Mental Health and Quality of Life of Women One Year after Maternal Near-Miss in Low and Middle-Income Countries: The Case of Zanzibar, Tanzania.

Sisay Alemu,Tanneke Herklots,Esther Sulkers,Regien Biesma,Shadya Mbarouk,Jelle Stekelenburg,Benoit Jacod,Janine de Zeeuw,Josue Almansa

doi:10.3390/ijerph17239034

Abstract

Women who experienced a maternal near-miss are at risk of mental health complications and lower quality of life, but long-term consequences are largely unknown. The aim of this study is to assess whether mental health symptoms and quality of life change over time and to examine associations with risk factors among post-partum women. In this cohort study, women with maternal near-miss were matched to women without or with mild complications at Mnazi Mmoja Hospital in Zanzibar. Depressive and post-traumatic stress disorder symptoms, and quality of life were measured at three, six, and twelve-months follow-up. A linear mixed-effects model was used for data analysis. Postpartum women in Zanzibar reported low levels of depressive and post-traumatic stress disorder symptoms. While depressive symptoms and quality of life trajectories were similar among women with and without maternal near-miss, differences for trajectories of post-traumatic stress disorder symptoms and physical quality of life were found. Social support, perinatal loss, and intercurrent illness were strongly associated with both depressive symptoms and quality of life in this group of Islamic women. These findings suggest that social support, embedded in the cultural context, should be considered in helping women cope with mental health issues in the aftermath of severe maternal complications.

Highlights

While maternal mortality ratios are declining globally, women increasingly experience life-threatening obstetric complications in low and middle-income countries (LMICs) [1].For every maternal death in LMICs, nearly 30 women survive a life-threatening obstetric complication; hereafter referred to as maternal near miss (MNM) [2]
quality of life (QoL) domain outcomes were right-skewed with a strong ceiling effect; we modelled the reversed of QoL scores as zero-inflated negative-binomial distribution
We found that postpartum women reported low levels of mental health problems and high quality of life scores that did not change much over time, except for post-traumatic stress disorder (PTSD) symptoms and physical QoL

Summary

Introduction

While maternal mortality ratios are declining globally, women increasingly experience life-threatening obstetric complications in low and middle-income countries (LMICs) [1]. For every maternal death in LMICs, nearly 30 women survive a life-threatening obstetric complication; hereafter referred to as maternal near miss (MNM) [2]. Care for women after MNM usually ends at discharge from the hospital [3]; the consequences of MNM can be long lasting. The impact is usually multidimensional, affecting physical functioning, mental health, and socio-economical aspects [3,4]. Some studies researched long-term mental health consequences in women with. Most studies (e.g., conducted in Morocco [7], Benin [8], and Burkina Faso [9]) found that women with

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