Antenatal and Postpartum Depression: Prevalence and Associated Risk Factors among Adolescents' in KwaZulu-Natal, South Africa

Tools for screening maternal mental health conditions in primary care settings in sub-Saharan Africa: systematic review

Introduction

In sub-Saharan Africa, pregnant and postpartum women with mental health problems are often missed in healthcare systems. To address this, a practical and simple screening tool for maternal mental health should be available to primary healthcare workers. An important step toward having such a tool is to assess the existing tools and their effectiveness in primary care settings.

Methods

We systematically searched PubMed, LILAC, CINAHL, Google Scholar, African Index Medicus, HINARI, and African Journals Online from inception to 31 January 2023, without language restriction. Reference lists of retrieved articles were reviewed and experts in the field were contacted for studies not captured by our searches. All retrieved records were collated in Endnote, de-duplicated, and exported to Rayyan for screening. Study selection and data extraction were done by at least two reviewers using a pre-tested flow chart and data extraction form. Disagreements between reviewers were resolved through discussion. We contacted primary authors for missing or insufficient information and conducted a content analysis of the psychometric properties of the tools.

Results

In total, 1,181 studies were retrieved by our searches, of which 119 studies were included in this review. A total of 74 out of 119 studies (62%) were screened for depression during pregnancy and or the postpartum period. The Edinburg Postpartum Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) were the most commonly used tools. In total, 12 studies reported specificity and sensitivity for tools for measuring depression (EPDS, PHQ-9, and Whooley) and psychological distress [Self Report Questionnaire (SRQ) and Kessler Psychological Distress Scale (KPDS)]. The average sensitivity and specificity of the EPDS reported were 75.5 and 76.5%, respectively, at a cut-off of ≥13. The EPDS appears to be the most acceptable, adaptable, user-friendly, and effective in screening for maternal mental health conditions during pregnancy and postpartum. However, the methodological approach varied for a particular tool, and documentation on the attributes was scanty.

Conclusion

The EPDS was the most commonly used tool and considered as most acceptable, adaptable, user-friendly, and effective. Information on the performance and psychometric properties of the vast majority of screening tools was limited.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022323558, identifier CRD42022323558 (PROSPERO).

Perinatal mental disorders and suicidal risk among adolescent mothers living in urban areas of Cameroon

Background

In sub-Saharan Africa the birth rate among teenage mothers is the highest in the world. In 2021, there would be 6,114,000 births for 15-19-year-olds in this part of the world. In Cameroon, the fertility rate among adolescents aged 15-19 is 24%. However, there is a significant lack of data on the mental health of teenage mothers. Given the biopsychosocial conditions of the perinatal period and adolescence, we hypothesise that the prevalence of mental disorders and the risk of suicide is very high in Cameroon. The aim is therefore to determine the prevalence of perinatal mental disorders and suicide risk among adolescent mothers in urban areas of Cameroon.

Methods

Following ethical approval of the submitted protocol, we recruited adolescent mothers and data were collected using diagnostic interviews based on the DSM-5, PDM-2 and MINI guidelines. The types of sampling used were typical and incidental. Data were tabulated with Epidata 3.1 and processed with SPSS 25.

Results

66.4% of adolescent mothers were diagnosed with a mental disorder and 27.4% with suicidal risk. It was found that there was a link between mental disorders and suicidal risk (p<0.001), with mothers at suicidal risk having an 8.4 times greater risk of having a mental disorder (OR=8.423). Linear regression confirmed the statistically significant relationship between perinatal mental disorders and suicidal risk. 31.1% of the total variance in suicidal risk was explained by mental disorders. The regression coefficients for mental disorders with a p<0.05 value is: perinatal depression (-0.279), post-partum psychosis (-0.133), trauma disorder (-0.034), generalised anxiety disorder (-0.008) and conduct disorder (-0.020).

Conclusions

Our hypothesis is confirmed, because the prevalence of 66.4% of mental disorders and 27.4% of suicidal risk are significantly high in Cameroon. In some way, the disorders predict suicidal risk, because the less an adolescent mother has one of these pathologies during the perinatal period, the less she will be at risk of suicide. More research of this kind is needed to contribute in providing more data, including solutions to address the morbidity and mortality problems associated with the mental health of teenage mothers.

