Abstract
BackgroundAlthough maternal common mental disorder (CMD) appears to be a risk factor for infant undernutrition in South Asian countries, the position in sub-Saharan Africa (SSA) is unclearMethodsA population-based cohort of 1065 women, in the third trimester of pregnancy, was identified from the demographic surveillance site (DSS) in Butajira, to investigate the effect of maternal CMD on infant undernutrition in a predominantly rural Ethiopian population. Participants were interviewed at recruitment and at two months post-partum. Maternal CMD was measured using the locally validated Self-Reported Questionnaire (score of ≥ six indicating high levels of CMD). Infant anthropometry was recorded at six and twelve months of age.ResultThe prevalence of CMD was 12% during pregnancy and 5% at the two month postnatal time-point. In bivariate analysis antenatal CMD which had resolved after delivery predicted underweight at twelve months (OR = 1.71; 95% CI: 1.05, 2.50). There were no other statistically significant differences in the prevalence of underweight or stunted infants in mothers with high levels of CMD compared to those with low levels. The associations between CMD and infant nutritional status were not significant after adjusting for pre-specified potential confounders.ConclusionOur negative finding adds to the inconsistent picture emerging from SSA. The association between CMD and infant undernutrition might be modified by study methodology as well as degree of shared parenting among family members, making it difficult to extrapolate across low- and middle-income countries.
Highlights
Maternal common mental disorder (CMD) appears to be a risk factor for infant undernutrition in South Asian countries, the position in sub-Saharan Africa (SSA) is unclear
Cases lost to follow-up were less likely to have children under five years old and more likely to be in a polygamous marriage compared to cases whose information is included in this paper
In this population-based prospective study from rural Ethiopia we evaluated the effect of maternal CMD in pregnancy and at two months postnatal upon infant
Summary
Study design and population A population based prospective cohort of pregnant women was established [29] within the framework of the demographic surveillance site (DSS) in Butajira [30] 135 km south of Addis Ababa, the capital city of Ethiopia. Sample size estimation We hypothesised that the infants born to women with high levels of CMD (SRQ20 ≥ 6) during their third trimester would have a 1.5 times higher risk of being stunted at six months of age compared to infants of mothers with a low SRQ score. Independent sample t-tests were used to compare mean score of nutritional indices of infants born to mothers with and without a high level of CMD. Taking each of the three CMD exposures in turn, the association with infant nutritional status was investigated with logistic regression for binary outcomes (undernourished versus well-nourished) and linear regression for continuous outcomes (weight-for-age and height-for-age z scores). All data analysis was done using STATA [37] with the probability of type 1 error set at 5%
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