregnant adults and mental health disorders may worsen HIV outcomes for postpartum women and their infants. PPD is effectively treated with psychosocial or pharmacologic interventions; however, few studies have evaluated the acceptability of treatment modalities in SSA. We analyzed interviews with 23 postpartum women with HIV to assess the acceptability of two depression treatments provided in the context of a randomized trial. Most participants expressed acceptability of treatment randomization and study visit procedures. Participants shared perceptions of high treatment efficacy of their assigned intervention. They reported ongoing HIV and mental health stigma in their communities and emphasized the importance of social support from clinic staff. Our findings suggest a full-scale trial of PPD treatment will be acceptable among women with HIV in Zambia.
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Affiliation(s)
- M Bridget Spelke
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, USA.
- University of North Carolina - Global Projects Zambia, 348 Independence Ave, Lusaka, Zambia, 10101.
| | - Eunice Okumu
- Social and Behavioral Science Core, Center for AIDS Research, University of North Carolina, Chapel Hill, USA
| | - Nzi R Perry
- Social and Behavioral Science Core, Center for AIDS Research, University of North Carolina, Chapel Hill, USA
| | - Bryan S Blette
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Ravi Paul
- Department of Psychiatry, University of Zambia School of Medicine, Lusaka, Zambia
| | - Crystal E Schiller
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, USA
| | - J M Ncheka
- Department of Psychiatry, University of Zambia School of Medicine, Lusaka, Zambia
| | - Margaret P Kasaro
- University of North Carolina - Global Projects Zambia, 348 Independence Ave, Lusaka, Zambia, 10101
| | - Joan T Price
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, USA
- University of North Carolina - Global Projects Zambia, 348 Independence Ave, Lusaka, Zambia, 10101
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Jeffrey S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, USA
- University of North Carolina - Global Projects Zambia, 348 Independence Ave, Lusaka, Zambia, 10101
| | - Elizabeth M Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, USA
- University of North Carolina - Global Projects Zambia, 348 Independence Ave, Lusaka, Zambia, 10101
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Ghahyazi K, Familiar-Lopez I, Culbert O, Uruchima J, Van Engen A, Cevallos W, Eisenberg JNS, Levy K, Lee GO. Correlates of maternal depression, anxiety and functioning across an urban-rural gradient in northern Ecuador. Glob Public Health 2024; 19:2291697. [PMID: 38084739 PMCID: PMC10787496 DOI: 10.1080/17441692.2023.2291697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023]
Abstract
Maternal depression remains under characterised in many low- and middle-income countries, especially in rural settings. We aimed to describe maternal depression and anxiety symptoms in rural and urban communities in northern Ecuador and to identify socioeconomic and demographic factors associated with these symptoms. Data from 508 mothers participating in a longitudinal cohort study were included. Depression and anxiety symptoms were assessed using the Hopkins Symptom Checklist (HSCL-25), and maternal psychological functioning was assessed using a checklist of daily activities. Tobit regression models were used to examine associations with sociodemographic variables and urbanicity. The median HSCL-25 score was 1.2 (IQR: 0.4) and 14% of women scored above the threshold for clinically relevant symptoms. Rural women reported similar food insecurity, less education, younger age of first pregnancy, and lower socio-economic status compared to their urban counterparts. After adjusting for these factors, rural women reported lower HSCL-25 scores compared to women lin urban areas (β = -0.48, 95%CI:0.65, -0.31). Rural residence was also associated with lower depression and anxiety HSCL-25 sub-scale scores, and similar levels of maternal functioning, compared to urban residence. Our results suggest that both household and community-level factors are risk factors for maternal depression and anxiety in this context.
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Affiliation(s)
- Kiana Ghahyazi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | - Oriana Culbert
- Rutgers Global Health Institute and Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey, USA
| | - Jessica Uruchima
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Amanda Van Engen
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - William Cevallos
- Instituto de Biomedicina, Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
| | - Joseph N S Eisenberg
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Karen Levy
- Department of Environmental and Occupational Health Sciences, University of Washington, School of Public Health, Seattle, Washington, USA
| | - Gwenyth O Lee
- Rutgers Global Health Institute and Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey, USA
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Bigley R, Barageine J, Nalubwama H, Neuhaus J, Mitchell A, Miller S, Obore S, Byamugisha J, Korn A, El Ayadi AM. Factors associated with reintegration trajectory following female genital fistula surgery in Uganda. AJOG GLOBAL REPORTS 2023; 3:100261. [PMID: 37719642 PMCID: PMC10502369 DOI: 10.1016/j.xagr.2023.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND A female genital fistula, primarily caused by prolonged obstructed labor or after cesarean delivery in resource-limited countries, affects 500,000 to 2,000,000 women worldwide. Fistula is preventable with timely access to high-quality obstetrical care. Access to surgical repair of a female genital fistula has greatly increased over time. However, research surrounding postrepair reintegration, the process of returning to an individual's normal life, remains limited, and further efforts are needed to understand the factors shaping women's ability to rebuild their relationships and lives following repair. OBJECTIVE This study aimed to characterize the 12-month reintegration trajectory after female genital fistula repair by participant sociodemographic and clinical characteristics. STUDY DESIGN This study analyzed quantitative survey and medical record data of women (N=60) participating in a longitudinal cohort study assessing recovery after genital fistula repair in Uganda, with baseline and 4 quarterly follow-up assessments in 12 months. The primary outcome of reintegration was assessed using a 19-item postfistula repair reintegration instrument (range, 0-100) where a higher score represents better reintegration. Predictors of interest included parity and living children, quality of life, depressive symptoms at baseline, self-esteem, stigma, trauma, physical symptoms, and social support. We described participant baseline characteristics using means and proportions and estimated a series of mixed-effects linear regression models, including interactions of characteristics with time to understand how these characteristics influence reintegration trajectory in the 12 months after repair. RESULTS The participants' physical and psychosocial morbidities at baseline were high; more than 80% of participants reported fistula-related physical symptoms, 82% of participants described their general health as poor, and measures of self-esteem, overall social support, and overall quality of life were low. The mean reintegration score at baseline was 33 (standard deviation, 20), which increased to 78 (standard deviation, 19) at 12 months after fistula repair. The participant sociodemographic characteristics statistically associated with reintegration included any living children (β, 1.08; 95% confidence interval, -0.08 to 2.23). Moreover, psychosocial factors significantly affected reintegration with steeper trajectories for women with depressive symptoms (β, 0.89; 95% confidence interval, 0.02-1.75) or women experiencing internalized stigma (β, 0.05; 95% confidence interval, -0.00 to 0.11) and less steep for those with higher self-esteem (β, -0.11; 95% confidence interval, -0.24 to 0.01), overall social support (β, -0.06; 95% confidence interval, -0.12 to -0.01), and partner support (β, -0.21; 95% confidence interval, -0.35 to -0.07). CONCLUSION Understanding the prominent factors associated with differences in reintegration trajectories across the year after genital fistula surgery has the potential to inform interventions that mitigate challenges and improve women's postrepair recovery experiences.
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Affiliation(s)
- Rachel Bigley
- University of California, San Francisco, School of Medicine, San Francisco, CA (Dr Bigley)
| | - Justus Barageine
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda (Drs Barageine, Ms Nalubwama, and Dr Byamugisha)
- Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda (Drs Barageine and Obore)
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda (Drs Barageine, Ms Nalubwama, and Dr Byamugisha)
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (Drs Neuhaus and El Ayadi)
| | - Ashley Mitchell
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA (Ms Mitchell)
| | - Suellen Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (Drs. Miller, Korn, and El Ayadi)
| | - Susan Obore
- Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda (Drs Barageine and Obore)
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda (Drs Barageine, Ms Nalubwama, and Dr Byamugisha)
| | - Abner Korn
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA (Ms Mitchell)
| | - Alison M. El Ayadi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (Drs Neuhaus and El Ayadi)
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA (Ms Mitchell)
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Wagner GJ, Gwokyalya V, Akena D, Nakigudde J, McBain R, Faherty L, Ngo V, Nakku J, Kyohangirwe L, Banegura A, Beyeza-Kashesya J, Wanyenze RK. Stressors and Maladaptive Coping Mechanisms Associated with Elevated Perinatal Depressive Symptoms and Suicidality Among Women Living with HIV in Uganda. Int J Behav Med 2023; 30:743-752. [PMID: 36127627 PMCID: PMC10084842 DOI: 10.1007/s12529-022-10124-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Perinatal depression is highly prevalent among women living with HIV and contributes to nonadherence to the PMTCT (prevention of mother-to-child transmission) care continuum. We examined correlates of elevated depressive symptoms and suicidality in this population. METHOD Baseline data from 391 Ugandan women enrolled in a cluster randomized controlled trial of a depression care intervention were analyzed. Adult women with confirmed sero-positive HIV status were eligible if their gestation period was ≤ 32 weeks, and they had a Patient Health Questionnaire (PHQ-9) score ≥ 5. Correlates of elevated depressive symptoms (PHQ-9 > 9) and moderate-to-severe suicidal ideation (more than half of the days in the prior 2 weeks) were assessed using bivariate and multivariate logistic regression models, controlling for clustering within study sites by using a random effects specification (with study site as the random effect), as well as age and education. RESULTS The mean PHQ-9 score was 12.7 (SD = 5.1); 267 (68.3%) participants had elevated depressive symptoms, and 51 (13.0%) reported moderate-to-severe suicidality. In multiple logistic regression analysis, perceived provider stigma of childbearing [OR (95% CI) = 1.81 (1.16, 2.84)], greater use of negative problem-solving [OR (95% CI) = 1.09 (1.04, 1.15)], and lower general social support [OR (95% CI) = 0.50 (0.30, 0.82)] were correlated with elevated depression symptoms, while moderate-to-severe suicidal ideation was correlated with greater experience of physical interpersonal violence (IPV) and greater use of negative problem-solving. CONCLUSIONS Programs aimed at improving provider support for the childbearing needs of persons living with HIV, supporting women who are experiencing IPV, and helping women to develop effective problem-solving skills and social supports may reduce symptoms of perinatal depression and help optimize PMTCT care outcomes. TRIAL REGISTRATION Clinicaltrials.gov NCT03892915 (registered March 21, 2019).
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Affiliation(s)
| | | | | | | | | | - Laura Faherty
- RAND Corporation, Santa Monica, CA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Victoria Ngo
- RAND Corporation, Santa Monica, CA, USA
- City University of New York Graduate School of Public Health and Health Policy, New York City, NY, USA
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Kaiyo-Utete M, Langhaug L, Chingono A, Dambi JM, Magwali T, Henderson C, Chirenje ZM. Antenatal depression: Associations with birth and neonatal outcomes among women attending maternity care in Harare, Zimbabwe. PLoS One 2023; 18:e0270873. [PMID: 37418441 PMCID: PMC10328234 DOI: 10.1371/journal.pone.0270873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/21/2022] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Antenatal depression is highly prevalent and is associated with negative birth and neonatal outcomes. However, the mechanisms and causality behind these associations remain poorly understood as they are varied. Given the variability in whether associations are present, there is need to have context-specific data to understand the complex factors that go into these associations. This study aimed to assess the associations between antenatal depression and birth and neonatal outcomes among women attending maternity care in Harare, Zimbabwe. METHODS We followed 354 pregnant women in second or third trimester, attending antenatal care services in two randomly selected clinics in Harare, Zimbabwe. Antenatal depression was assessed using the Structured Clinical Interview for DSM-IV. Birth outcomes included birth weight, gestational age at delivery, mode of delivery, Apgar score, and initiation of breastfeeding within one-hour postdelivery. Neonatal outcomes at six weeks postdelivery included infant's weight, height, illness, feeding methods and maternal postnatal depressive symptoms. The association between antenatal depression and categorical and continuous outcomes were assessed by logistic regression and point-biserial correlation coefficient, respectively. Multivariable logistic regression determined the confounding effects on statistically significant outcomes. RESULTS Prevalence of antenatal depression was 23.7%. It was associated with low birthweight [AOR = 2.30 (95% CI: 1.08-4.90)], exclusive breastfeeding [AOR = 0.42 (95%CI: 0.25-0.73)] and postnatal depressive symptoms [AOR = 4.99 (95%CI: 2.81-8.85)], but not with any other birth or neonatal outcomes measured. CONCLUSIONS The prevalence of antenatal depression in this sample is high with significant associations demonstrated for birth weight, maternal postnatal depressive symptoms and infant feeding methods Effective management of antenatal depression is thus crucial to the promotion of maternal and child health.