Father involvement is a protective factor for maternal mental health in Western Kenya

Depression is a major global health concern especially among mothers of young children in low- and middle-income countries (LMICs). While various risk and protective factors have been well-established, the role of fathers in potentially mitigating maternal depression remains understudied. This study aimed to investigate the association between father involvement and maternal depressive symptoms in rural Western Kenya. We used cross-sectional baseline data collected in February-March 2023 from a cluster-randomized controlled trial evaluating the effectiveness of a community-based parenting program for improving early childhood development. Primary caregivers with children 0-18 months of age were enrolled into the trial across 51 villages in Nyamira and Vihiga counties. We analyzed data from 413 mothers who were in a relationship with a male partner (i.e., father of the young child). Maternal depressive symptoms were measured using the CESD-10. Father involvement was reported using a multidimensional measure of men's engagement in childcare activities, household chores, early learning activities, and affection towards their child. We used multilevel regression models to estimate the adjusted associations between father involvement (overall score and by specific domains) and maternal depressive symptoms. We also conducted exploratory subgroup analyses to assess whether this association differed by child age. Overall, greater father involvement was associated with fewer maternal depressive symptoms. Specifically, fathers' engagement in household chores and childcare activities had the strongest protective associations. Exploratory subgroup analyses revealed larger associations for mothers with younger children under 6 months. Our findings suggest that father involvement is a protective factor for maternal mental health. Engaging fathers in early childhood interventions and encouraging men's involvement in caregiving activities may potentially benefit maternal well-being.

Depression and suicidal ideation among adolescent girls in refugee settlements in northern Uganda

Depression is a leading cause of disability, morbidity, and mortality among adolescent girls in Africa, with varying prevalence across different populations. However, there is paucity of data on the burden of depression among priority groups in unique settings like adolescent girls living in refugee settlements, where access to mental health services including psychosocial support and psychiatric consultation is scarce. We conducted a cross-sectional, descriptive, observational study among adolescent girls from 4 selected refugee settlements in Obongi and Yumbe districts, Uganda. A multi-stage sampling, and cluster sampling techniques, where each settlement represented 1 cluster was done. Prevalence of depression was assessed using the patient health questionnaire-9 modified for adolescents, followed by the P4 screener assessment tool for suicidal risks. We performed modified Poisson regression analysis to establish predictors of depression. P < .05 was considered statistically significant. We included 385 participants with a mean age of 17 (IQR: 15-18) years. The prevalence of depression was 15.1% (n = 58, 95% confidence interval [CI]: 11.6-19.0). Overall, 8.6% (n = 33) participants had recent suicidal thoughts (within 1 month) and 2.3% (n = 9) attempted suicide. Participants who experienced pregnancy (adjusted prevalence ratio [aPR]: 2.4, 95% CI: 1.00-5.94, P = .049), sexual abuse (aPR: 2.1, 95% CI: 1.19-3.76, P = .011), and physical abuse (aPR: 1.7, 95% CI: 1.01-2.74, P = .044) were independently associated with depression. In this study, we found about one in every 6 adolescents living in refugee settlements of northern Uganda to suffer from depression, particularly among those who experienced adolescent pregnancy and various forms of abuses. Incorporating mental health care in the existing health and social structures within the refugee settlements, exploring legal options against perpetrators of sexual abuse and encouraging education is recommended in this vulnerable population.

Depression during pregnancy and associated factors among women in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Pregnancy is one of the most remarkable experiences in a woman's life. Prenatal depression, characterized by stress and worry associated with pregnancy, can reach severe levels. On a global scale, mental and addictive disorders affect more than one billion people, causing 19% of years lived with disability. It is estimated that 25-35% of pregnant women experience depressive symptoms, with 20% meeting the diagnostic criteria for major depression.

METHODS

A systematic review and meta-analysis were conducted to examine depression during pregnancy in Ethiopia. The search was conducted from March 1-31, 2023. Data extraction used Microsoft Excel, and analysis was performed using STATA version 17. The New Castle-Ottawa Scale quality assessment tool was employed to evaluate the methodological quality of included studies. The Cochrane Q test and I2 statistics were used to assess heterogeneity. A weighted inverse variance random-effects model estimated the pooled level of antenatal depression (APD). Publication bias was detected using a funnel plot and Begg's and Egger's tests.

RESULTS

Out of 350 studies searched, 18 were included in the analysis. The overall pooled prevalence of depression in Ethiopia was 27.85% (95% CI: 23.75-31.96). Harari region reported the highest prevalence (37.44%), while Amhara region had the lowest (23.10%). Factors significantly associated with depression included unplanned pregnancies, low social support, low income, previous history of depression, intimate partner violence, and history of abortion.

