Magnitude and associated factors of postpartum depression among women in Nekemte town, East Wollega zone, west Ethiopia, 2019: A community-based study

PLoS ONE, Volume 14, No. 11, Year 2019

Interpretation

Background Postpartum depression is a non-psychotic disorder that happens during the first 1year after childbirth. It affects both the mother’s health and child’s development and is given significant public health concern in developed countries. However, in developing countries including Ethiopia, postnatal care is mainly concerned with obstetric problems and the baby’s health, while the psychological well-being of the mother is given little attention. Therefore, this study was aimed to assess the magnitude and associated factors of postpartum depression among women in Nekemte town, East Wollega zone, West Ethiopia, 2019. Methods Community-based cross-sectional study was conducted on 295 postnatal women, from May 15 to June 5, 2019, in Nekemte town. The study participants were selected by a simple random sampling method and interviewed using structured questionnaires. Multivariable logistic regression was used to find the independent variables which are associated with postnatal depression. All associations between dependent and independent variables and statistical significance were measured using odds ratio at 95% confidence interval and p-value less than 0.05. Results From the total of 295 women sampled, 287 were participated in the study. Out of these 287 women participated, 20.9% had developed postnatal depression. Unplanned pregnancy (AOR = 7.84, 95% CI: 3.19, 19.26), Being first time mother (AOR = 4.99, 95% CI: 1.54, 16.09), History of previous depression (AOR = 3.06, 95% CI: 1.06, 8.82), Domestic violence (AOR = 5.92, 95% CI: 2.44, 14.40), History of substance use (AOR = 3.95, 95% CI: 1.52, 10.30) and poor social support (AOR = 6.59, 95% CI: 2.25, 19.29) were significantly associated with postnatal depression. Conclusion In this study, the magnitude of postnatal depression was found moderate compared to other studies. Perinatal depression screening and intervention need to be integrated with maternal health care services, especially for mothers at risk of postnatal depression. This study was conducted in Nekemte town from May 15 to June 5, 2019. Nekemte town is the largest town in East Wollega Zone located at a distance of 328 kilometers from capital city Addis Ababa. This town has an estimated total population of 84,506 of whom 42,121 were males and 42, 385 were females. The total number of households in this town is about 16,901 and the number of postpartum women with an infant less than 12 months are estimated to be 2414. The community based cross-sectional study design was employed in this study. All postpartum women in Nekemte town who gave birth within 12 months before data collection were the source population and sampled postpartum women were the study population. All women who gave birth within the last 12 months prior to data collection were included in the study. Postpartum women who are eligible but not willing to take part in the study were excluded from the study. The sample size of the study was calculated using the formula for estimation of a single population proportion with the assumptions of 95% Confidence Level (CL) and marginal error (d) of 0.05. Twenty-two-point four percent (22.4%) of proportion of postpartum women with depression was taken from the previous study done in Mizan Aman town, Bench Maji zone, Southwest Ethiopia [11]. After adding a non-response rate of 10%, a total of 295 postpartum women were enrolled in the study. A simple random sampling method was used to select the study participants. First, postpartum women with an infant less than 12 months of age living in Nekemte town were identified with the help of local extension workers. The data collectors physically visited all households of the town and searched the postpartum women according to our inclusion criteria. The local extension worker assisted the data collectors in the door to door searching of postpartum women. Then, by using simple random sampling methods, a total of 295 postpartum women living in Nekemte town were recruited to be participated in the study. Data was collected using a validated, pre-tested structured questionnaire and a face-to-face interview was used for data collection. Edinburgh postnatal depression scale (EPDS), 3-item Kansas Marital Satisfaction Scale and 3-item Oslo Social Support Scale were used to assess postpartum depression, level of marital satisfaction and level of social support respectively. EPDS has 10 items and each item has 4 Likert scales and it has a maximum score of 30 and minimum scores of zero. Postpartum women were categorized in to depressed (total sum score ≥10) and not depressed (total sum score <10) [24]. Women with Kansas Marital Satisfaction scale score ≥17 was considered as satisfied and those <17 indicates dissatisfaction with marital status [25]. Women with 3- Items Oslo Social Support Scale score of 3–8 is considered as having poor support, 9–11 is moderate support and 12–15 is strong support [26]. Mothers were considered as a victim of domestic violence when they experienced any of physical, psychological or sexual harm within their intimate relationship. Women were considered as using substances when using any kind of addictive substance during pregnancy or after childbirth measured by yes or no items with at least one yes response. Data was collected by six trained nurses and three senior midwives as a supervisor for a duration of approximately 20 days. The data were coded, checked, cleaned and entered into Epi data version 3.1 and then exported to SPSS window version 20.0 for analysis. Descriptive statistics such as frequencies and percentages were performed. Bivariate analysis was done to find an association between each independent variable with postpartum depression. Finally, multivariable logistic regression was used to find out the independent variables which influence postpartum depression. All associations between dependent and independent variables and statistical significance were measured using odds ratio at 95% confidence interval and p-value less than 0.05. The questionnaire was prepared in English language and then translated to local language Afan Oromo and then translated back to English by expertise to check for consistency. Five percent (5%) of the questionnaire was pre-tested on postpartum women living in Gimbi town which is found at about 87 kilometers distance from Nekemte town. Data collectors and supervisors were trained for two days on the clarity of tools and overall data collection procedures. Each day after completion of data collection, data collectors meeting was held and filled questionnaires were cross-checked for possible errors. The study was reviewed and approved by the Institutional Review Boards of Wollega University Ethical review board. A formal letter was submitted to Nekemte town administrative office and Nekemte town health bureau. After getting permission from the Nekemte town administrative office, all participants of the study were provided written consent, clearly stating the objectives of the study and their right to refuse. Participants were interviewed after clearly informing the consent and signing the consent form written in local language. After the mothers signed the written consent form, the data collectors commenced the interview. Filled out questionnaires of the study were also carefully handled and all access to results was kept strictly within the author to prevent unnecessary exposure by third parties.

