Abstract
BackgroundLow- and middle-income countries are disproportionately affected by postnatal depression (PND). High prevalence of PND in urban Zimbabwe has been reported but the situation in rural settings is largely unknown and this is one of the first studies to report prevalence of PND in Chipinge and Mutasa districts.ObjectivesThis study explored the prevalence and associated factors of PND among women attending postnatal care services in two rural districts of Chipinge and Mutasa, Manicaland, Zimbabwe between August and September 2017.MethodsOne hundred and ninety-two women were recruited consecutively as they attended postnatal services at 7 days and 42 days post-delivery. The Diagnostic and Statistical Manual for Mental Disorders, fifth edition criteria was used to classify depression among participants. Prevalence of PND and 95.0% confidence intervals (CIs) were estimated and associations with key socio-demographic and risk factors assessed.ResultsThe mean age of participants was 23.7 years (standard deviation = 6.14). Pooled prevalence of PND across the two districts was 26.0% (95% CI: 19.04–31.74). There was a higher prevalence of PND in Mutasa (31.0%) as compared to Chipinge (21.48%) but this was not statistically significant (p = 0.142). Having insufficient food in the household, intimate partner violence and having a child with birthweight under 2500 g significantly increased the likelihood of PND twofold: adjusted odds ratio (aOR) = 2.8 (95% CI: 1.2–6.1), aOR = 2.5 (95% CI: 1.2–5.3) and aOR = 2.4 (95% CI: 1.1–5.6), respectively.ConclusionThe high prevalence of PND and its associated risk factors indicates the need for routine screening and targeted interventions for PND in Zimbabwe, especially in rural areas.
Highlights
Postnatal depression (PND) is a major threat to survival of both mother and child
The World Health Organization has ranked depression as the single largest contributor to global disability, affecting 322 million people and accounting for 7.5% of years lived with disability in 2015.1 A recent systematic review reported an overall adjusted pooled global prevalence of perinatal depression of 11.9% in 2017.2 Low- and middle-income countries (LMICs) are disproportionately affected, with an estimated pooled prevalence of PND of 19.0% in 2016.3 Studies from sub-Saharan Africa have reported higher rates of PND exceeding 30.0% in South Africa, Nigeria and Zimbabwe,[3] with substantial within-country heterogeneity
Factors such as low socio-economic status and intimate partner violence have been reported to be associated with PND in most LMICs.[3]
Summary
Postnatal depression (PND) is a major threat to survival of both mother and child. The World Health Organization has ranked depression as the single largest contributor to global disability, affecting 322 million people and accounting for 7.5% of years lived with disability in 2015.1 A recent systematic review reported an overall adjusted pooled global prevalence of perinatal depression of 11.9% in 2017.2 Low- and middle-income countries (LMICs) are disproportionately affected, with an estimated pooled prevalence of PND of 19.0% in 2016.3 Studies from sub-Saharan Africa have reported higher rates of PND exceeding 30.0% in South Africa, Nigeria and Zimbabwe,[3] with substantial within-country heterogeneity. Several studies have highlighted strong associations between infant mortality and maternal perinatal depression.[5,6,7,8] Given that the effects of PND transcend beyond the mother to include the family and communities,[9] there is need to understand the factors that place postnatal women at risk of PND Factors such as low socio-economic status and intimate partner violence have been reported to be associated with PND in most LMICs.[3] A recent review on depression in Zimbabwean women showed that significant risk factors for PND include socio-economic difficulties, history of experiencing adverse events and intimate partner violence.[4]. High prevalence of PND in urban Zimbabwe has been reported but the situation in rural settings is largely unknown and this is one of the first studies to report prevalence of PND in Chipinge and Mutasa districts
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