CONCLUSION

This systematic review and meta-analysis demonstrate that approximately one-quarter of pregnant women in Ethiopia experience depression during pregnancy. Unplanned pregnancy, low social support, low income, previous history of depression, history of abortion, and intimate partner violence are determinants of depression. To address this high prevalence, the Ethiopian government and stakeholders should develop policies that incorporate counseling during pregnancy follow-ups. Improving the quality of life for pregnant women is crucial for the well-being of families, communities, and the nation as a whole.

Prevalence and correlates of intimate partner sexual violence among pregnant women in Napak district, Northeastern Uganda

Intimate partner sexual violence (IPSV) during pregnancy is of key reproductive health concern as it is associated with various risks linked to severe intrapartum complications. This study assessed the prevalence and the correlates of intimate partner sexual violence among pregnant women in Napak district, Northeastern Uganda. This was an analytical cross-sectional study conducted among 284 pregnant women who were obtained by systematic sampling in Napak district between November and December 2020. A structured questionnaire was used to collect the data, and this was analyzed using STATA version 15. The correlates of IPSV were determined at a multivariable level using a Poisson regression model with robust variance at the individual, relationship, and societal levels of the socio-ecological model. The study enrolled 284 pregnant women of whom, 65.5% were aged between 18 and 28 years and 62.0% were not formally educated. Also, 56% of the pregnant women had experienced IPSV during their current pregnancies, the most prevalent form (35.6%) being unwanted sexual advances. Factors of women being in their third or subsequent pregnancies, primiparity, women who rated their communication with their partners as low, being in a relationship for less than five years, lower age of the spouse, and a lower level of education (primary) among women showed a statistical association with IPSV. This study reports a high prevalence of IPSV during pregnancy, and it was associated with individual, relationship, and societal factors. Based on this, concerted efforts through sensitization on the dangers of IPSV are required to avert the practice.

Postpartum depression: Addressing misinformation and harmful attitudes

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Lived experiences of pregnant and parenting adolescents in Africa: A scoping review

BACKGROUND

Previous studies have not synthesized existing literature on the lived experiences of pregnant and parenting adolescents (aged 10-19) in Africa. Such evidence synthesis is needed to inform policies, programs, and future research to improve the well-being of the millions of pregnant or parenting adolescents in the region. Our study fills this gap by reviewing the literature on pregnant and parenting adolescents in Africa. We mapped existing research in terms of their substantive focus, and geographical distribution. We synthesized these studies based on thematic focus and identified gaps for future research.

METHODS

We used a three-step search strategy to find articles, theses, and technical reports reporting primary research published in English between January 2000 and June 2021 in PubMed, Jstor, AJOL, EBSCO Host, and Google Scholar. Three researchers screened all articles, including titles, abstracts, and full text, for eligibility. Relevant data were extracted using a template designed for the study. Overall, 116 studies met the inclusion criteria and were included in the study. Data were analyzed using descriptive and thematic analyses.

RESULTS

Research on pregnant and parenting adolescents is limited in volume and skewed to a few countries, with two-fifths of papers focusing on South Africa (41.4%). Most of the studies were African-led (81.9%), received no funding (60.3%), adopted qualitative designs (58.6%), and were published between 2016 and 2021 (48.3%). The studies highlighted how pregnancy initiates a cycle of social exclusion of girls with grave implications for their physical and mental health and social and economic well-being. Only 4.3% of the studies described an intervention. None of these studies employed a robust research design (e.g., randomized controlled trial) to assess the intervention's effectiveness. Adolescent mothers' experiences (26.7%) and their education (36.2%) were the most studied topics, while repeat pregnancy received the least research attention.

CONCLUSION

Research on issues affecting pregnant and parenting adolescents is still limited in scope and skewed geographically despite the large burden of adolescent childbearing in many African countries. While studies have documented how early pregnancy could result in girls' social and educational exclusion, few interventions to support pregnant and parenting adolescents exist. Further research to address these gaps is warranted.