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Affiliation(s)
- Malinda Kaiyo-Utete
- Department of Primary Health Care Sciences, Mental Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- African Mental Health Research Initiative (AMARI), Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Lisa Langhaug
- African Mental Health Research Initiative (AMARI), Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Alfred Chingono
- Department of Primary Health Care Sciences, Mental Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jermaine M. Dambi
- African Mental Health Research Initiative (AMARI), Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- Department of Primary Health Care Sciences, Rehabilitation Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- The Friendship Bench, Harare, Zimbabwe
| | - Thulani Magwali
- Department of Primary Health Care Sciences, Obstetrics and Gynaecology Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Claire Henderson
- Department of Health Services and Population Research, King’s College London Institute of Psychiatry, Psychology and Neurosciences, London, United Kingdom
| | - Z. Mike Chirenje
- Department of Primary Health Care Sciences, Obstetrics and Gynaecology Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- Faculty of Medicine and Health Sciences, Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
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Kesande C, Bapolisi A, Kaggwa MM, Nakimuli-Mpungu E, Maling S, Ashaba S. Prevalence and factors associated with psychological distress among pregnant and non-pregnant youth living with HIV in rural Uganda: a comparative study. PSYCHOL HEALTH MED 2023; 28:344-358. [PMID: 35260003 PMCID: PMC9458768 DOI: 10.1080/13548506.2022.2050270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/01/2022] [Indexed: 02/08/2023]
Abstract
Youth living with HIV (YLHIV) are prone to psychological distress, which may have detrimental effects on health outcomes. Pregnant youth have poor access to HIV care increasing the risk of vertical transmission of HIV to their infants. Both HIV and pregnancy are independently associated with poor mental health among adolescents. The factors that predispose women to poor mental health may also increase their risk of contracting HIV. Despite their desire to have children YLHIV are at a high risk of psychological distress. However, factors associated with psychological distress among YLHIV in rural Uganda are not well explored. Therefore, the purpose of this study was to determine the prevalence of, and factors associated with psychological distress among pregnant and non-pregnant YLHIV in south western Uganda. We enrolled 224 YLHIV aged 15-24 years both pregnant and nonpregnant (ratio 1:1) between December 2018 and March 2019. We obtained information on psychological distress and factors hypothesized to affect mental health outcomes among people living with HIV including internalized HIV stigma, intimate partner violence, self-esteem and social support. Bivariate and multivariable logistic regression analysis were used to estimate factors independently associated with psychological distress. The prevalence of psychological distress was 48.2%% among pregnant YLHIV and 32.14% among non-pregnant YLHIV. Factors significantly associated with psychological distress among pregnant YLHIV were HIV stigma (AOR=4.61; 95% CI 1.63-13.84; P=0.004), physical abuse (AOR=4.97; 95% CI 1.41- 17.56; P= 0.013), and separation from partner (AOR =0.03; 95% CI 0.001-0.580; P=0.020).
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Affiliation(s)
- Claire Kesande
- Mbarara University of science and Technology, Mbarara, Uganda
| | - Achille Bapolisi
- Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | | | | | - Samuel Maling
- Mbarara University of science and Technology, Mbarara, Uganda
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Yeboa NK, Muwanguzi P, Olwit C, Osingada CP, Ngabirano TD. Prevalence and associated factor of postpartum depression among mothers living with HIV at an urban postnatal clinic in Uganda. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231158471. [PMID: 36852708 PMCID: PMC9986891 DOI: 10.1177/17455057231158471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Postpartum depression among mothers living with HIV is a significant public health problem due to its effects on engagement in care, HIV disease progression, and an increased risk of mother-to-child transmission of HIV. OBJECTIVE The objective of this study was to determine the prevalence and factors associated with postpartum depression among mothers living with HIV. DESIGN The study employed a cross-sectional quantitative research design. METHODS In this cross-sectional survey, we consecutively recruited 290 participants among mothers attending postnatal, immunization, and family planning clinics at an urban clinic in Uganda. Using an interviewer-administered questionnaire, we collected data on socio-demographics, obstetric, and HIV-related characteristics. Postpartum depression was assessed using the Patient Health Questionnaire version 9. We classified participants with Patient Health Questionnaire version 9 scores of ⩾10 as having postpartum depression. We conducted logistic regression to examine the association between postpartum depression and independent variables. RESULTS The prevalence of postpartum depression was 15.9%. After controlling for other variables, participants who reported poor male partner support were more likely to experience postpartum depression compared to those who had good partner support (adjusted odds ratio = 4.52, confidence interval = 2.31-8.84, p value < 0.001). CONCLUSION Mothers living with HIV should be routinely assessed for the presence of depression and male partner support. Health care providers of HIV-infected women should design strategies to promote male partner support for better maternal, infant, and HIV treatment outcomes.
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Affiliation(s)
- Naomi Kyeremaa Yeboa
- School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Patience Muwanguzi
- School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Connie Olwit
- School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Peter Osingada
- School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tom Denis Ngabirano
- School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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Rukundo GZ, Wakida EK, Karungi CK, Asasira J, Kumakech E, Obua C. Depression, suicidality, substance-use and associated factors among people living with HIV the COVID-19 pandemic in Uganda. PLoS One 2023; 18:e0285310. [PMID: 37146057 PMCID: PMC10162553 DOI: 10.1371/journal.pone.0285310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/19/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Mental disorders are common in people living with HIV (PLHIV) but they are often unrecognized and untreated. Furthermore, the COVID-19 pandemic has disrupted the already limited mental health services in low resource countries such as Uganda, and yet the extent to which the COVID-19 mitigation measures have affected the mental health of PLHIV is not fully known. We aimed to determine the burden of depression, suicidality, substance use and associated factors among adult PLHIV who were seeking care at two HIV clinics in northern and southwestern Uganda. METHODS We conducted a phenomenological qualitative and quantitative cross-sectional study among 431 PLHIV to determine the burden of depression, suicidality and substance-use disorders at two HIV clinics, at Lira Regional Referral Hospital and Mbarara Regional Referral Hospital in northern and southwestern Uganda respectively, during the COVID-19 lockdown. We used the Patient Health Questionnaire (PHQ-9) to assess for depression and suicidality, and the Michigan Assessment-Screening Test for Alcohol and drugs (MAST-AD) to assess for substance use disorder. We conducted descriptive statistics analysis to determine the burden of the disorders, and logistic regression to determine the associated factors. For the qualitative method we conducted in-depth interviews with 30 PLHIV and did thematic analysis. RESULTS Of the 431 PLHIV surveyed, mean age was 40.31 ± 12.20 years; 53.1% (n = 229) had depression; 22.0% (n = 95) had suicidality; and 15.1% (n = 65) had substance-use disorder. Female gender (PR = 1.073, 95%CI 1.004-1.148, P = 0.038), lack of formal education (PR = 1.197, 95% CI 1.057-1.357, P = 0.005), substance-use disorder (PR = 0.924, 95%CI 0.859-0.994, P = 0.034) and suicidality (PR = 0.757, 95%CI 0.722-0.794, p = 0.000) were associated with depression after adjusting for confounders. Further analysis showed that being female (PR = 0.843, 95% CI 0.787-0.903, P = 0.000*) and having depression (PR = 0.927, 95% CI 0.876-0.981, P = 0.009) and owning a large business (PR = 0.886, 95% CI 0.834-0.941, p = 0.000*) were significantly associated with having a substance-use disorder. Only depression was independently associated with suicidality after adjusting for confounding factors (PR 0.108, 95%CI 0.054-0.218, p = 0.000*). For the qualitative results, there were three apriori themes: a) Burden of depression, b) substance-use, and c) suicidality among the PLHIV during the COVID-19 containment measures. CONCLUSION There was high prevalence of depression, suicidality and substance-use disorder in adult PLHIV in Uganda during the COVID-19 pandemic and the associated lockdown measures. The three mental health problems seem to have bidirectional relationships and gender has a lot of contribution to the relationships. Interventions aimed at any of the disorders should consider these bidirectional relationships.
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Affiliation(s)
- Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edith K Wakida
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medical Education, California University of Science and Technology, Milpitas, CA, United States of America
| | - Christine K Karungi
- Office of Research Administration, Mbarara University of Science and Technology Mbarara, Mbarara, Uganda
| | - Jenipher Asasira
- Office of Research Administration, Mbarara University of Science and Technology Mbarara, Mbarara, Uganda
| | - Edward Kumakech
- Department of Nursing and Midwifery, Faculty of Health Sciences, Lira University, Lira, Uganda
| | - Celestino Obua
- Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Mbarara, Uganda
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Concepcion T, Velloza J, Kemp CG, Bhat A, Bennett IM, Rao D, Polyak CS, Ake JA, Esber A, Dear N, Maswai J, Owuoth J, Sing'oei V, Bahemana E, Iroezindu M, Kibuuka H, Collins PY. Perinatal Depressive Symptoms and Viral Non-suppression Among a Prospective Cohort of Pregnant Women Living with HIV in Nigeria, Kenya, Uganda, and Tanzania. AIDS Behav 2023; 27:783-795. [PMID: 36210392 PMCID: PMC9944362 DOI: 10.1007/s10461-022-03810-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 12/14/2022]
Abstract
Depression is common during pregnancy and is associated with reduced adherence to HIV-related care, though little is known about perinatal trajectories of depression and viral suppression among women living with HIV (WLHV) in sub-Saharan Africa. We sought to assess any association between perinatal depressive symptoms and viral non-suppression among WLWH. Depressive symptomatology and viral load data were collected every 6 months from WLWH enrolled in the African Cohort Study (AFRICOS; January 2013-February 2020). Generalized estimating equations modeled associations between depressive symptoms [Center for Epidemiological Studies Depression (CES-D) ≥ 16] and viral non-suppression. Of 1722 WLWH, 248 (14.4%) had at least one pregnancy (291 total) and for 61 pregnancies (21.0%), women reported depressive symptoms (13.4% pre-conception, 7.6% pregnancy, 5.5% one-year postpartum). Depressive symptomatology was associated with increased odds of viral non-suppression (aOR 2.2; 95% CI 1.2-4.0, p = 0.011). Identification and treatment of depression among women with HIV may improve HIV outcomes for mothers.
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Affiliation(s)
- Tessa Concepcion
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jennifer Velloza
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Christopher G Kemp
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Ian M Bennett
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Allahna Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Nicole Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- US Army Medical Research Directorate-Africa, Kericho, Kenya
| | - John Owuoth
- U.S. Army Medical Research Directorate-Africa, Kisumu, Kenya
- HJF Medical Research International, Kisumu, Kenya
| | - Valentine Sing'oei
- U.S. Army Medical Research Directorate-Africa, Kisumu, Kenya
- HJF Medical Research International, Kisumu, Kenya
| | - Emmanuel Bahemana
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- HJF Medical Research International, Mbeya, Tanzania
| | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- HJF Medical Research International, Abuja, Nigeria
| | - Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Pamela Y Collins
- Department of Global Health, University of Washington, Seattle, WA, USA.
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
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Kulisewa K, Dussault JM, Gaynes BN, Hosseinipour MC, Go VF, Kutengule A, LeMasters K, Meltzer-Brody S, Midiani D, Mphonda SM, Udedi M, Pence BW, Bengtson AM. The feasibility and acceptability of a task-shifted intervention for perinatal depression among women living with HIV in Malawi: a qualitative analysis. BMC Psychiatry 2022; 22:833. [PMID: 36581849 PMCID: PMC9798611 DOI: 10.1186/s12888-022-04476-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Kazione Kulisewa
- Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Faculty of Medicine, Private Bag 360, Blantyre, Malawi
| | - Josée M Dussault
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Bradley N Gaynes
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mina C Hosseinipour
- UNC-Project Malawi, Lilongwe, Malawi
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Angela M Bengtson
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, Rhode Island, USA
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Kaggwa MM, Najjuka SM, Bongomin F, Mamun MA, Griffiths MD. Prevalence of depression in Uganda: A systematic review and meta-analysis. PLoS One 2022; 17:e0276552. [PMID: 36264962 PMCID: PMC9584512 DOI: 10.1371/journal.pone.0276552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
Abstract
Background Depression is one of the most studied mental health disorders, with varying prevalence rates reported across study populations in Uganda. A systematic review and meta-analysis was carried out to determine the pooled prevalence of depression and the prevalence of depression across different study populations in the country. Methods Papers for the review were retrieved from PubMed, Scopus, PsycINFO, African Journal OnLine, and Google Scholar databases. All included papers were observational studies regarding depression prevalence in Uganda, published before September 2021. The Joanna Briggs Institute Checklist for Prevalence Studies was used to evaluate the risk of bias and quality of the included papers, and depression pooled prevalence was determined using a random-effects meta-analysis. Results A total of 127 studies comprising 123,859 individuals were identified. Most studies were conducted among individuals living with HIV (n = 43; 33.9%), and the most frequently used instrument for assessing depression was the Depression sub-section of the Hopkins Symptom Checklist (n = 34). The pooled prevalence of depression was 30.2% (95% confidence interval [CI]: 26.7–34.1, I2 = 99.80, p<0.001). The prevalence of depression was higher during the COVID-19 pandemic than during the pre-pandemic period (48.1% vs. 29.3%, p = 0.021). Refugees had the highest prevalence of depression (67.6%; eight studies), followed by war victims (36.0%; 12 studies), individuals living with HIV (28.2%; 43 studies), postpartum or pregnant mothers (26.9%; seven studies), university students (26.9%; four studies), children and adolescents (23.6%; 10 studies), and caregivers of patients (18.5%; six studies). Limitation Significantly high levels of heterogeneity among the studies included. Conclusion Almost one in three individuals in Uganda has depression, with the refugee population being disproportionately affected. Targeted models for depression screening and management across various populations across the country are recommended. Trial registration Protocol registered with PROSPERO (CRD42022310122).
