Perinatal common mental disorders and child survival in Ethiopia

Abstract

The study aims to evaluate the impact of perinatal common mental disorders (CMDs) on child mortality up to 3.5 years in a demographic surveillance site at Butajira, Ethiopia. One thousand sixty-five eligible women were assessed for CMD in the third trimester of pregnancy and at 2 months post-delivery using the Self-Reporting Questionnaire. We derived a four-level categorical exposure variable for the course of perinatal CMD. The outcome measure was child death recorded from 1 month after the postnatal assessment up to 3.5 years. Potential confounders and mediators were evaluated. The cumulative child mortality rates were 62.6/1000 at 1 year and 82.5/1000 at 3.5 years, respectively. Exposure to perinatal CMD did not significantly affect child survival at 3.5 years, with results showing fully adjusted hazard ratio (HR) and 95% confidence interval (95% CI) of 1.85 (0.43, 7.88) for CMD in pregnancy only, 1.47 (0.14, 15.66) for CMD in postnatal period only and 0.41 (0.02, 7.38) for persistent CMD (both in pregnancy and postnatal). Only using soap less frequently than daily (HR 5.67, 95% CI 1.58-20.30) and episode of malaria in pregnancy (HR 5.02, 95% CI 2.15-11.72) were associated with child mortality in multivariable analysis. Maternal health, health behaviours and family structure appear to be the most important factors affecting post-neonatal child mortality in this Ethiopian birth cohort, with little evidence for an effect of maternal perinatal CMD.