Socio-ecological factors associated with probable depression among pregnant and parenting adolescent girls: findings from a cross-sectional study in Burkina Faso and Malawi

BACKGROUND

Pregnant and parenting adolescent girls are at risk of poor mental health because of stigma and social exclusion. Despite one in four girls starting childbearing by the age of 19 in Africa, no study, to the best of our knowledge, has examined the multi-layered factors (individual, family, friends, and neighborhood-related factors) associated with depressive symptoms among pregnant and parenting girls in Africa. Our study contributes to addressing this gap by examining the socio-ecological factors associated with depression symptoms among pregnant and parenting adolescent girls.

METHODS

Our study adopted a cross-sectional design. Between March and September 2021, we interviewed 980 pregnant and parenting adolescent girls in Ouagadougou, Burkina Faso, and 669 in Blantyre, Malawi. We recruited pregnant and parenting adolescent girls in randomly selected urban and rural enumeration areas in Burkina Faso (n = 71) and Malawi (n = 66). We assessed depressive symptoms using the Patient Health Questionnaire (PHQ-9), which generated an overall score of 27. We considered a score of 10 or more as probable depression. We also obtained information on individual, family, friends, and neighborhood characteristics. We employed logistic regression models to examine the significant factors associated with probable depression among pregnant and parenting adolescent girls.

RESULTS

The prevalence of probable depression was 18.8% and 14.5% in Burkina Faso and Malawi, respectively. At the individual level, having secondary education was significantly associated with a lower likelihood of probable depression in Malawi (AOR: 0.47; 95% CI 0.27-0.82) but not in Burkina Faso. At the family level, denying paternity (AOR: 3.14; 95% CI 1.34-7.11 in Malawi) and no parental support (AOR: 2.08; 95% CI 1.22-3.55 in Burkina Faso) were associated with higher odds of probable depression. At the community level, perceived neighborhood safety was associated with a lower likelihood of probable depression in Malawi (AOR: 0.74; 95% CI 0.61-0.89) and Burkina Faso (AOR: 0.81; 95% CI 0.73-0.90). Having a safety net within the community was associated with lower odds of probable depression in Burkina Faso (AOR: 0.87; 95% CI 0.78-0.96) but not in Malawi.

CONCLUSION

Depressive symptoms are common among pregnant and parenting adolescents, suggesting the need to screen them regularly for depression during antenatal and postnatal visits. Factors associated with depression among pregnant and parenting girls operate at multiple levels suggesting a need for multilevel interventions that address all areas of vulnerabilities.

Effects of the Covid-19 Pandemic on the Prevalence of Insomnia, Anxiety, and Depression During Pregnancy: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis study aims to determine the effects of the Covid-19 pandemic on the prevalence of insomnia, anxiety, and depression symptoms during pregnancy. Reviews were done through PubMed, EBSCO (Medline, CINAHL), Embase (OVID), Web of Science, PsycINFO, TR Index, Turkish Thesis Center databases using (pregnancy OR pregnant) and (sleep OR sleep disorders OR insomnia), and (anxiety OR depression) keywords between April and May 2021. The meta-analysis included 48 articles (sample: 77,299). It was found that the Covid-19 pandemic did not affect the prevalence of depression symptoms and anxiety during pregnancy, but it increased insomnia. While insomnia ratio was reported 39.6% (95% CI: 0.253-0.560) in the studies conducted before the pandemic, it was reported 88.8% (95% CI: 0.821-0.921) in the studies conducted during the pandemic. This study found that the Covid-19 pandemic did not have effects on depression symptoms and anxiety, but it increased insomnia complaints.

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

Background

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

Methods

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

Results

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

Conclusion

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

A focus on postpartum depression among Jordanian mothers

BACKGROUND

The magnitude of postpartum depression in Jordan is under documented, and little is known about its potential sociodemographic and clinical correlates.

PURPOSE

The aim of this study was to explore the prevalence and risk factors associated with postpartum depression among Jordanian mothers in the first 18 months after delivery.

METHOD

This descriptive cross-sectional study was carried out from April to June 2020 in Jordan. A web-based survey was used for recruiting eligible participants. An Arabic version of the validated self-administered Edinburgh Postnatal Depression Scale questionnaire was used to measure postpartum depression with a cut-off score of ⩾12 which indicates probable depression.