AI Digest

Study Justification:

– Postpartum depression is a significant public health concern in developed countries, but it receives little attention in developing countries like Ethiopia.
– This study aimed to assess the magnitude and associated factors of postpartum depression among women in Nekemte town, East Wollega zone, West Ethiopia in order to address this gap in knowledge.

Highlights:

– The study found that 20.9% of the women surveyed had developed postpartum depression.
– Factors significantly associated with postpartum depression included unplanned pregnancy, being a first-time mother, history of previous depression, domestic violence, history of substance use, and poor social support.
– The magnitude of postpartum depression in Nekemte town was found to be moderate compared to other studies.

Recommendations:

– Perinatal depression screening and intervention should be integrated with maternal health care services, especially for mothers at risk of postnatal depression.
– Policies and programs should be developed to address the identified risk factors, such as providing support for women with unplanned pregnancies, first-time mothers, and those with a history of depression.
– Efforts should be made to address domestic violence and substance use, as these were also found to be significant factors associated with postpartum depression.

Key Role Players:

– Ministry of Health: Responsible for developing policies and guidelines for integrating perinatal depression screening and intervention into maternal health care services.
– Health care providers: Involved in implementing the screening and intervention programs, providing support and counseling to women at risk of postpartum depression.
– Community health workers: Play a crucial role in identifying and referring women at risk of postpartum depression to appropriate health care services.
– Non-governmental organizations (NGOs): Can provide support in terms of funding, training, and awareness campaigns.

Cost Items for Planning Recommendations:

– Training programs for health care providers and community health workers on perinatal depression screening and intervention.
– Development and printing of screening tools and educational materials.
– Awareness campaigns targeting the general public and specific populations at risk.
– Integration of perinatal depression screening and intervention into existing maternal health care services.
– Monitoring and evaluation of the program’s effectiveness.
Please note that the cost items provided are general suggestions and may vary depending on the specific context and resources available.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is community-based and conducted on a relatively large sample size. The study uses structured questionnaires and employs multivariable logistic regression to identify associated factors. However, the abstract does not provide information on the validity and reliability of the questionnaires used, and there is no mention of any measures taken to ensure data quality. To improve the strength of the evidence, future studies could include information on the validation of the questionnaires and describe the steps taken to ensure data quality, such as training of data collectors and data cleaning procedures.