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Mbarara University of Science & Technology, Mbarara, Uganda
- African Centre for Suicide Prevention and Research, Mbarara, Uganda
- Department of Psychiatry and Behavioural Neurosciences, Forensic Psychiatry Program, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Sarah Maria Najjuka
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Mohammed A. Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Mark D. Griffiths
- Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
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Desalegn SY, Asaye MM, Temesgan WZ, Badi MB. Antenatal depression and associated factors among HIV-positive pregnant women in South Gondar zone public health facilities, northwest Ethiopia, a cross-sectional study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Sileo KM, Wanyenze RK, Schmarje Crockett K, Naigino R, Ediau M, Lule H, Kalichman SC, Lin CD, Menzies N, Bateganya MH, Kiene SM. Prevalence and correlates of depressive symptoms, and points of intervention, in rural central Uganda: results from a cross-sectional population-based survey of women and men. BMJ Open 2022; 12:e054936. [PMID: 35641013 PMCID: PMC9157366 DOI: 10.1136/bmjopen-2021-054936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The present study aimed to identify the prevalence and correlates of depressive symptoms and potential intervention points among women and men from a population-based sample in rural central Uganda. DESIGN A cross-sectional study. SETTING Four districts in rural Uganda. PARTICIPANTS Women and men aged 15-59 residing in four districts in rural Uganda accepting home-based HIV testing who completed a baseline survey at the time of testing. PRIMARY OUTCOME MEASURES Depressive symptoms measured by the 10-item Center for Epidemiological Studies Depression Scale using a cut-off score of 13 for significant depressive symptoms. RESULTS Among a sample of 9609 women and 6059 men, 1415 (14.7%) women and 727 (12.0%) men met criteria for significant depressive symptoms. Having ever received mental health services was associated with lower odds of significant depressive symptoms (women: adjusted OR (adjOR)=0.32, 95% CI=0.22 to 0.47; men: adjOR=0.36, 95% CI=0.18 to 0.62). Having received outpatient (women: adjOR=3.64, 95% CI=3.14 to 4.22; men: adjOR=3.37, 95% CI=2.78 to 4.07) or inpatient (women: adjOR=5.44, 95% CI=4.24 to 6.97; men: adjOR=3.42, 95% CI=2.21 to 5.28) care in the prior 6 months was associated with greater odds of significant depressive symptoms. For women only, known HIV positive status (adjOR=1.37, 95% CI=1.05 to 1.77), and for men only, alcohol misuse (adjOR=1.38, 95% CI=1.12 to 1.70), were associated with increased odds of significant depressive symptoms. CONCLUSION Our findings suggest that depression screening within outpatient and inpatient settings may help to identify people in need of mental health services. Routine screening in outpatient or inpatient clinics along with the implementation of evidence-based interventions could ultimately help close the mental health gap for depression in this and similar settings.
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
| | - Katherine Schmarje Crockett
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Rose Naigino
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Michael Ediau
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Haruna Lule
- Division of Health Systems Strengthening, Global Centre of Excellence in Health (GLoCEH), Kampala, Uganda
| | - Seth C Kalichman
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Chii-Dean Lin
- Department of Mathematics and Statistics, San Diego State University, San Diego, California, USA
| | - Nicolas Menzies
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Moses H Bateganya
- Infectious Diseases and Health Systems, FHI 360, Durham, North Carolina, USA
| | - Susan M Kiene
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
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Asiimwe R, Tseng C, Murray SM, Ojuka JC, Arima EG, Familiar‐Lopez I. Association of pregnancy‐related stigma and intimate partner violence with anxiety and depression among adolescents. J Adolesc 2022; 94:270-275. [DOI: 10.1002/jad.12008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Ronald Asiimwe
- Department of Human Development and Family Studies Michigan State University East Lansing Michigan USA
| | - Chi‐Fang Tseng
- Department of Human Development and Family Studies Michigan State University East Lansing Michigan USA
| | - Sarah M. Murray
- Department of Mental Health Johns Hopkins School of Public Health Baltimore Maryland USA
| | | | - Ethan G. Arima
- Makerere University Johns Hopkins University Research Collaboration Kampala Uganda
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Abebe W, Gebremariam M, Molla M, Teferra S, Wissow L, Ruff A. Prevalence of depression among HIV-positive pregnant women and its association with adherence to antiretroviral therapy in Addis Ababa, Ethiopia. PLoS One 2022; 17:e0262638. [PMID: 35051244 PMCID: PMC8775187 DOI: 10.1371/journal.pone.0262638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Vertical transmission of HIV remains one of the most common transmission modes. Antiretroviral therapy (ART) decreases the risk of transmission to less than 2%, but maintaining adherence to treatment remains a challenge. Some of the commonly reported barriers to adherence to ART include stress (physical and emotional), depression, and alcohol and drug abuse. Integrating screening and treatment for psychological problem such as depression was reported to improve adherence. In this study, we sought to determine the prevalence of depression and its association with adherence to ART among HIV-positive pregnant women attending antenatal care (ANC) clinics in Addis Ababa, Ethiopia.
Methods
We conducted a cross-sectional survey from March through November 2018. Participants were conveniently sampled from 12 health institutions offering ANC services. We used the Patient Health Questionnaire-9 (PHQ-9) to screen for depression and the Center for Adherence Support Evaluation (CASE) Adherence index to evaluate adherence to ART. Descriptive statistics was used to estimate the prevalence of depression during third-trimester pregnancy and nonadherence to ART. A bivariate logistic regression analysis was used to get significant predictors for each of the two outcome measures. The final multivariable logistic regression analysis included variables with a P<0.25 in the bivariate logistic regression model; statistical significance was evaluated at P<0.05.
Results
We approached 397 eligible individuals, of whom 368 (92.7%) participated and were included in the analysis. Of the total participants, 175(47.6%) had depression. The participants’ overall level of adherence to ART was 82%. Pregnant women with low income were twice more likely to have depression (AOR = 2.10, 95%CI = 1.31–3.36). Women with WHO clinical Stage 1 disease were less likely to have depression than women with more advanced disease (AOR = 0.16, 95%CI = 0.05–0.48). There was a statistically significant association between depression and nonadherence to ART (P = 0.020); nonadherence was nearly two times higher among participants with depression (AOR = 1.88, 95%CI = 1.08–3.27).
Conclusion
We found a high prevalence of depression among HIV-positive pregnant women in the selected health facilities in Addis Ababa, and what was more concerning was its association with higher rates of nonadherence to ART adversely affecting the outcome of their HIV care. We recommend integrating screening for depression in routine ANC services.
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Affiliation(s)
- Workeabeba Abebe
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Mahlet Gebremariam
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mitike Molla
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Larry Wissow
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Andrea Ruff
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
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Negesse A, Hune Y, Temesgen H, Getaneh T, Bekalu A. A meta-analysis on burden of postpartum depression and its predictors among lactating women in East African countries from 1998 up to 2018. SAGE Open Med 2022; 10:20503121221135403. [DOI: 10.1177/20503121221135403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- Ayenew Negesse
- Department of Human Nutrition, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Yidersail Hune
- Department of Human Nutrition, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Habtamu Temesgen
- Department of Human Nutrition, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Temesgen Getaneh
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Amare Bekalu
- Department of Human Nutrition, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Bedaso A, Adams J, Peng W, Sibbritt D. The association between social support and antenatal depressive and anxiety symptoms among Australian women. BMC Pregnancy Childbirth 2021; 21:708. [PMID: 34686140 PMCID: PMC8532351 DOI: 10.1186/s12884-021-04188-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background Antenatal depression and antenatal anxiety adversely affect several obstetric and foetal outcomes, and increase the rate of postnatal mental illness. Thus, to tackle these challenges the need for social support during pregnancy is vital. However, an extensive literature search failed to show a published study on the relationship between domains of social support and antenatal depressive, as well as antenatal anxiety symptoms in Australia. This study examined the association between domains of social support and antenatal depressive and anxiety symptoms among Australian women. Methods The current study used data obtained from the 1973–78 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH), focusing upon women who reported being pregnant (n = 493). Depression and anxiety were assessed using the 10 item Center for Epidemiological Studies Depression (CES-D-10) scale, and the 9-item Goldberg Anxiety and Depression scale (GADS) respectively. The 19 item-Medical Outcomes Study Social Support index (MOSS) was used to assess social support. A logistic regression model was used to examine the associations between domains of social support and antenatal depressive and anxiety symptoms after adjusting for potential confounders. Result The current study found 24.7 and 20.9% of pregnant women screened positive for depressive and anxiety symptoms respectively. After adjusting for potential confounders, our study found that the odds of antenatal depressive symptoms was about four and threefold higher among pregnant women who reported low emotional/informational support (AOR = 4.75; 95% CI: 1.45, 15.66; p = 0.010) and low social support (overall support) (AOR = 3.26; 95%CI: 1.05, 10.10, p = 0.040) respectively compared with their counterpart. In addition, the odds of antenatal anxiety symptoms was seven times higher among pregnant women who reported low affectionate support/positive social interaction (AOR = 7.43; 95%CI: 1.75, 31.55; p = 0.006). Conclusion A considerable proportion of pregnant Australian women had depressive symptoms and/or anxiety symptoms, which poses serious health concerns. Low emotional/informational support and low affectionate support/positive social interaction have a significant association with antenatal depressive and anxiety symptoms respectively. As such, targeted screening of expectant women for social support is essential. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04188-4.
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Affiliation(s)
- Asres Bedaso
- Hawassa University, College of Medicine and Health Sciences, School of Nursing, Hawassa, Ethiopia. .,Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Jon Adams
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Wenbo Peng
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - David Sibbritt
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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20
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Li KMC, Li KYC, Bick D, Chang Y. Human immunodeficiency virus-positive women's perspectives on breastfeeding with antiretrovirals: A qualitative evidence synthesis. MATERNAL & CHILD NUTRITION 2021; 17:e13244. [PMID: 34258858 PMCID: PMC8476435 DOI: 10.1111/mcn.13244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/03/2022]
Abstract
Human immunodeficiency virus (HIV)-positive women can breastfeed with minimal risk of mother-to-child transmission if taking antiretrovirals. Guidelines surrounding infant feeding for HIV-positive women have evolved several times over the last two decades. Our review aimed to explore perspectives of breastfeeding with antiretrovirals from HIV-positive women since the World Health Organization (2010) infant feeding and antiretroviral guidelines. HIV-positive pregnant and postnatal women from all countries/settings were eligible. HIV-positive women were either on an antiretroviral regimen at the time of the study, previously on an antiretroviral regimen, not initiated on a regimen yet, or enrolled in prevention of mother-to-child transmission (PMTCT) care. Quality assessment of all included studies were conducted. Four databases (CINAHL, EMBASE, MEDLINE and PsycINFO) were searched for studies conducted from January 2010 to October 2020. Nine papers were included in the review, of which two presented findings from the same study. Five analytical themes were developed via thematic synthesis: (1) awareness of breastfeeding with antiretrovirals, (2) turmoil of emotions, (3) coping mechanisms, (4) the intertwining of secret, stigma and support and (5) support needed. Support from family and health care professionals and coping approaches were important to overcome stigma and the emotional challenges of breastfeeding with antiretrovirals. Health care professionals should be familiar with the most updated national and local guidance surrounding infant feeding and antiretrovirals. Further research into interventions to encourage HIV-positive women to adhere and commit to lifelong antiretroviral treatment (Option B+) for breastfeeding is required.