RESULTS

A total of 1,071 Jordanian women participated in the study. Of those, 567 women had postpartum depression (52.9%). Multivariate logistic regression analysis revealed that postpartum depression was significantly associated with marital conflict (OR: 4.91; 95% CI: 2.36-10.20), negative attitude from the pregnancy (OR: 0.67; 95% CI: 0.45-0.99), unplanned pregnancies (OR: 1.73; 95% CI: 1.16-2.60), lack of social support (OR: 1.93; 95% CI: 1.12-3.32), time from last delivery (OR: 0.99; 95% CI: 0.98-1.00), insomnia (OR: 0.53; 95% CI: 0.35-0.82), and depression during the pregnancy (OR: 0.51; 95% CI: 0.33-0.78). Most of the participants (65.7%) sought social support to avoid, reduce, or treat postpartum depression.

CONCLUSIONS

Postpartum depression among Jordanian women was the highest in comparison to that of women in other countries in the region. Therefore, screening for the presence of depressive symptoms should be implemented during regular pregnancy care visits. Social support should be encouraged in order to avoid, reduce, or treat postpartum depression.

Mental health problems and service gaps experienced by pregnant adolescents and young women in Sub-Saharan Africa: A systematic review

BACKGROUND

Pregnant adolescent girls and young women (AGYW, aged 12-24 years) are at high risk for mental health problems, particularly in the Sub-Saharan African (SSA) region.

METHODS

We performed a systematic review of mental health studies among pregnant AGYW in SSA published between January 1, 2007 and December 31, 2020 in PubMed, Embase, CINAHL, PsycInfo, and Global Index Medicus following PRISMA guidelines (PROSPERO: CRD42021230980). We used Bronfenbrenner's bioecological model to frame and synthesize results from included studies.

FINDINGS

Our search yielded 945 articles from which 18 studies were included (N = 8 quantitative, N = 9 qualitative, N = 1 case report). The most frequently studied mental health problem was depression (N = 9 studies); the most frequently utilized measurement tool was the Edinburgh Postnatal Depression Scale (N = 3). Studies reported life course factors, individual, microsystem, exosystem, macrosystem, and chronosystem-level factors associated with mental health problems. Gaps in mental health service delivery for pregnant AGYW included lack of confidentiality, judgmental healthcare worker attitudes, and lack of services tailored to their unique needs.

INTERPRETATION

Gaps remain in research and services for mental health among pregnant AGYW in SSA. Integration of mental health services within school, community, and healthcare settings that are tailored to pregnant AGYW could strengthen health systems within SSA.

FUNDING

Author contributions were supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (F31HD101149 to AL) and the Fogarty International Center (K43TW010716 to MK). The funding agencies had no role in the writing of the manuscript or the decision to submit it for publication. The project itself was not funded.

Suicide and Maternal Mortality

PURPOSE OF REVIEW

Suicide is a leading cause of death in the perinatal period (pregnancy and 1 year postpartum). We review recent findings on prevalence, risk factors, outcomes, and prevention and intervention for suicide during pregnancy and the first year postpartum.

RECENT FINDINGS

Standardization of definitions and ascertainment of maternal deaths have improved identification of perinatal deaths by suicide and risk factors for perinatal suicide. Reports of a protective effect of pregnancy and postpartum on suicide risk may be inflated. Clinicians must be vigilant for risk of suicide among their perinatal patients, especially those with mental health diagnoses or prior suicide attempts. Pregnancy and the year postpartum are a time of increased access to healthcare for many, offering many opportunities to identify and intervene for suicide risk. Universal screening for suicide as part of assessment of depression and anxiety along with improved access to mental health treatments can reduce risk of perinatal suicide.

Prevalence and Associated Factors of Common Mental Disorders Among Pregnant Mothers in Rural Eastern Ethiopia

BACKGROUND

Antenatal common mental disorder is a significant public health issue, especially in low- and middle-income countries with an extensive treatment gap. Common mental disorders have multifaceted implications on maternal and fetal health outcomes during pregnancy with long-running economic and social sequels. This study aimed to determine the prevalence of common mental disorder and associated factors among pregnant mothers in eastern Ethiopia, Kersa and Haramaya Health, and Demographic surveillance sites.

METHODS

A community-based cross-sectional study was conducted in Kersa and Haramaya health and demographic surveillance sites from January 30 to April 30, 2021. World Health Organization Self-Reporting Questionnaire (SRQ-20) was used to measure common mental disorder among 1,015 randomly selected pregnant women. Data were collected face-to-face using open data kit software. Logistic regression was fitted to identify factors associated with common mental disorders.