Abstract

This study was conducted in Nekemte town from May 15 to June 5, 2019. Nekemte town is the largest town in East Wollega Zone located at a distance of 328 kilometers from capital city Addis Ababa. This town has an estimated total population of 84,506 of whom 42,121 were males and 42, 385 were females. The total number of households in this town is about 16,901 and the number of postpartum women with an infant less than 12 months are estimated to be 2414. The community based cross-sectional study design was employed in this study. All postpartum women in Nekemte town who gave birth within 12 months before data collection were the source population and sampled postpartum women were the study population. All women who gave birth within the last 12 months prior to data collection were included in the study. Postpartum women who are eligible but not willing to take part in the study were excluded from the study. The sample size of the study was calculated using the formula for estimation of a single population proportion with the assumptions of 95% Confidence Level (CL) and marginal error (d) of 0.05. Twenty-two-point four percent (22.4%) of proportion of postpartum women with depression was taken from the previous study done in Mizan Aman town, Bench Maji zone, Southwest Ethiopia [11]. After adding a non-response rate of 10%, a total of 295 postpartum women were enrolled in the study. A simple random sampling method was used to select the study participants. First, postpartum women with an infant less than 12 months of age living in Nekemte town were identified with the help of local extension workers. The data collectors physically visited all households of the town and searched the postpartum women according to our inclusion criteria. The local extension worker assisted the data collectors in the door to door searching of postpartum women. Then, by using simple random sampling methods, a total of 295 postpartum women living in Nekemte town were recruited to be participated in the study. Data was collected using a validated, pre-tested structured questionnaire and a face-to-face interview was used for data collection. Edinburgh postnatal depression scale (EPDS), 3-item Kansas Marital Satisfaction Scale and 3-item Oslo Social Support Scale were used to assess postpartum depression, level of marital satisfaction and level of social support respectively. EPDS has 10 items and each item has 4 Likert scales and it has a maximum score of 30 and minimum scores of zero. Postpartum women were categorized in to depressed (total sum score ≥10) and not depressed (total sum score <10) [24]. Women with Kansas Marital Satisfaction scale score ≥17 was considered as satisfied and those <17 indicates dissatisfaction with marital status [25]. Women with 3- Items Oslo Social Support Scale score of 3–8 is considered as having poor support, 9–11 is moderate support and 12–15 is strong support [26]. Mothers were considered as a victim of domestic violence when they experienced any of physical, psychological or sexual harm within their intimate relationship. Women were considered as using substances when using any kind of addictive substance during pregnancy or after childbirth measured by yes or no items with at least one yes response. Data was collected by six trained nurses and three senior midwives as a supervisor for a duration of approximately 20 days. The data were coded, checked, cleaned and entered into Epi data version 3.1 and then exported to SPSS window version 20.0 for analysis. Descriptive statistics such as frequencies and percentages were performed. Bivariate analysis was done to find an association between each independent variable with postpartum depression. Finally, multivariable logistic regression was used to find out the independent variables which influence postpartum depression. All associations between dependent and independent variables and statistical significance were measured using odds ratio at 95% confidence interval and p-value less than 0.05. The questionnaire was prepared in English language and then translated to local language Afan Oromo and then translated back to English by expertise to check for consistency. Five percent (5%) of the questionnaire was pre-tested on postpartum women living in Gimbi town which is found at about 87 kilometers distance from Nekemte town. Data collectors and supervisors were trained for two days on the clarity of tools and overall data collection procedures. Each day after completion of data collection, data collectors meeting was held and filled questionnaires were cross-checked for possible errors. The study was reviewed and approved by the Institutional Review Boards of Wollega University Ethical review board. A formal letter was submitted to Nekemte town administrative office and Nekemte town health bureau. After getting permission from the Nekemte town administrative office, all participants of the study were provided written consent, clearly stating the objectives of the study and their right to refuse. Participants were interviewed after clearly informing the consent and signing the consent form written in local language. After the mothers signed the written consent form, the data collectors commenced the interview. Filled out questionnaires of the study were also carefully handled and all access to results was kept strictly within the author to prevent unnecessary exposure by third parties.

Materials

N/A

Innovations

Based on the provided information, here are some potential recommendations for innovations to improve access to maternal health:

1. Implement perinatal depression screening: Integrate screening for postpartum depression into routine maternal health care services. This can help identify women at risk and provide appropriate support and intervention.

2. Increase awareness and education: Develop educational programs and campaigns to raise awareness about postpartum depression among healthcare providers, mothers, and their families. This can help reduce stigma and promote early detection and treatment.

3. Strengthen social support systems: Enhance social support networks for postpartum women, including family, friends, and community organizations. This can help reduce the risk of postpartum depression by providing emotional support and practical assistance.

4. Address domestic violence: Develop comprehensive strategies to address domestic violence and provide support for victims. This can include training healthcare providers to identify signs of domestic violence and providing resources for intervention and support.