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Affiliation(s)
- Kan Man Carmen Li
- Guy's and St. Thomas' NHS Foundation TrustEvelina London Children's HospitalLondonUK
| | - Kan Yan Chloe Li
- Institute of Cardiovascular ScienceUniversity College LondonLondonUK
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical SchoolUniversity of WarwickWarwickUK
| | - Yan‐Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
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21
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Nakku JEM, Nalwadda O, Garman E, Honikman S, Hanlon C, Kigozi F, Lund C. Group problem solving therapy for perinatal depression in primary health care settings in rural Uganda: an intervention cohort study. BMC Pregnancy Childbirth 2021; 21:584. [PMID: 34429087 PMCID: PMC8386083 DOI: 10.1186/s12884-021-04043-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perinatal depression is of substantial public health importance in low and middle income countries. The study aimed to evaluate the impact of a mental health intervention delivered by non-specialist health workers on symptom severity and disability in women with perinatal depression in Uganda. METHODS Pregnant women in the second and third trimester were consecutively screened using the Luganda version of the 9-item Patient Health Questionnaire (PHQ-9). Women who scored ≥5 on the PHQ-9 and who were confirmed to have depression by a midwife were recruited into a treatment cohort and offered a psychological intervention in a stepped care fashion. Women were assessed with PHQ-9 and WHODAS-2.0 at baseline and again at 3 and 6 months after the intervention. Negative regression analysis was done to examine change in PHQ-9 and WHODAS-2.0 scores from baseline to end line. Data were analysed using STATA version 14. RESULTS A total of 2652 pregnant women (98.3%) consented to participate in the study and 153 (5.8%) were diagnosed as depressed. Over a quarter (28.8%) reported having experienced physical interpersonal violence (IPV) while (25.5%) reported sexual IPV in the past year. A third (34.7%) of women diagnosed with depression received 4 or more group PST sessions. There was a mean reduction in PHQ-9 score of 5.13 (95%CI - 6.79 to - 3.47, p < 0.001) and 7.13 (95%CI - 8.68 to - 5.59, p < 0.001) at midline and endline, respectively. WHODAS scores reduced significantly by - 11.78 points (CI 17.64 to - 5.92, p < 0.001) at midline and - 22.92 points (CI 17.64 to - 5.92, p < 0.001) at endline. Clinical response was noted among 69.1% (95%CI 60.4-76.6%) and 93.7% (95%CI 87.8-96.8%) of respondents at midline and endline, respectively. CONCLUSION An evidence based psychological intervention implemented in primary antenatal care by trained and supervised midwives in a real-world setting may lead to improved outcomes for women with perinatal depression. Future randomised studies are needed to confirm the efficacy of this intervention and possibility for scale up.
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Affiliation(s)
| | - Oliva Nalwadda
- Butabika National Referral Mental Hospital, Kampala, Uganda.
| | - Emily Garman
- Department of psychiatry and mental health, University of Cape Town, Cape Town, South Africa
| | - Simone Honikman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.,Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fred Kigozi
- Butabika National Referral Mental Hospital, Kampala, Uganda
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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22
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Chipanta D, Stöckl H, Toska E, Chanda P, Mwanza J, Kaila K, Matome C, Tembo G, Estill J, Keiser O. Facing the quality of life: physical illness, anxiety, and depression symptoms among people living with HIV in rural Zambia - a cross-sectional study. AIDS Care 2021; 34:957-965. [PMID: 34383600 DOI: 10.1080/09540121.2021.1966693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Widespread access to ART has not improved the quality of life (QoL) for people living with HIV (PLHIV). We used the United Nations Disability project (UNPRPD) evaluation data to examine how physical illness, anxiety, and depression shape the QoL of PLHIV in households receiving the social cash transfers safety nets in Luapula, Zambia. We explored associations between each outcome - physical illness, anxiety, depression symptoms - and age, gender, poverty, hunger and disability, using univariable and multivariable regressions. We adjusted p-values for multiple hypothesis testing with sharpened Qs. The sample comprised 1925 respondents 16-55 years old, median age 31 (IQR 22-42 years), majority women (n = 1514, 78.6%). Two-thirds (1239, 64.4%) reported having a physical illness, a third (671, 34.9%) anxiety, and nine per cent (366) depression symptoms. More HIV positive people had a disability (34.6%, 53 versus 28.3%, 502; Q = 0.033), were physically ill (72.5%, 111 versus 63.7%, 1128; Q = 0.011), and two-fold (aOR 1.97 95% CI 1.31-2.94) more likely to report depression symptoms than HIV negative peers. Food insecurity and disability among PLHIV may worsen their physical illnesses, anxiety, depression symptoms, and other QoL domains. More research on the quality of life of PLHIV in poverty is required.
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Affiliation(s)
- David Chipanta
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Heidi Stöckl
- Institute for Medical Information Processing, Biometry, and Epidemiology Medical Faculty, Ludwig Maximilians University, München, Germany
| | - Elona Toska
- Department of Sociology, University of Cape Town, Rondebosch, South Africa
| | - Patrick Chanda
- Social Work and Sociology, University of Zambia, Lusaka, Zambia
| | - Jason Mwanza
- Social Work and Sociology, University of Zambia, Lusaka, Zambia
| | - Kelly Kaila
- Disability Inclusion Project Luapula, International Labour Organisation, Lusaka, Zambia
| | | | - Gelson Tembo
- Palm Associates Limited, Lusaka, Zambia.,Economics and Agricultural Sciences, University of Zambia, Lusaka, Zambia
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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23
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Atuhaire C, Rukundo GZ, Nambozi G, Ngonzi J, Atwine D, Cumber SN, Brennaman L. Prevalence of postpartum depression and associated factors among women in Mbarara and Rwampara districts of south-western Uganda. BMC Pregnancy Childbirth 2021; 21:503. [PMID: 34247576 PMCID: PMC8272966 DOI: 10.1186/s12884-021-03967-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) is a significant cause of maternal morbidity and has severe consequences on the well-being of mothers, new-borns, families, and communities. PPD reduces the mother's response to the child's needs. In severe cases, mothers suffering from PPD are prone to postpartum psychosis, commit suicide and, in rare cases, infanticide. We aimed to determine the prevalence and understand the factors associated with PPD among mothers in southwestern Uganda. METHODS This was a cross-sectional study between November 2019 and June 2020 among 292 mothers, 6 to 8 weeks' postpartum. Mothers were selected from three health facilities in southwestern Uganda and enrolled using stratified consecutive sampling. Postpartum depression was clinically diagnosed using the Diagnostic and Statistical Manual of Mental Disorders V. The factors associated with PPD were assessed by using a structured interviewer administered questionnaire. The factors were analyzed using bivariate chi square analyses and multivariate logistic regression. RESULTS Overall prevalence of PPD was 27.1% (95% CI: 22.2-32.5). This did not vary by the number of previous births or mode of birth. Five factors associated with PPD were low perceived social support, HIV positive status, rural residence, obstetrical complications and the baby crying excessively. CONCLUSION AND RECOMMENDATIONS Prevalence of PPD in Mbarara and Rwampara districts is higher than what has previously been reported in Uganda indicating an urgent need to identify pregnant women who are at increased risk of PPD to mitigate their risk or implement therapies to manage the condition. Midwives who attend to these mothers need to be empowered with available methods of mitigating prevalence and consequences of PPD. Women who are HIV positive, residing in rural settings, whose babies cry excessively, having low social support systems and who have birth complications may be a particularly important focus for Ugandan intervention strategies to prevent and reduce the prevalence of PPD.
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Affiliation(s)
- Catherine Atuhaire
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda.
| | - Godfrey Zari Rukundo
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Grace Nambozi
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Joseph Ngonzi
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Daniel Atwine
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Samuel Nambile Cumber
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Laura Brennaman
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
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24
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Schnittman SR, Byakwaga H, Boum Y, Kabakyenga J, Matthews LT, Burdo TH, Huang Y, Tracy RP, Haberer JE, Kembabazi A, Kaida A, Moisi D, Lederman MM, Bangsberg DR, Martin JN, Hunt PW. Changes in Immune Activation During Pregnancy and the Postpartum Period in Treated HIV Infection. Open Forum Infect Dis 2021; 8:ofab245. [PMID: 34159218 PMCID: PMC8214017 DOI: 10.1093/ofid/ofab245] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/12/2021] [Indexed: 12/30/2022] Open
Abstract
Background Pregnant women with HIV (PWWH) have high postpartum morbidity and mortality from infections like tuberculosis. Immunologic changes during pregnancy and postpartum periods may contribute to these risks, particularly the immunoregulatory kynurenine pathway of tryptophan catabolism, which contributes to both HIV and tuberculosis pathogenesis and increases in the early postpartum period. Methods Women with HIV initiating antiretroviral therapy (ART) in the Uganda AIDS Rural Treatment Outcomes (UARTO) cohort who were pregnant at enrollment or became pregnant during observation were studied (n = 54). Plasma kynurenine/tryptophan (KT) ratio, soluble CD14 (sCD14), sCD163, sCD27, interferon-inducible protein 10 (IP-10), D-dimer, interleukin-6, and intestinal fatty-acid binding protein levels were assessed through the first year of ART and at 3-month intervals throughout pregnancy and 1 year postpartum. Biomarker changes were assessed with linear mixed models adjusted for ART duration. Hemoglobin concentration changes were used to estimate pregnancy-related changes in plasma volume. Results The median pre-ART CD4 count was 134. D-dimer increased through the third trimester before returning to baseline postpartum, while most other biomarkers declined significantly during pregnancy, beyond what would be expected from pregnancy-associated plasma volume expansion. IP-10 and sCD14 remained suppressed for at least 12 months postpartum. KT ratio was the only biomarker that increased above prepregnancy baseline postpartum (mean + 30%; P < .001) and remained higher than baseline for ≥9 months (P ≤ .045 for all time points). Conclusions Several immune activation markers decline during pregnancy and remain suppressed postpartum, but the kynurenine pathway of tryptophan catabolism increases above baseline for ≥9 months postpartum. The mechanisms underlying postpartum kynurenine pathway activity are incompletely understood but may contribute to increased tuberculosis risk in this setting.
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Affiliation(s)
| | - Helen Byakwaga
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yap Boum
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Lynn T Matthews
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tricia H Burdo
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Yong Huang
- University of California San Francisco, San Francisco, California, USA
| | | | - Jessica E Haberer
- Massachusetts General Hospital and Harvard University, Boston, Massachusetts, USA
| | - Annet Kembabazi
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Angela Kaida
- Simon Fraser University, Vancouver, British Columbia, Canada
| | - Daniela Moisi
- Case Western Reserve University, Cleveland, Ohio, USA
| | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda.,Oregon Health and Sciences University and Portland State University School of Public Health, Portland, Oregon, USA
| | - Jeffrey N Martin
- University of California San Francisco, San Francisco, California, USA
| | - Peter W Hunt
- University of California San Francisco, San Francisco, California, USA
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25
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Venkatesh KK, Morrison L, Tuomala RE, Stek A, Read JS, Shapiro DE, Livingston EG. Profile of Chronic Comorbid Conditions and Obstetrical Complications Among Pregnant Women With Human Immunodeficiency Virus and Receiving Antiretroviral Therapy in the United States. Clin Infect Dis 2021; 73:969-978. [PMID: 33768226 DOI: 10.1093/cid/ciab203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To evaluate the frequency and associated characteristics of chronic comorbid conditions and obstetrical complications among pregnant women with human immunodeficiency virus (HIV) and receiving antiretroviral therapy (ART) in comparison to those without HIV. METHODS We compared 2 independent concurrent US pregnancy cohorts: (1) with HIV (International Maternal Pediatric Adolescent AIDS Clinical Trials Protocol P1025, 2002-2013) and (2) without HIV (Consortium for Safe Labor Study, 2002-2007). Outcomes were ≥2 chronic comorbid conditions and obstetrical complications. For women with HIV, we assessed whether late prenatal care (≥14 weeks), starting ART in an earlier era (2002-2008), and a detectable viral load at delivery (≥400 copies/mL) were associated with study outcomes. RESULTS We assessed 2868 deliveries (n = 2574 women) with HIV and receiving ART and 211 910 deliveries (n = 193 170 women) without HIV. Women with HIV were more likely to have ≥2 chronic comorbid conditions versus those without HIV (10 vs 3%; adjusted OR [AOR]: 2.96; 95% CI: 2.58-3.41). Women with HIV were slightly less likely to have obstetrical complications versus those without HIV (both 17%; AOR: .84; 95% CI: .75-.94), but secondarily, higher odds of preterm birth <37 weeks. Late entry to prenatal care and starting ART in an earlier era were associated with a lower likelihood of ≥2 chronic comorbidities and obstetrical complications; detectable viral load at delivery was associated with a higher likelihood of obstetric complications. CONCLUSIONS Pregnant women with HIV receiving ART have more chronic comorbid conditions, but not necessarily obstetrical complications, than their peers without HIV.