RESULTS

The overall prevalence of common mental disorders (SRQ > 6) among pregnant women was 37.5% (95% CI: 34.5, 40.5). Current substance use (AOR = 1.99, 95% CI 1.37, 2.88), intimate partner violence (AOR = 2.67, 95% CI 2.02, 3.53), null parity (AOR = 3.10, 95% CI 1.65, 5.84), gestational age [first trimester (AOR = 2.22, 95% CI 1.01, 4.93) and third trimester (AOR = 1.74, 95% CI 1.31, 2.31)], history of abortion (AOR = 2.03, 95% CI 1.27, 3.24), and absence of antenatal care follow-up (AOR = 1.43, 95% CI 1.08, 1.89) were significantly associated with common mental disorder during pregnancy.

CONCLUSION

Common mental disorders are prevalent among pregnant women in the study area with significant correlates. Administration of regular screening programs for maternal mental health conditions in rural, low-income communities, integrating into primary health care settings is imperative to reduce the risk.

Under-5 mortality in sub-Saharan Africa: is maternal age at first childbirth below 20 years a risk factor?

OBJECTIVES

This study aimed at examining the association between young maternal age at first childbirth and under-5 mortality in sub-Saharan Africa (SSA).

DESIGN AND SETTING

This cross-sectional study pooled nationally-representative data from the most recent Demographic and Health Surveys conducted in 30 countries in SSA from 2010 to 2019.

PARTICIPANTS

116 379 mothers of children under 5.

RESULTS

The prevalence of adolescent childbirth and death in children under 5 in SSA were 57.36% (95% CI 53.73% to 60.99%) and 4.10% (95% CI 3.65% to 4.54%), respectively. Children born to mothers whose first childbirth occurred at <20 years were 11% more likely to die before the age of 5 compared with those whose mothers' first childbirth occurred at age ≥20 years (adjusted odds ratio (aOR) 1.11; 95% CI 1.05 to 1.18). In terms of the covariates, the likelihood of under-5 mortality was higher among children born to single (aOR 1.54; 95% CI 1.41 to 1.67) and cohabiting mothers (aOR 1.10; 95% CI 1.01 to 1.21) compared with married mothers. Children born to mothers who were obese were more likely to die before the age of 5 compared with those born to mothers with normal body weight (aOR 1.17; 95% CI 1.09 to 1.26). The odds of under-5 mortality were higher among children whose weight at birth was <2500 g compared with those whose weight was ≥2500 g at birth (aOR 1.83; 95% CI 1.64 to 2.03).

CONCLUSIONS

The findings call for the need to enhance policies aimed at reducing under-5 mortality in SSA by reducing adolescent pregnancy and childbirth through family planning, comprehensive sexuality education, and the elimination of child marriage. Again, Since under-5 mortality among adolescent mothers is linked with their poor socio-economic status, there is the need for government and non-governmental organisations in SSA to introduce poverty alleviation programmes and improve access to both formal and informal education as a way of enhancing the socioeconomic status of adolescent mothers. Public health education, through continuous advocacy programmes should be done to encourage adolescent mothers to access antenatal care and health facility deliveries as a way of enhancing the survival status of their children. These interventions should be implemented, taking into consideration other characteristics of mothers such marital status and BMI and child's characteristics such as child's weight, which were found to be associated with high under-5 mortality.

Maternal age at first childbirth and under-five morbidity in sub-Saharan Africa: analysis of cross-sectional data of 32 countries

BACKGROUND

The prevalence of childhood morbidity remains high in low-and middle-income countries, including sub-Saharan Africa (SSA). In this study, the association between maternal age at first childbirth and under-five morbidity in SSA was examined.

METHODS

This was a cross-sectional study involving nationally-representative data from the most recent Demographic and Health Surveys conducted in 32 countries in SSA from 2010 to 2019. A sample size of 311,603 mothers of children under-five was considered. The outcome variable for this study was under-five morbidity. This variable was derived from the experience of fever, cough, and diarrhoea among children under-five. Both multilevel and binary logistic regression models were used to test the hypothesis that adolescent childbirth is associated with under-five morbidity. The results were presented as crude odds ratios (cORs) and adjusted odds ratios (aORs), with 95 % confidence intervals (CIs).

