Effect of postpartum depression on exclusive breast-feeding practices in sub-Saharan Africa countries: a systematic review and meta-analysis

BMC Pregnancy and Childbirth, Volume 21, No. 1, Year 2021

Ukuhunyushwa

Background: Postpartum depression (PPD) is a serious mood disorder that affects behavioural, physical and mental health of women and newborn after childbirth. Although a wide range of research have been conducted on maternal and infant health outcomes, the effect of postpartum depression on exclusive breastfeeding practices remains ambiguous, and needs addressing. The aim of this study was to assess the effect of postpartum depression on exclusive breast feeding practices in sub-Saharan African countries. Methods: PubMed, Google Scholar, Science Direct and Cochrane Library were systematically searched for relevant articles published between 2001 and 2020. STATA version 14 was used to calculate the pooled odd ratio with 95% confidence intervals (95% CI). The DerSimonian and Laird random effects meta-analysis was used to measure the effect of postpartum depression on exclusive breast feeding practices. The heterogeneity and publication bias were assessed by using I2 test statistics and Egger’s test, respectively. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Result: A total of 1482 published articles and gray literatures were retrieved from different databases. Additional articles were identified from the reference list of identified reports and articles. After assessment of obtained articles, studies not meeting the inclusion criteria were excluded. Twenty six studies involving 30,021 population met the inclusion criteria were included in this review. In sub Saharan Africa the overall estimated level of postpartum depression was 18.6% (95% CI: 13.8, 23.4). This review found that postpartum depression had no significant effect on exclusive breast feeding practices (OR = 0.46, 95% CI: 0.18, 1.14). Conclusion: In Sub Saharan Africa, the prevalence of postpartum depression was lower than the report of World Health Organization for developing Country in 2020. This review reveled that maternal postpartum depression has no significant effect on exclusive breast feeding practices. Thus, the investigators strongly recommend the researchers to conduct primary studies using strong study design in sub-Saharan Africa. A three-step search strategy was used in this review. Firstly, an initial limited search of MEDLINE/PubMed was undertaken, followed by an analysis of the text words contained in the title and abstract and the index terms used to describe the articles. A second search using all identified keywords and index terms was undertaken across databases, including PubMed, Google Scholar, Science Direct, Proquest MedNar and Cochrane Library. Thirdly, the reference list of all identified reports and articles was searched for additional studies. The initial keywords were postnatal, postpartum, depression, mental disorders and exclusive breast feeding practices. These keywords were used separately and/or in combination using Boolean operators such as “OR” or “AND”. “Depression, postpartum”[All fields] AND (“africa south of the sahara”[MeSH Terms] OR and “prevalence” [Subheading] OR “(“africa south of the sahara”[MeSH Terms]” [All fields] AND “Ethiopia” [MeSH Terms] OR “africa south of the sahara”[All Fields]), “Infant breastfeeding”. Study setting: Sub-Sahara Africa. Study participants: Exclusive Breast feeding mothers. Publication condition: All published articles and gray literatures. Language: English language. Types of studies: Observational study designs. Publication date: From January 2001 to June 28, 2020, due to the lack of studies from sub Saharan Africa on the topic before 2001. Exclusion criteria: Unable to access full-texts after two email contacts of the principal investigator. This review considered studies that examined exclusive breast feeding practices in women with postpartum depression versus women without postpartum depression. Postpartum depression is defined as depression that starts within one month after childbirth and whose symptoms last more than two weeks. We can measure postnatal depression by using the Diagnostic and Statistical Manual of Mental Disorders or Edinburgh Postnatal Depression Scale and self-reporting questionnaire-20. This review excluded studies that have been conducted on mothers with preexisting psychological disorders. The outcome interest of this review was the pooled prevalence of PPD and its effect on exclusive breast feeding practices in Sub Saharan Africa. Effect size was estimated in the form of log odds ratios. This review considered studies with observational study designs: prospective, retrospective follow up studies and cross-sectional studies reporting an association between postpartum depression and exclusive breast feeding practices were considered for this review. Quality of each original study was assessed independently (DW, YT) by using Newcastle-Ottawa Scale (NOS) quality assessment tool [26]. Any disagreements were resolved by taking the mean score. Finally, studies with a scale of ≥5 out of 10 were considered as achieving high quality. Any disagreements that arise between the reviewers were resolved through discussion with a third reviewer (BS) (Table 1). Characteristics of studies included in the systematic review and meta-analysis on the effect of postpartum on exclusive breast feeding practices in Sub-Saharan Africa, 2020 Note: CES-D Centre for Epidemiologic Studies-Depression, EPHD Edinburgh Postnatal Depression, PHQ Patient Health Questionnaire, SRQ Self-reporting Questionnaire, SSQ Shona Symptom Questionnaire The standard data extraction tool was prepared in a Microsoft Excel spreadsheet. This included the specific details about the exposures, populations, study methods and outcomes of significance to the review question and specific objectives. The authors of primary studies were contacted by email in case there is incomplete information. Two reviewers (DW and YT) extracted the data independently. Any differences among reviewers were negotiated with review team members until agreement was reached. Data were analyzed using STATA version 14. Heterogeneity was assessed using the standard I2 and visual inspection of forest plots. To check publication bias, both objective and subjective (funnel plot) methods were used. Mainly, objective methods such as Eggers’ and Beggs’ tests (p-value < 0.05) were used to assess publication bias [53, 54]. The result of Eggers’ test revealed statistically significant publication bias (p-value < 0.001). Finally, Duval and Tweedie’s nonparametric trim and fill analysis was performed to account for this publication bias. The pooled prevalence and effect size was expressed as standardized mean differences and their 95% confidence intervals were calculated using the DerSimonian and Laird method. Moreover, odds ratios and their 95% confidence intervals were calculated.