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Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio, USA
| | - Leavitt Morrison
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ruth E Tuomala
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Alice Stek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer S Read
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, USA
| | - David E Shapiro
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth G Livingston
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
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26
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Social and Demographic Factors Associated with Postnatal Depression Symptoms among HIV-Positive Women in Primary Healthcare Facilities, South Africa. Healthcare (Basel) 2021; 9:healthcare9010065. [PMID: 33445414 PMCID: PMC7826739 DOI: 10.3390/healthcare9010065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Mothers living with HIV are at risk for mental health problems, which may have a negative impact on the management of their HIV condition and care of their children. Although South Africa has a high prevalence of HIV, there is a dearth of studies on sociodemographic predictors of postnatal depression (PND) among HIV-positive women in South Africa, even in KwaZulu Natal, a province with the highest prevalence of HIV in the country. Objective: The objective of the study was to determine sociodemographic factors associated with the prevalence of postnatal depression symptoms among a sample of HIV-positive women attending health services from primary healthcare facilities in Umhlathuze District, KwaZulu Natal. Methods: A quantitative cross-sectional survey was used to collect data from 386 HIV-positive women who had infants aged between 1 and 12 weeks. The Edinburgh Postnatal Depression Scale (EPNDS), to which sociodemographic questions were added, was used to collect data. Results: The prevalence of PND symptoms among this sample of 386 HIV-positive women was 42.5%. The age of the mothers ranged from 16 to 42 years, with a mean of 29 years. The majority of the mothers were single or never married (85.5%; n = 330), living in a rural setting (81.9%; n = 316%), with a household income of less than R 2000 (estimated 125 USD) per month (64.9%; n = 120). The government child support grant was the main source of income for most of the mothers (53%; n = 183). PND symptoms were significantly associated with the participant’s partner having other sexual partners (p-value < 0.001), adverse life events (p-value = 0.001), low monthly income (p-value = 0.015), and being financially dependent on others (p-value = 0.023). Conclusion: The prevalence of PND symptoms among the sample is high, with a number of social and demographic factors found to be significantly associated with PND. This requires the consideration of sociodemographic information in the overall management of both HIV and postnatal depression. Addressing the impact of these factors can positively influence the health outcomes of both the mother and the baby.
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27
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Gelaw MM, Zeleke EG, Asres MS, Reta MM. One-Third of Perinatal Women Living with HIV Had Perinatal Depression in Gondar Town Health Facilities, Northwest Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:887-895. [PMID: 33324114 PMCID: PMC7733382 DOI: 10.2147/hiv.s268686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
Background Depression is the most common co-morbidity among perinatal women living with HIV. It affects client’s adherence to care and treatment, which results in increased viral load; further exposing women to opportunistic infections that reduce quality-of-life. A cumulative effect of these may increase mother-to-child transmission of HIV. Methods An institution-based cross-sectional study was conducted among perinatal women living with HIV in Gondar town health facilities, Northwest Ethiopia from October 1–30, 2018. A single population proportion formula was used to calculate the sample size. The sample was stratified and proportionally allocated to each health facility. Participants were chosen from each stratum independently using a simple random sampling technique. A total of 422 study participants were selected. The World Health Organization (WHO) 20-item self-reported questionnaire (SRQ-20) was used to measure perinatal depression among women living with HIV. Perceived stigma was measured using HIV stigma scale. Women were interviewed at the PMTCT clinic during follow-up care, and clinical variables were extracted from client chart. Bi-variable and multivariable logistic regression models were used to identify factors associated with perinatal depression. Variables having an odds ratio with 95% confidence interval and a P-value less than 0.05 were taken as significant variables associated with perinatal depression. Results The prevalence of perinatal depression among women living with HIV was found to be 38.4% (95% CI=34.1–43.1%). Fair and poor ART drug adherence (AOR=5.44; 95% CI= 2.81–10.56%), the presence of comorbid illness (AOR=3.24; 95% CI: 1.83–5.75), being on second line ART (AOR=2.97; 95% CI=1.08–8.17), perceived stigma (AOR=3.61; 95% CI=2.11–6.17), and suicidal ideation (AOR=3.89; 95% CI=1.28–11.81) were factors associated with perinatal depression. Conclusion The prevalence of perinatal depression among women living with HIV was found to be high. Adherence counseling needs to be strengthened; preventing first line treatment failure has to be encouraged; greater emphasis has to be given for those women on second line ART. Early identification and management of co-morbidity has to be considered. HIV positive perinatal women need counseling to reduce HIV-related perceived stigma.
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Affiliation(s)
| | - Ejigu Gebeye Zeleke
- Department of Epidemiology and Biostatistics, Institution of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Silamsaw Asres
- Department of Internal Medicine, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Mebratu Mitiku Reta
- Department of Internal Medicine, School of Medicine, University of Gondar, Gondar, Ethiopia
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28
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Clinical and Obstetric Risk Factors for Postnatal Depression in HIV Positive Women: A Cross Sectional Study in Health Facilities in Rural KwaZulu-Natal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228425. [PMID: 33202528 PMCID: PMC7697934 DOI: 10.3390/ijerph17228425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
Postnatal depression (PND) remains underdiagnosed and undertreated in different socio-economic backgrounds in South Africa. This study determined the prevalence of and clinical and obstetric risk factors for PND symptoms among HIV positive women in health facilities in a rural health district in South Africa. The Edinburgh Postnatal Depression Scale was used to measure PND from 386 women who had delivered a live infant. More than half (58.5%) tested HIV positive during the current pregnancy. The prevalence of PND symptoms was 42.5%. Logistic regression analysis yielded significant associations between clinical and obstetric variables of pre-term baby (p-value < 0.01), baby health status p-value < 0.01), baby hospitalization, (p-value < 0.01), and knowing the baby’s HIV status (p-value = 0.047). Maternal variables associated with PND were level of education (p-value < 0.01), monthly income (p-value < 0.01), and source of income (p-value = 0.05). At multivariate analysis, none of the clinical and obstetrical risk factors were independently associated with the PND. The high prevalence of PND symptoms underscore the need to integrate routine screening for PND in prevention of mother to child transmission of HIV programmes to enable early diagnosing and treatment of PND.
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Atuhaire C, Brennaman L, Cumber SN, Rukundo GZ, Nambozi G. The magnitude of postpartum depression among mothers in Africa: a literature review. Pan Afr Med J 2020; 37:89. [PMID: 33244352 PMCID: PMC7680231 DOI: 10.11604/pamj.2020.37.89.23572] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/21/2020] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Catherine Atuhaire
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Laura Brennaman
- Nova Southeastern University College of Nursing, Fort Myers Campus, 3650 Colonial Court, Fort Myers, Florida, United State of America
| | - Samuel Nambile Cumber
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa.,Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.,School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Institute of Health and Care Sciences, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Godfrey Zari Rukundo
- Faculty of Medicine, Department of Psychiatry, Mbarara University of Science and Technology, Uganda
| | - Grace Nambozi
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
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Remmert JE, Mosery N, Goodman G, Bangsberg DR, Safren SA, Smit JA, Psaros C. Breastfeeding Practices Among Women Living with HIV in KwaZulu-Natal, South Africa: An Observational Study. Matern Child Health J 2020; 24:127-134. [PMID: 31832911 DOI: 10.1007/s10995-019-02848-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Exclusive breastfeeding (EBF) is the safest infant feeding option in resource-limited settings, though women living with HIV have the lowest rates of EBF. Barriers to EBF in the absences of a formal intervention in women living with HIV in KwaZulu-Natal, where the prevalence of HIV among pregnant women is among the highest in the world, are understudied. Thus, this study sought to describe barriers to EBF and examine differences in social support, disclosure status, mood, and HIV-related stigma among women with different feeding methods. METHODS Women living with HIV enrolled in preventing mother-to-child transmission treatment (n = 156) were interviewed postpartum (M = 13.1 weeks) at a district hospital and self-reported infant feeding method, reasons not breastfeeding (if applicable), and HIV disclosure status. Mood, HIV-related stigma, functional social support, and HIV-related social support were also assessed. RESULTS No participants reported mixed feeding, 30% reported EBF, and 70% reported exclusive formula feeding. Commonly reported reasons for not breastfeeding included fear of HIV transmission to the infant and being away from the infant for extended periods of time. Social support (p = 0.02) and HIV-related social support (p < 0.01) were significantly higher in women who had attempted breastfeeding compared to women who never attempted breastfeeding. DISCUSSION Rates of EBF in this sample are lower than in other recent studies, suggesting this sample experiences multiple barriers to EBF. Healthcare providers should seek to correct misconceptions regarding HIV transmission and breastfeeding practices. Social and logistical support for EBF may be important considerations for future interventions.
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Affiliation(s)
- Jocelyn E Remmert
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, USA
| | - Nzwakie Mosery
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Georgia Goodman
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
| | - David R Bangsberg
- School of Public Health, Oregon Health Sciences University - Portland State University, Portland, OR, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Jennifer A Smit
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa.,Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Christina Psaros
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.
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Psaros C, Smit JA, Mosery N, Bennett K, Coleman JN, Bangsberg DR, Safren SA. PMTCT Adherence in Pregnant South African Women: The Role of Depression, Social Support, Stigma, and Structural Barriers to Care. Ann Behav Med 2020; 54:626-636. [PMID: 32128556 PMCID: PMC7459185 DOI: 10.1093/abm/kaaa005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Depression is a robust predictor of nonadherence to antiretroviral (ARV) therapy, which is essential to prevention of mother-to-child transmission (PMTCT). Women in resource-limited settings face additional barriers to PMTCT adherence. Although structural barriers may be minimized by social support, depression and stigma may impede access to this support. PURPOSE To better understand modifiable factors that contribute to PMTCT adherence and inform intervention development. METHODS We tested an ARV adherence model using data from 200 pregnant women enrolled in PMTCT (median age 28), who completed a third-trimester interview. Adherence scores were created using principal components analysis based on four questions assessing 30-day adherence. We used path analysis to assess (i) depression and stigma as predictors of social support and then (ii) the combined associations of depression, stigma, social support, and structural barriers with adherence. RESULTS Elevated depressive symptoms were directly associated with significantly lower adherence (est = -8.60, 95% confidence interval [-15.02, -2.18], p < .01). Individuals with increased stigma and depression were significantly less likely to utilize social support (p < .01, for both), and higher social support was associated with increased adherence (est = 7.42, 95% confidence interval [2.29, 12.58], p < .01). Structural barriers, defined by income (p = .55) and time spent traveling to clinic (p = .31), did not predict adherence. CONCLUSIONS Depression and social support may play an important role in adherence to PMTCT care. Pregnant women living with HIV with elevated depressive symptoms and high levels of stigma may suffer from low social support. In PMTCT programs, maximizing adherence may require effective identification and treatment of depression and stigma, as well as enhancing social support.