5. Improve access to mental health services: Increase the availability and accessibility of mental health services, including counseling and therapy, specifically tailored to address postpartum depression. This can involve training healthcare providers in mental health care and establishing referral systems for specialized care.

6. Integrate mental health into maternal health care: Ensure that mental health is integrated into routine maternal health care services, including antenatal and postnatal care. This can involve training healthcare providers to screen for and address mental health issues during pregnancy and the postpartum period.

7. Strengthen collaboration and coordination: Foster collaboration and coordination among different stakeholders, including healthcare providers, community organizations, and policymakers, to improve access to maternal mental health services. This can help streamline efforts and ensure a comprehensive approach to addressing postpartum depression.

It is important to note that these recommendations are based on the specific context of the study conducted in Nekemte town, East Wollega zone, West Ethiopia, and may need to be adapted to suit the local context and resources available in other settings.

AI Innovations Description

Based on the findings of the study, here is a recommendation that can be developed into an innovation to improve access to maternal health:

Integrate perinatal depression screening and intervention into maternal health care services: The study found that postpartum depression is a significant issue among women in Nekemte town, East Wollega zone, West Ethiopia. Currently, postnatal care in Ethiopia mainly focuses on obstetric problems and the baby’s health, while the psychological well-being of the mother is given little attention. To address this, it is recommended to integrate perinatal depression screening and intervention into maternal health care services. This can be done by training healthcare providers to identify and assess postpartum depression symptoms, and providing appropriate support and treatment options for affected mothers. By integrating mental health services into routine maternal health care, women at risk of postnatal depression can be identified early and provided with the necessary support, thus improving access to maternal health services and overall well-being of mothers and their children.

AI Innovations Methodology

Based on the provided study, here are some potential recommendations for improving access to maternal health:

1. Increase awareness and education: Implement comprehensive education programs to raise awareness about postpartum depression among women, their families, and healthcare providers. This can include information about risk factors, symptoms, and available support services.

2. Strengthen antenatal care: Integrate mental health screening and support into routine antenatal care visits. This can help identify women at risk of postpartum depression early on and provide appropriate interventions.

3. Enhance postnatal care: Improve postnatal care services to include mental health assessments and support for new mothers. This can involve training healthcare providers to identify and manage postpartum depression, as well as providing counseling and referral services.

4. Promote social support networks: Establish support groups and community-based programs that provide emotional support and practical assistance to new mothers. This can help reduce feelings of isolation and provide a safe space for women to share their experiences and seek guidance.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific population that will be affected by the recommendations, such as postpartum women in Nekemte town.

2. Collect baseline data: Gather data on the current access to maternal health services, including the prevalence of postpartum depression and the availability of screening and support programs.

3. Develop a simulation model: Create a mathematical model that represents the population and the various factors that influence access to maternal health. This model should include variables such as the number of healthcare providers, the availability of resources, and the level of awareness and education.

4. Input data and parameters: Input the baseline data and parameters into the simulation model. This includes information on the current state of access to maternal health services and the potential impact of the recommendations.

5. Run simulations: Use the simulation model to run multiple scenarios that simulate the impact of implementing the recommendations. This can involve adjusting variables such as the availability of resources, the level of awareness, and the coverage of screening and support programs.

6. Analyze results: Analyze the results of the simulations to assess the potential impact of the recommendations on improving access to maternal health. This can include evaluating changes in the prevalence of postpartum depression, the utilization of maternal health services, and the overall well-being of new mothers.

7. Refine and validate the model: Refine the simulation model based on the results and feedback from stakeholders. Validate the model by comparing the simulated outcomes with real-world data, if available.

8. Communicate findings: Present the findings of the simulation study to relevant stakeholders, such as policymakers, healthcare providers, and community organizations. Use the results to advocate for the implementation of the recommendations and to guide decision-making processes.

It is important to note that the methodology for simulating the impact of recommendations may vary depending on the specific context and available data. The steps outlined above provide a general framework for conducting such a simulation study.

Author

Dima Health

Statistics:

Citations: 14

Identifiers:

DOI: 10.1371/journal.pone.0224792

Research Areas:

Community Interventions, Disparities, Health System and Policy, Maternal Access, Maternal and Child Health, Mental Health, Quality of Care, Sexual and Reproductive Health, Substance Abuse, Violence and Injury, Workforce

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory, randomised-control-trial

Study Approach:

Quantitative

Participants Gender:

Female