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Purpose: Postnatal depression (PND) rates in low-resource countries have reached levels between 4.9% and 59%. Maternal mental health has not been researched in Sudan, and there are no existing statistics on prevalence or significant risk factors for PND. Consequently, no screening test has been validated to screen for PND at the primary health care level. This study investigates the 3 months prevalence of PND and validates the Edinburgh Postnatal Depression Scale (EPDS) against the Mini-International Neuropsychiatric Interview (MINI). Methodology: Pregnant Sudanese women in the second and third trimesters were recruited to the study during routine antenatal care visits in two major maternity hospitals in Khartoum state. They were screened for PND at 3 months postpartum using the EPDS. Test positive women were matched with test negative women according to nearest date of birth. A clinical psychologist verified their depression status using the MINI. Results: The follow-up rate was 79%. At a cutoff point of ≥12, the 3 months prevalence of PND was 9.2%. The sensitivity and specificity of the EPDS were 89% and 82%, respectively. The EPDS and MINI showed a strong positive relationship (odds ratio =36). The positive predictive value and negative predictive value, using this study’s prevalence, were 33% and 98.7%, respectively. The receiver operator characteristic analysis showed an area under the curve of 0.89. The cut-off point ≥12 was the most acceptable point as it had the lowest number needed to diagnose (1.4) and a false-positive rate of 18%. Conclusion: The EPDS is a valid tool for screening for PND on a Sudanese population. It was accepted, easily administered, and understood by postnatal women. Health care personnel, especially village midwives, should be trained on screening and referral of depressed women for clinical evaluation and management. Due to limited resources available in Sudan, shorter screening tests need to be validated in the future.
In this cross-sectional study, women were recruited before delivery and then screened for PND at 3 months postpartum. Women presenting at two antenatal clinics (antenatal care [ANC]) in two major public tertiary hospitals were invited to participate in the study. The clinics provide routine ANC services for pregnant woman living within or outside the hospitals’ catchment population. The hospitals were Omdurman Maternity Teaching Hospital (90% of total sample) and Ibrahim Malik Teaching Hospital (10% of sample). Omdurman Maternity hospital has one of the biggest catchment populations in Khartoum state.26 According to the hospital statistical reports, the hospital has 38,000 deliveries per year and 900 ANC visits per month, on average. Sudan follows the World Health Organization protocol for utilization of ANC services: pregnant women should receive a minimum of four visits during pregnancy. Khartoum state has the highest level of utilization of ANC services in Sudan and the highest level of institutional-based deliveries as well.27 ANC attendance in Khartoum state is 88%.27 This is the proportion of women that attend “at least one” ANC visit by a skilled provider during their pregnancy. Doctors provide 67% of these services in Khartoum state while village midwives and health visitors provide 21%, mainly at primary health care facilities. About 11.7% do not receive any ANC during their pregnancy.27 Women from all localities of Khartoum state can access ANC services in Omdurman Maternity Hospital because access does not depend on location of residence.28 There is no linking between the different ANC clinics, so a woman could be registered at more than one clinic during her pregnancy. Inclusion criteria were women of Sudanese nationality, in the second or third trimester, of any parity with full contact information (at least two working telephone numbers). Illiteracy was not an exclusion criterion as data collection was via interviews. The Study protocol was ethically approved in Sudan by the Sudan Ministry of Health and in Norway by REK (Regional Committees for Medical and Health Research Ethics, reference no 2013/353/REK). All women diagnosed as depressed by the Mini-International Neuropsychiatric Interview (MINI) were referred for adequate follow-up at local mental health clinics.
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