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Affiliation(s)
- Christina Psaros
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Jennifer A Smit
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
- School of Pharmacy and Pharmacology, Faculty of Health Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Nzwakie Mosery
- MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Kara Bennett
- Bennett Statistical Consulting, Inc., Ballston Lake, NY
| | - Jessica N Coleman
- Department of Psychology and Neuroscience, Duke University, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - David R Bangsberg
- School of Public Health, Oregon Health Sciences University–Portland State University, Portland, OR
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL
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Raggio GA, Psaros C, Fatch R, Goodman G, Matthews LT, Magidson JF, Amanyire G, Cross A, Asiimwe S, Hahn JA, Haberer JE. High Rates of Biomarker-Confirmed Alcohol Use Among Pregnant Women Living With HIV in South Africa and Uganda. J Acquir Immune Defic Syndr 2019; 82:443-451. [PMID: 31567551 PMCID: PMC6857734 DOI: 10.1097/qai.0000000000002156] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/22/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Alcohol use is common among people living with HIV and particularly harmful during pregnancy. However, objective data on alcohol use in pregnant women living with HIV (WLWH) are lacking. In areas with high levels of alcohol use generally, such as South Africa and Uganda, these data are needed to inform interventions. METHODS Pregnant and nonpregnant, antiretroviral therapy-naive WLWH were recruited from outpatient clinics in South Africa and Uganda. Women provided self-report data on previous three-month alcohol use and potential mental health correlates of alcohol use (depression and stigma). Blood samples were used to measure phosphatidylethanol (PEth), an objective biomarker of recent alcohol intake. We analyzed any alcohol use (ie, any self-reported use or PEth-positive [≥8 ng/mL]) and under-reporting of alcohol use (ie, no self-reported use with concurrent PEth-positive). RESULTS Among pregnant WLWH (n = 163, median age was 26 [interquartile range: 23-29], median gestational age was 20 weeks [interquartile range: 16-26]), 40% were using alcohol and 16% under-reported alcohol use. Neither any alcohol use nor under-reporting of alcohol use differed significantly between pregnant and nonpregnant women or by country (P > 0.05). Greater depression (but not greater stigma) was significantly associated with any alcohol use (adjusted odds ratio = 1.41, 95% confidence interval: [1.01 to 1.99]; P = 0.045). CONCLUSIONS Alcohol use was prevalent and under-reported among pregnant WLWH in South Africa and Uganda, similar to nonpregnant participants, and associated with depression. General health care and antenatal clinic settings present opportunities to provide integrated alcohol-based counseling and depression treatment.
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Affiliation(s)
- Greer A. Raggio
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- National Center for Weight and Wellness, Washington, DC
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robin Fatch
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Georgia Goodman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lynn T. Matthews
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Anna Cross
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa;
| | - Stephen Asiimwe
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda; and
- Kabwohe Clinical Research Center, Kabwohe, Uganda.
| | - Judith A. Hahn
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Jessica E. Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Familiar I, Sikorskii A, Murray S, Ruisenor-Escudero H, Nakasujja N, Korneffel C, Boivin M, Bass J. Depression Symptom Trajectories Among Mothers Living with HIV in Rural Uganda. AIDS Behav 2019; 23:3411-3418. [PMID: 30877579 DOI: 10.1007/s10461-019-02465-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim was to identify latent class trajectories of depression symptoms among HIV+ women in Uganda. Depression was assessed at four time points using the Hopkins Symptom Checklist among 288 women caring for a child 2-5 years old. Mixture modeling was used to estimate the number and nature of classes defined by trajectories of depressive symptoms over time. Maternal and child characteristics were explored as predictors of class. Three trajectories of symptoms of depression were identified; (1) stable-low, (2) moderate-subclinical, and (3) chronic-high. About 8% of women reported moderately or highly elevated symptoms at the first assessment and consistently onward (i.e. chronically). Higher anxiety levels, less social support, more functionality problems, and more executive behavior problems in children predicted membership in the moderate-subclinical and chronic-high classes. Identifying patterns of depression trajectories can help target intervention efforts for women who are likely to experience the most chronic and impairing symptomatology.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, 909 Fee Rd. A322, East Lansing, MI, USA.
| | - Alla Sikorskii
- Departments of Psychiatry and Statistics, Michigan State University, East Lansing, MI, USA
| | - Sarah Murray
- Mental Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Clinton Korneffel
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Michael Boivin
- Departments of Psychiatry and Neurology, Michigan State University, East Lansing, MI, USA
| | - Judith Bass
- Departments of Psychiatry and Statistics, Michigan State University, East Lansing, MI, USA
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Rotheram-Borus MJ, Weichle TW, Wynn A, Almirol E, Davis E, Stewart J, Gordon S, Tubert J, Tomlinson M. Alcohol, But Not Depression or IPV, Reduces HIV Adherence Among South African Mothers Living with HIV Over 5 Years. AIDS Behav 2019; 23:3247-3256. [PMID: 31401739 DOI: 10.1007/s10461-019-02617-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Alcohol, depression, and intimate partner violence (IPV) are endemic in sub-Saharan Africa. This article examines whether and how these conditions affect mothers living with HIV (MLH), compared to mothers without HIV (MWOH). In particular, we assess the influence of these comorbidities on engagement in HIV care and adherence to antiretroviral therapies (ARV) among MLH. Data on maternal HIV care are typically based on clinic samples, with substantial loss to follow-up. This study fills that gap by including all mothers in specified areas. A cohort study examines MLH in Cape Town, South Africa recruited in pregnancy and followed repeatedly for 5 years, compared to MWOH. Almost all (98%) pregnant women in 12 neighborhoods (N = 594) were recruited in pregnancy. Mothers and children were reassessed five times over 5 years with high retention rates at each of the six assessments, from 98.7% at 2 weeks to 82.8% at 5 years post-birth. MLH's uptake and adherence to HIV care was evaluated over time associated with maternal comorbidities of alcohol use, depressed mood, and IPV using mixed effects logistic regression. MLH have fewer resources (income, food, education) and are more likely to face challenges from alcohol, depression, and having seropositive partners over time than MWOH. Only 22.6% of MLH were consistently engaged in HIV care from 6 months to 5 years post-birth. At 5 years, 86.7% self-reported engaged in HIV care, 76.9% were receiving ARVs and 87% of those on ARV reported consistent ARV adherence. However, data on viral suppression are unavailable. Alcohol use, but not depressed mood or IPV, was significantly related to reduced uptake of HIV care and adherence to ARV over time. Adherence to lifelong ARV by MLH requires a combination of structural and behaviorally-focused interventions. Alcohol abuse is not typically addressed in low and middle-income countries, but is critical to support MLH.
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Affiliation(s)
- Mary Jane Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA.
| | - Thomas W Weichle
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
| | - Adriane Wynn
- Division of Infectious Diseases & Global Public Health, School of Medicine, UCSD, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Ellen Almirol
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
| | - Emily Davis
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
| | - Jacqueline Stewart
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Francie van Zijl Drive, Cape Town, 7505, South Africa
| | - Sarah Gordon
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Francie van Zijl Drive, Cape Town, 7505, South Africa
| | - Julia Tubert
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Francie van Zijl Drive, Cape Town, 7505, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
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Depression and anxiety among pregnant women living with HIV in Kilimanjaro region, Tanzania. PLoS One 2019; 14:e0224515. [PMID: 31671160 PMCID: PMC6822761 DOI: 10.1371/journal.pone.0224515] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Mental health disorders in pregnant women living with HIV are associated with poor maternal and child outcomes, and undermine the global goals of prevention of mother-to-child transmission of HIV (PMTCT). This study aimed to determine prevalence of depression and anxiety and identify factors associated with these common mental health disorders among HIV-infeced pregnant women in Tanzania. METHODS We enrolled 200 pregnant women living with HIV from antenatal care clinics in the Kilimanjaro region. Women were eligible if they were in the second or third trimester of pregnancy and had been in PMTCT care for a minimum of one month. Data were collected via interviewer administered surveys. Participants self reported depression symptoms (Edinburgh Postnatal Depression Scale, EPDS) and anxiety symptoms (Brief Symptom Index, BSI). Multivariate logistic regression models examined factors associated with depression, anxiety, and comorbid depression and anxiety. RESULTS 25.0% of women met screening criteria for depression (EPDS ≥10). Depression was significantly associated with being single (aOR = 4.2, 95% CI = 1.1-15.5), food insecurity (aOR = 2.4, 95% CI = 1.0-6.4), and HIV shame (aOR = 1.2, 95% CI = 1.1-1.3). 23.5% of participants met screening criteria for anxiety (BSI ≥1.01). Anxiety was associated with being single (aOR = 3.6, 95%CI = 1.1-11.1), HIV shame (aOR = 1.1, 95% CI = 1.1-1.2) and lifetime experience of violence (aOR = 2.3, 95% CI = 1.0-5.1). 17.8% of the sample met screening criteria for both depression and anxiety. Comorbid depression and anxiety was associated with being single (aOR = 4.5, 95%CI = 1.0-19.1), HIV shame (aOR = 1.2, 95%CI = 1.1-1.3) and lifetime experience of violence (aOR = 3.4, 95% CI = 1.2-9.6). CONCLUSION Depression and anxiety symptomatology was common in this sample of pregnant women living with HIV, with a sizable number screening positive for comorbid depression and anxiety. In order to successfully engage women in PMTCT care and support their well-being, strategies to screen for mental health disorders and support women with mental illnesses are needed.
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Sarna A, Singh RJ, Duggal M, Chandra P, Reynolds N. The prevalence and determinants of depression among HIV-positive perinatal women receiving antiretroviral therapy in India. Arch Womens Ment Health 2019; 22:399-404. [PMID: 30141027 PMCID: PMC6387642 DOI: 10.1007/s00737-018-0904-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/09/2018] [Indexed: 01/08/2023]
Abstract
To assess the prevalence and correlates of perinatal depression, 200 HIV-positive pregnant/post-partum women receiving antiretroviral therapy (ART) were interviewed at eight government ART centers in four states across India. 52.5% (105) participants had depressive symptomology (Edinburgh Postnatal Depression Scale score > 13) while 23% of the participants reported thoughts of self-harm; there was no difference between pregnant and postpartum participants. Poor illness perception was associated with depression (AOR, 1.09; 95%CI, 1.05, 1.14); there was no association between adherence and depression in this population.
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Affiliation(s)
- Avina Sarna
- Population Council, India Habitat Centre, New Delhi, 110048, India.
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Depression among HIV positive pregnant women in Zimbabwe: a primary health care based cross-sectional study. BMC Pregnancy Childbirth 2019; 19:53. [PMID: 30704428 PMCID: PMC6357405 DOI: 10.1186/s12884-019-2193-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is a common psychiatric disorder that is highly prevalent among people living with HIV (PLWH). Depression is linked to poor adherence to anti-retroviral medication while in the peri-natal period may affect birth outcomes. Intimate partner violence (IPV) has been linked to depression. Little is known about the factors associated with depression in HIV positive pregnant women in Zimbabwe. METHODS We carried out a cross-sectional study in 4 busy primary care clinics offering antenatal services during the months of June through to September in 2016. Simple random sampling was used to screen HIV positive pregnant women while they waited to be attended to at each clinic. Eligible women who gave written informed consent were screened using a locally validated screening tool-the Edinburgh Postnatal Depression Scale (EPDS). RESULTS A total of 198(85%) participants were recruited out of 234 that were approached. The mean age of participants was 26.6(SD 4.5), of these, 176 (88.9%) had secondary education or more. A total of 78 (39.4%) (95% CI 32.5-46.3) met criteria for antenatal depression according to the local version of the EPDS. Factors associated with antenatal depression after multivariate analysis were intimate partner violence (IPV) [OR 3.2 (95% CI 1.5-6.7)] and previous history of depression OR 4.1 (95% CI 2.0-8.0)]. CONCLUSION The prevalence of antenatal depression among HIV positive pregnant women in primary care clinics is high. Factors associated with antenatal depression in pregnant HIV positive women are IPV and previous history of depression. There is need for routine screening for depression during the antenatal period and interventions targeting depression in this population should include components to address IPV.