RESULTS

Children born to mothers whose first childbirth occurred at < 20 years were 16 % times more likely to suffer from under-five morbidity, compared to those whose mothers' first childbirth occurred at age ≥ 20 years [cOR = 1.16; CI = 1.13-1.19], and this persisted but with reduced odds after controlling for covariates [aOR = 1.10; CI = 1.07-1.12]. At the country level, children born to mothers whose first childbirth occurred at < 20 years were more likely to suffer from under-five morbidity, compared to those whose mothers' first childbirth occurred at age ≥ 20 years in Angola, Burundi, Congo DR, Guinea, Kenya, and Uganda.

CONCLUSIONS

In this study, an association between adolescent childbirth and morbidity in children under five in SSA has been established. The study concludes that under-five morbidity is higher among children born to mothers whose first childbirth occurred before 20 years compared to those whose mothers' first childbirth occurred at 20 years and above. The findings indicate that in order to reduce under-five morbidity, there is the need to deal with adolescent childbearing through cultural and social change, coupled with engagement of adolescents and stakeholders in adolescent sexual and reproductive health programmes.

Informative title: Effects of social support, parenting stress and self-efficacy on postpartum depression among adolescent mothers in Jordan

AIM AND OBJECTIVE

This study investigated the effects of social support, parenting stress and maternal self-efficacy on postpartum depression among adolescent mothers in Jordan.

BACKGROUND

Adolescent pregnancy may have serious health, social and economic consequences for young women, families and communities. In Jordan, the incidence of adolescent pregnancy has increased from 5% in 2012 to 15% in 2018. Little attention has been given to postpartum depression among adolescent mothers in Arab and Middle Eastern countries.

METHOD

In a cross-sectional design using convenience sampling, 200 women aged less than 20 years, six to eight weeks postpartum and who could speak and read Arabic were interviewed in a participating health clinic. The interview occurred before or after a woman's scheduled clinic appointment and included socio-demographic data, Edinburgh Postnatal Depression Scale (EPDS), Maternity Social Support Scale (MSSS), Parenting Stress Scale (PSS) and Perceived Self-efficacy Scale (PSES). Data collection took place between December of 2018 and April of 2019. Reporting followed the STROBE guidelines.

RESULTS

Results revealed that 28.5% of adolescent mothers had probable postpartum depression. Mothers who reported high social support, high parenting stress, low self-efficacy, financial stress and marital conflict had significantly higher EPDS scores than those who did not report these stressors.

CONCLUSION

Prevalence of postpartum depression reported in this study warrants immediate action on early assessment, detection and intervention. High levels of social support may feel overwhelming for young mothers and contribute to high parenting stress, low maternal self-efficacy and marital conflict.

RELEVANCE TO CLINICAL PRACTICE

Adolescent mothers are at increased risk of PPD compared to mothers over 20 years of age. Perceived quality rather than availability of social support needs to be considered. Young mothers require education and early intervention prevention strategies to better prepared them for motherhood and manage stressors associated with their changing social role.

Antenatal Depression and Associated Factors among Pregnant Women Attending Antenatal Care Service in Kochi Health Center, Jimma Town, Ethiopia

BACKGROUND

Antenatal depression has immense public health importance, as it can adversely affect both the mother and child health. The problem contributes to the disease burden in both developed and developing countries. Despite this, it is less investigated and not getting the necessary attention in the study setting.

OBJECTIVE

The aim of the study was to assess the prevalence of antenatal depression and associated factors among women attending antenatal care (ANC) service in Kochi Health Center, Jimma town, southwest Ethiopia, 2019.

METHOD

Institutional based cross-sectional survey was conducted on 314 pregnant women attending Kochi Health Center from February 15 to April 15, 2019. A systematic random sampling technique was used to include the study participants. Antenatal depression was assessed using the Patient Health Questionnaire (PHQ-9) tool. Data was collected through face-to-face interviews using a pretested and structured questionnaire. Descriptive statistics was done to summarize the dependent and independent variables. Moreover, the chi-square test analysis was done to determine the association between the outcome and explanatory variables.

RESULTS

A total of 314 pregnant women participated in the study, making a response rate of 96.7%. The study has revealed a total of 52 (16.6%) of the respondent had antenatal depression. A chi-square test of independence analysis showed a significant association between antenatal depression and marital status, family history of depression, pregnancy planning, history of abortion, social support, and intimate partner violence (P < 0.00001).

CONCLUSION

The study has shown that the prevalence of antenatal depression was high and associated with multiple psychosocial, clinical, and obstetric factors. Therefore, screening pregnant women for depression and the provision of necessary mental health services is recommended to mitigate the adverse health outcome of the problem.

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

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

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

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

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