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Ashaba S, Cooper-Vince C, Vořechovská D, Maling S, Rukundo GZ, Akena D, Tsai AC. Development and validation of a 20-item screening scale to detect major depressive disorder among adolescents with HIV in rural Uganda: A mixed-methods study. SSM Popul Health 2018; 7:100332. [PMID: 30560198 PMCID: PMC6289958 DOI: 10.1016/j.ssmph.2018.100332] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/31/2018] [Accepted: 11/25/2018] [Indexed: 12/27/2022] Open
Abstract
Background Depression is a major cause of disability among children and adolescents and is associated with elevated risks for substance abuse, HIV transmission risk behavior, and suicide. Among adolescents living with HIV (ALWH), depression undermines adherence to antiretroviral treatment, leading to poorer health outcomes. However, there are few instruments available for depression screening among ALWH in sub-Saharan Africa. Methods Using mixed methods we developed and validated a 20-item depression screening scale to be used among ALWH in rural Uganda. First, we conducted focus group discussions and in-depth interviews with adolescents and adult caregivers (n = 80) to elicit participant perspectives about mental health challenges facing HIV-affected children and adolescents. We generated an initial pool of 40 items, pilot tested it with ALWH and adolescents of unknown serostatus (n = 40), and then administered the items to a validation sample of ALWH (n = 224). Exploratory factor analysis was used to examine the factor structure of the scale. We evaluated the scale for its reliability, and validity. Results The mean age of the participants in the validation sample was 14.9 years (standard deviation [SD] 1.4), 131 (58%) were girls and 48 (21%) were orphans. Exploratory factor analysis revealed two factors related to affective and cognitive symptoms of depression. The 20-item depression scale was internally consistent (Cronbach’s alpha = 0.91) with moderate test-retest and inter-rater reliability. Construct validity was excellent, as demonstrated through correlation with related constructs like stigma (P< 0.001) and bullying (P< 0.001). At the optimized cutoff score, 64 (29%) participants screened positive for probable depression. Using the Mini-International Neuropsychiatric Interview for Children and Adolescents, we found that 37 participants (17%) were diagnosed with major depressive disorder. In reference to the criterion standard, the depression scale showed excellent discrimination (c-statistic = 0.84). Conclusion This new 20-item depression scale was reliable and valid for detecting major depressive disorder among ALWH in rural Uganda. There are few culturally- and age-appropriate screening scales for use among adolescents with HIV in sub-Saharan Africa. We used qualitative methods to generate new scale items, and adapted items from previously published depression screening scales. The items in the newly developed scale consist of well-known affective and cognitive symptoms of depression. The scale has adequate internal consistency, test-retest, and inter-rater reliability, and adequate evidence of construct and criterion-related validity.
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Affiliation(s)
| | - Christine Cooper-Vince
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Samuel Maling
- Mbarara University Science and Technology, Mbarara, Uganda
| | | | - Dickens Akena
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Alexander C Tsai
- Mbarara University Science and Technology, Mbarara, Uganda.,Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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El Ayadi AM, Barageine J, Korn A, Kakaire O, Turan J, Obore S, Byamugisha J, Lester F, Nalubwama H, Mwanje H, Tripathi V, Miller S. Trajectories of women's physical and psychosocial health following obstetric fistula repair in Uganda: a longitudinal study. Trop Med Int Health 2018; 24:53-64. [PMID: 30372572 PMCID: PMC6324987 DOI: 10.1111/tmi.13178] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post-surgery. METHODS We recruited a 60-woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014-June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results. RESULTS Across post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI -30.1, -12.4). CONCLUSIONS Our longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | - Justus Barageine
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | - Othman Kakaire
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Janet Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Susan Obore
- Urogynaecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felicia Lester
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Haruna Mwanje
- Urogynaecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | | | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
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Ongeri L, Wanga V, Otieno P, Mbui J, Juma E, Stoep AV, Mathai M. Demographic, psychosocial and clinical factors associated with postpartum depression in Kenyan women. BMC Psychiatry 2018; 18:318. [PMID: 30285745 PMCID: PMC6167779 DOI: 10.1186/s12888-018-1904-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 09/23/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Few longitudinal studies have examined associations between risk factors during pregnancy and mental health outcomes during the postpartum period. We used a cohort study design to estimate the prevalence, incidence and correlates of significant postpartum depressive symptoms in Kenyan women. METHODS We recruited adult women residing in an urban, resource-poor setting and attending maternal and child health clinics in two public hospitals in Nairobi, Kenya. A translated Kiswahili Edinburgh Postpartum Depression Scale was used to screen for depressive symptoms at baseline assessment in the 3rd trimester and follow up assessment at 6-10 weeks postpartum. Information was collected on potential demographic, psychosocial and clinical risk variables. Potential risk factors for postpartum depression were evaluated using multivariate logistic regression analysis. RESULTS Out of the 171 women who were followed up at 6-10 weeks postpartum, 18.7% (95% CI: 13.3-25.5) were found to have postpartum depression using an EPDS cut off of 10. In multivariate analyses, the odds of having postpartum depression was increased more than seven-fold in the presence of conflict with partner (OR = 7.52, 95% CI: 2.65-23.13). The association between antepartum and postpartum depression was quite strong but did not reach statistical significance (OR = 3.37, 95% CI: 0.98-11.64). CONCLUSIONS The high prevalence of significant postnatal depressive symptoms among Kenyan women underscores the need for addressing this public health burden. Depression screening and psychosocial support interventions that address partner conflict resolution should be offered as part of maternal health care.
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Affiliation(s)
- Linnet Ongeri
- Kenya Medical Research Institute, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
| | - Valentine Wanga
- University of Washington, Jefferson St. Seattle WA 98104, Nairobi, 908 Kenya
| | - Phelgona Otieno
- Kenya Medical Research Institute, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
| | - Jane Mbui
- Kenya Medical Research Institute, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
| | - Elizabeth Juma
- Kenya Medical Research Institute, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
| | - Ann Vander Stoep
- University of Washington, Jefferson St. Seattle WA 98104, Nairobi, 908 Kenya
| | - Muthoni Mathai
- University of Nairobi, P.O. Box 30197, Off Ngong Road, Nairobi, Kenya
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Chang JL, Tsai AC, Musinguzi N, Haberer JE, Boum Y, Muzoora C, Bwana M, Martin JN, Hunt PW, Bangsberg DR, Siedner MJ. Depression and Suicidal Ideation Among HIV-Infected Adults Receiving Efavirenz Versus Nevirapine in Uganda: A Prospective Cohort Study. Ann Intern Med 2018; 169:146-155. [PMID: 29946683 PMCID: PMC6475600 DOI: 10.7326/m17-2252] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Evidence regarding potential adverse neuropsychiatric effects of efavirenz is conflicting, and data from sub-Saharan Africa, where 70% of persons living with HIV (PLHIV) reside and efavirenz is used as first-line therapy, are limited. OBJECTIVE To estimate associations between efavirenz use and depression and suicidal ideation among PLHIV in Uganda. DESIGN Prospective observational cohort study. (ClinicalTrials.gov: NCT01596322). SETTING Mbarara, Uganda. PARTICIPANTS Adult PLHIV enrolled at the start of antiretroviral therapy (ART) and observed every 3 to 4 months from 2005 to 2015. MEASUREMENTS The exposure of interest was time-varying efavirenz use, defined as use during the 7 days and in 60 or more of the 90 days before a study visit, compared with nevirapine use. Self-reported outcomes were depression, defined as a mean score greater than 1.75 on the Hopkins Symptom Checklist depression subscale, and suicidal ideation. Multivariable-adjusted generalized estimating equations (GEE) logistic regression, Cox proportional hazards regression, and marginal structural models were fit to estimate the association between efavirenz use and the risk for depression and suicidal ideation. RESULTS 694 participants (median age, 33 years; median pretreatment CD4+ count, 1.8 × 109 cells/L) contributed 1200 person-years of observation (460 person-years receiving efavirenz). No baseline differences in depression or suicidal ideation were found between patients ever exposed to efavirenz and those never exposed to efavirenz and receiving nevirapine (P > 0.80 for both). Of 305 participants ever-exposed to efavirenz, 61 (20.0%) and 19 (6.2%) had depression and suicidal ideation, respectively, on at least 1 follow-up visit, compared with 125 (32.1%) and 47 (12.1%) of the 389 who received nevirapine. In adjusted GEE models, efavirenz use was associated with decreased odds of depression compared with nevirapine use (adjusted odds ratio, 0.62 [95% CI, 0.40 to 0.96]) and was not significantly associated with suicidal ideation (adjusted odds ratio, 0.61 [CI, 0.30 to 1.25]). Time-to-event and marginal structural models yielded similar estimates. LIMITATION Nonrandom assignment to treatment and substantial differences between the efavirenz and nevirapine groups. CONCLUSION No evidence was found that use of efavirenz in first-line ART increased the risk for depression or suicidal ideation compared with nevirapine use among PLHIV in Uganda. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Jonathan L Chang
- Duke University School of Medicine, Durham, North Carolina, and Massachusetts General Hospital, Boston, Massachusetts (J.L.C.)
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda (A.C.T., N.M., C.M., M.B.)
| | - Nicholas Musinguzi
- Mbarara University of Science and Technology, Mbarara, Uganda (A.C.T., N.M., C.M., M.B.)
| | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.E.H.)
| | - Yap Boum
- Mbarara University of Science and Technology, Mbarara, Uganda; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Epicentre Mbarara, Mbarara, Uganda (Y.B.)
| | - Conrad Muzoora
- Mbarara University of Science and Technology, Mbarara, Uganda (A.C.T., N.M., C.M., M.B.)
| | - Mwebesa Bwana
- Mbarara University of Science and Technology, Mbarara, Uganda (A.C.T., N.M., C.M., M.B.)
| | - Jeffrey N Martin
- University of California, San Francisco, San Francisco, California (J.N.M., P.W.H.)
| | - Peter W Hunt
- University of California, San Francisco, San Francisco, California (J.N.M., P.W.H.)
| | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda, and Oregon Health & Science University, Portland, Oregon (D.R.B.)
| | - Mark J Siedner
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, and Mbarara University of Science and Technology, Mbarara, Uganda (M.J.S.)
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Lewinsohn R, Crankshaw T, Tomlinson M, Gibbs A, Butler L, Smit J. “This baby came up and then he said, “I give up!”: The interplay between unintended pregnancy, sexual partnership dynamics and social support and the impact on women's well-being in KwaZulu-Natal, South Africa. Midwifery 2018; 62:29-35. [DOI: 10.1016/j.midw.2018.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/02/2018] [Accepted: 03/04/2018] [Indexed: 12/16/2022]
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Seffren V, Familiar I, Murray SM, Augustinavicius J, Boivin MJ, Nakasujja N, Opoka R, Bass J. Association between coping strategies, social support, and depression and anxiety symptoms among rural Ugandan women living with HIV/AIDS. AIDS Care 2018; 30:888-895. [PMID: 29471677 PMCID: PMC9850497 DOI: 10.1080/09540121.2018.1441969] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Poor mental health detrimentally affects quality of life among women living with HIV/AIDS. An improved understanding of how coping and social support relate to depression and anxiety in this population can facilitate the design and implementation of appropriate mental health treatment and support services. Secondary analysis was conducted on baseline data from 288 HIV-positive women enrolled in a parenting intervention in Uganda. Depression and anxiety symptoms, social support, and coping were assessed with the Hopkins Symptom Checklist and adapted versions of the Multidimensional Scale for Perceived Social Support and Ways of Coping Questionnaire. General linear regression models were used to estimate associations between coping and mental health. Based on report of elevated symptoms, approximately 10% of women were categorized as having clinically-relevant depression or anxiety. Emotion-focused (EF: p < .001) and problem-focused (PF: p = .01) coping were associated with more depressive symptoms while greater family support (EF: p = .002; PF: p = .003) was associated with fewer depression symptoms. More anxiety symptoms were associated with reporting both coping strategies (EF: p < .001; PF: p = .02) and higher community support (EF&PF: p = .01). The cross-sectional nature of the study limits our ability to rule out the role of reverse causation in the significant relationship between coping and mental health. Findings do suggest that high family support can be protective against depression and anxiety symptoms among women living with HIV.
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Affiliation(s)
- Victoria Seffren
- a Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - Itziar Familiar
- b Department of Psychiatry , Michigan State University , East Lansing , MI , USA
| | - Sarah M Murray
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Jura Augustinavicius
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Michael J Boivin
- b Department of Psychiatry , Michigan State University , East Lansing , MI , USA
- f Departments of Psychiatry and Neurology & Ophthalmology , Michigan State University , East Lansing , MI , USA
- g Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA
| | | | - Robert Opoka
- e Department of Pediatrics and Child Health , Makerere University , Kampala , Uganda
| | - Judith Bass
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Atuhaire C, Cumber SN. Factors associated with postpartum depression among adolescents in Uganda. Pan Afr Med J 2018; 30:170. [PMID: 30455799 PMCID: PMC6235503 DOI: 10.11604/pamj.2018.30.170.15333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/10/2018] [Indexed: 01/05/2023] Open
Abstract
Postpartum depression (PPD) is a common and disabling public health complication of the postpartum period in women. It is believed to occur three times more commonly in developing countries than in the developed world and is more prevalent among women in the first six weeks after birth. Research suggests that postpartum depression is more commonly diagnosed among adolescents and may be a risk factor for poor growth and development in children born to these mothers. Therefore, adolescents are a special age group that requires specific health care maternal interventions in order to detect and treat post-partum depression.
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Affiliation(s)
- Catherine Atuhaire
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Samuel Nambile Cumber
- Institute of Medicine, Department of Public Health and Community Medicine, University of Gothenburg, Box 414, SE-405 30 Gothenburg, Sweden
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Dunkley E, Ashaba S, Burns B, O’Neil K, Sanyu N, Akatukwasa C, Kastner J, Berry NS, Psaros C, Matthews LT, Kaida A. "I beg you…breastfeed the baby, things changed": infant feeding experiences among Ugandan mothers living with HIV in the context of evolving guidelines to prevent postnatal transmission. BMC Public Health 2018; 18:188. [PMID: 29378548 PMCID: PMC5789624 DOI: 10.1186/s12889-018-5081-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 01/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND For women living with HIV (WLWH) in low- and middle-income countries, World Health Organization (WHO) infant feeding guidelines now recommend exclusive breastfeeding until six months followed by mixed feeding until 24 months, alongside lifelong maternal antiretroviral therapy (ART). These recommendations represent the sixth major revision to WHO infant feeding guidelines since 1992. We explored how WLWH in rural Uganda make infant feeding decisions in light of evolving recommendations. METHODS We conducted semi-structured interviews with 20 postpartum Ugandan WLWH accessing ART, who reported pregnancy < 2 years prior to recruitment. Interviews were conducted between February-August 2014 with babies born between March 2012-October 2013, over which time, the regional HIV treatment clinic recommended lifelong ART for all pregnant and breastfeeding women (Option B+). Content analysis was used to identify major themes. Infant feeding experiences was an emergent theme. NVivo 10 software was used to organize analyses. RESULTS Among 20 women, median age was 33 years [IQR: 28-35], number of livebirths was 3 [IQR: 2-5], years on ART was 2.3 [IQR: 1.5-5.1], and 95% were virally suppressed. Data revealed that women valued opportunities to reduce postnatal transmission. However, women made infant feeding choices that differed from recommendations due to: (1) perception of conflicting recommendations regarding infant feeding; (2) fear of prolonged infant HIV exposure through breastfeeding; and (3) social and structural constraints shaping infant feeding decision-making. CONCLUSIONS WLWH face layered challenges navigating evolving infant feeding recommendations. Further research is needed to examine guidance and decision-making on infant feeding choices to improve postpartum experiences and outcomes. Improved communication about changes to recommendations is needed for WLWH, their partners, community members, and healthcare providers.
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Affiliation(s)
- Emma Dunkley
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, B.C. V5A 1S6 Canada
| | - Scholastic Ashaba
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Bridget Burns
- Massachusetts General Hospital (MGH) Global Health, Boston, MA USA
| | - Kasey O’Neil
- Massachusetts General Hospital (MGH) Global Health, Boston, MA USA
| | - Naomi Sanyu
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | | | - Jasmine Kastner
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, B.C. V5A 1S6 Canada
| | - Nicole S. Berry
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, B.C. V5A 1S6 Canada
| | - Christina Psaros
- Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA USA
| | - Lynn T. Matthews
- Massachusetts General Hospital (MGH) Global Health, Boston, MA USA
- Division of Infectious Disease, Massachusetts General Hospital (MGH), Boston, MA USA
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, B.C. V5A 1S6 Canada
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Peltzer K, Rodriguez VJ, Jones D. Prevalence of prenatal depression and associated factors among HIV-positive women in primary care in Mpumalanga province, South Africa. SAHARA J 2017; 13:60-7. [PMID: 27250738 PMCID: PMC4955403 DOI: 10.1080/17290376.2016.1189847] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study aimed to assess the prevalence of depressed symptoms and associated factors in prenatal HIV-positive women in primary care facilities in rural South Africa. In a cross-sectional study, 663 HIV-positive prenatal women in 12 community health centres in Mpumalanga province, South Africa, were recruited by systematic sampling (every consecutive patient after HIV post-test counselling). Results indicate that overall, 48.7% [95% CI: 44.8, 52.6] of women during the prenatal period reported depressed mood (scores of ≥ 13 on the Edinburgh Postnatal Depression Scale 10). In multivariate analysis, not being employed, unplanned pregnancy, not having an HIV-positive child, poor antiretroviral therapy adherence, non-condom use at last sex, and intimate partner violence were associated with depressive symptoms. Potential risk factors among HIV-infected prenatal women were identified which could be utilized in interventions. Routine screening for depression may be integrated into prenatal care settings.
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Affiliation(s)
- Karl Peltzer
- a PhD, is a distinguished Research Fellow in HIV/AIDS/STIs and TB (HAST) Research Programme , Human Sciences Research Council , Pretoria , South Africa.,b is a Professor at the ASEAN Institute for Health Development , Mahidol University , Salaya , Thailand.,c is a Research Associate in the Department of Research & Innovation , University of Limpopo , Sovenga , South Africa
| | - Violeta J Rodriguez
- d MSEd, is a Research Associate in Department of Psychiatry & Behavioral Sciences , University of Miami Miller School of Medicine , Miami , USA
| | - Deborah Jones
- e PhD, is a Professor in Department of Psychiatry & Behavioral Sciences , University of Miami Miller School of Medicine , Miami , USA
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Miller K, Muyindike W, Matthews LT, Kanyesigye M, Siedner MJ. Program Implementation of Option B+ at a President's Emergency Plan for AIDS Relief-Supported HIV Clinic Improves Clinical Indicators But Not Retention in Care in Mbarara, Uganda. AIDS Patient Care STDS 2017; 31:335-341. [PMID: 28650703 PMCID: PMC5564010 DOI: 10.1089/apc.2017.0034] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
2013 WHO guidelines for prevention of mother to child transmission recommend combination antiretroviral therapy (ART) for all pregnant women, regardless of CD4 count (Option B/B+). We conducted a retrospective analysis of data from a government-operated HIV clinic in Mbarara, Uganda before and after implementation of Option B+ to assess the impact on retention in care. We limited our analysis to women not on ART at the time of their first reported pregnancy with CD4 count >350. We fit regression models to estimate relationships between calendar period (Option A vs. Option B+) and the primary outcome of interest, retention in care. One thousand and sixty-two women were included in the analysis. Women were more likely to start ART within 6 months of pregnancy in the Option B+ period (68% vs. 7%, p < 0.0001) and had significantly greater increases in CD4 count 1 year after pregnancy (+172 vs. -5 cells, p < 0.001). However, there was no difference in the proportion of women retained in care 1 year after pregnancy (73% vs. 70%, p = 0.34). In models adjusted for age, distance to clinic, marital status, and CD4 count, Option B+ was associated with a nonsignificant 30% increased odds of retention in care at 1 year [adjusted odds ratio (AOR) = 1.30, 95% CI 0.98-1.73, p = 0.06]. After transition to an Option B+ program, pregnant women with CD4 count >350 were more likely to initiate combination therapy; however, interventions to mitigate losses from HIV care during pregnancy are needed to improve the health of women, children, and families.
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Affiliation(s)
- Kathleen Miller
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Winnie Muyindike
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Lynn T. Matthews
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Kanyesigye
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J. Siedner
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Abstract
Depression is a known barrier for antiretroviral therapy (ART) adherence, but less is understood about its effects on ART initiation. We followed 1013 HIV-infected individuals participating in the Partners Demonstration Project, an open-label study of integrated pre-exposure prophylaxis (PrEP) and ART delivery for HIV serodiscordant couples in Kenya and Uganda. Associations between depression, measured annually with the Hopkins Symptoms Checklist-Depression (HSCL-D), and ART initiation were assessed with Cox proportional hazards regression. At enrollment, 162 participants (16.0%) reported symptoms consistent with probable depression, defined by a HSCL-D mean score >1.75, and this proportion decreased during study follow-up (6.7 and 3.6% at 12- and 24-months, respectively; p value < 0.001). Greater depressive symptom severity was associated with a greater likelihood of ART initiation overall (adjusted hazard ratio [aHR] 1.32, 95% CI 1.01-1.73) and among participants with CD4 count ≤ 350 cells/µl (aHR 1.30, 95% CI 1.01-1.67). Depression decreased 6 months after ART initiation (adjusted odds ratio [aOR] 0.34, 95% CI 0.23-0.51). Among East African HIV-infected persons in HIV serodiscordant couples, depression was not a barrier to ART initiation. ART initiation was associated with improved depressive symptoms in this setting.
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Ashaba S, Kaida A, Burns BF, O'Neil K, Dunkley E, Psaros C, Kastner J, Tsai AC, Bangsberg DR, Matthews LT. Understanding coping strategies during pregnancy and the postpartum period: a qualitative study of women living with HIV in rural Uganda. BMC Pregnancy Childbirth 2017; 17:138. [PMID: 28482821 PMCID: PMC5423027 DOI: 10.1186/s12884-017-1321-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/03/2017] [Indexed: 01/03/2023] Open
Abstract
Background In sub-Saharan Africa, 58% of adults living with HIV are women. In Uganda, HIV prevalence is 8.3% for women compared to 6.1% for men. Access to antiretroviral therapy (ART) and prevention of mother to child transmission (PMTCT) programs have enabled women living with HIV (WLWH) to have children with minimal risk of perinatal transmission. Nevertheless, pregnant WLWH face many challenges. We explored women’s perceptions of how they cope with the challenges of pregnancy and the postpartum period as HIV-infected women. Methods We conducted semi-structured interviews with postpartum WLWH accessing ART who had a pregnancy within 2 years prior to recruitment between February–August, 2014. Childbearing associated stressors and coping strategies were discussed. We used content analysis to identify major themes and NVivo 10 software facilitated data analysis. Results Twenty women were interviewed with median age 33 (IQR: 28–35) years, CD4 cell count 677 cells/mm3 (IQR: 440–767), number of live births 4 (IQR: 2–6), and number of living children 3 (IQR: 2–4.3). We summarize five identified coping strategies within a socio-ecological framework according to Bronfenbrenner’s Ecological Model. Coping strategies on the individual level included acceptance of self and HIV status, and self-reliance. On the interpersonal level, participants reported coping through support from partners, family, and friends. On the organizational level, participants reported coping through HIV-related healthcare delivery and system supports. At the community level, women reported coping through support from church and spirituality. Conclusions The results highlight coping strategies used by WLWH to manage the myriad challenges faced during pregnancy and the postpartum period. Intervention programs for WLWH must emphasize psychosocial care and incorporate strategies that address psychosocial challenges in the HIV care package in order to optimize well-being. Additionally policies that support networks of WLWH should be put in place and funding support should be provided through existing funding mechanisms in order to respond to the needs and challenges of WLWH. Programmes that support WLWH for economic empowerment and improved livelihoods should be strengthened across all regions in the country. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1321-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | - Kasey O'Neil
- MGH Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Emma Dunkley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jasmine Kastner
- Research Institute McGill University Health Centre Montreal, Montreal, Canada
| | - Alexander C Tsai
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - David R Bangsberg
- MGH Global Health, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lynn T Matthews
- MGH Global Health, Massachusetts General Hospital, Boston, MA, USA.,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Ashaba S, Kaida A, Coleman JN, Burns BF, Dunkley E, O'Neil K, Kastner J, Sanyu N, Akatukwasa C, Bangsberg DR, Matthews LT, Psaros C. Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda. PLoS One 2017; 12:e0176256. [PMID: 28459866 PMCID: PMC5411062 DOI: 10.1371/journal.pone.0176256] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 04/07/2017] [Indexed: 01/08/2023] Open
Abstract
The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28-35], a median of 3 living children [IQR: 2-5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member as well as policy makers, funders and program implementers to work together for the common cause. These consolidated efforts may not only lower the risk of psychological distress but has potential to create long lasting solutions to benefit the wider community.
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Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Jessica N Coleman
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, United States of America
| | - Bridget F Burns
- Division of Global Health, Massachusetts General Hospital (MGH), Boston, United States of America
| | - Emma Dunkley
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Kasey O'Neil
- Division of Global Health, Massachusetts General Hospital (MGH), Boston, United States of America
| | - Jasmine Kastner
- Research Institute, McGill University Health Centre, Montreal, Canada
| | - Naomi Sanyu
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Cecilia Akatukwasa
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - David R Bangsberg
- Oregon Health Sciences University-Portland State University School of Public Health, Portland, OR, United States of America
| | - Lynn T Matthews
- Division of Global Health, Massachusetts General Hospital (MGH), Boston, United States of America
- Division of Infectious Disease, Massachusetts General Hospital (MGH), Boston, United States of America
| | - Christina Psaros
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, United States of America
- Harvard Medical School, Boston, MA
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