I-AI Digest

Study Justification:

– Postpartum depression (PPD) is a significant mood disorder that affects the well-being of women and newborns after childbirth.
– The impact of PPD on exclusive breastfeeding practices in sub-Saharan African countries is not well understood.
– This study aimed to assess the effect of PPD on exclusive breastfeeding practices in sub-Saharan Africa.

Highlights:

– A systematic review and meta-analysis were conducted, analyzing 26 studies involving 30,021 participants.
– The overall estimated prevalence of postpartum depression in sub-Saharan Africa was 18.6%.
– The review found that postpartum depression had no significant effect on exclusive breastfeeding practices.
– The prevalence of postpartum depression in sub-Saharan Africa was lower than the World Health Organization’s report for developing countries in 2020.

Recommendations:

– Researchers are strongly recommended to conduct primary studies using strong study designs in sub-Saharan Africa to further investigate the relationship between postpartum depression and exclusive breastfeeding practices.

Key Role Players:

– Researchers and research institutions
– Healthcare professionals and organizations
– Policy makers and government agencies
– Non-governmental organizations (NGOs) focused on maternal and child health

Cost Items for Planning Recommendations:

– Research funding for primary studies
– Training and capacity building for healthcare professionals
– Implementation of interventions and support programs for women with postpartum depression
– Monitoring and evaluation of interventions
– Awareness campaigns and educational materials for healthcare providers and the general public

Amandla Obufakazi

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted a systematic review and meta-analysis, which is a rigorous approach to synthesizing evidence. The study included a large number of studies (26) and a substantial population (30,021). However, the evidence could be strengthened by addressing the following actionable steps: 1) Improve the search strategy by including additional databases and considering other relevant keywords. 2) Assess and address the heterogeneity among the included studies. 3) Conduct a thorough assessment of publication bias and consider using additional methods to account for it. 4) Provide more details on the quality assessment of the included studies and the criteria used to determine high quality. 5) Clearly report the results of the meta-analysis, including the pooled prevalence and effect size with their confidence intervals.

Abstract

A three-step search strategy was used in this review. Firstly, an initial limited search of MEDLINE/PubMed was undertaken, followed by an analysis of the text words contained in the title and abstract and the index terms used to describe the articles. A second search using all identified keywords and index terms was undertaken across databases, including PubMed, Google Scholar, Science Direct, Proquest MedNar and Cochrane Library. Thirdly, the reference list of all identified reports and articles was searched for additional studies. The initial keywords were postnatal, postpartum, depression, mental disorders and exclusive breast feeding practices. These keywords were used separately and/or in combination using Boolean operators such as “OR” or “AND”. “Depression, postpartum”[All fields] AND (“africa south of the sahara”[MeSH Terms] OR and “prevalence” [Subheading] OR “(“africa south of the sahara”[MeSH Terms]” [All fields] AND “Ethiopia” [MeSH Terms] OR “africa south of the sahara”[All Fields]), “Infant breastfeeding”. Study setting: Sub-Sahara Africa. Study participants: Exclusive Breast feeding mothers. Publication condition: All published articles and gray literatures. Language: English language. Types of studies: Observational study designs. Publication date: From January 2001 to June 28, 2020, due to the lack of studies from sub Saharan Africa on the topic before 2001. Exclusion criteria: Unable to access full-texts after two email contacts of the principal investigator. This review considered studies that examined exclusive breast feeding practices in women with postpartum depression versus women without postpartum depression. Postpartum depression is defined as depression that starts within one month after childbirth and whose symptoms last more than two weeks. We can measure postnatal depression by using the Diagnostic and Statistical Manual of Mental Disorders or Edinburgh Postnatal Depression Scale and self-reporting questionnaire-20. This review excluded studies that have been conducted on mothers with preexisting psychological disorders. The outcome interest of this review was the pooled prevalence of PPD and its effect on exclusive breast feeding practices in Sub Saharan Africa. Effect size was estimated in the form of log odds ratios. This review considered studies with observational study designs: prospective, retrospective follow up studies and cross-sectional studies reporting an association between postpartum depression and exclusive breast feeding practices were considered for this review. Quality of each original study was assessed independently (DW, YT) by using Newcastle-Ottawa Scale (NOS) quality assessment tool [26]. Any disagreements were resolved by taking the mean score. Finally, studies with a scale of ≥5 out of 10 were considered as achieving high quality. Any disagreements that arise between the reviewers were resolved through discussion with a third reviewer (BS) (Table 1). Characteristics of studies included in the systematic review and meta-analysis on the effect of postpartum on exclusive breast feeding practices in Sub-Saharan Africa, 2020 Note: CES-D Centre for Epidemiologic Studies-Depression, EPHD Edinburgh Postnatal Depression, PHQ Patient Health Questionnaire, SRQ Self-reporting Questionnaire, SSQ Shona Symptom Questionnaire The standard data extraction tool was prepared in a Microsoft Excel spreadsheet. This included the specific details about the exposures, populations, study methods and outcomes of significance to the review question and specific objectives. The authors of primary studies were contacted by email in case there is incomplete information. Two reviewers (DW and YT) extracted the data independently. Any differences among reviewers were negotiated with review team members until agreement was reached. Data were analyzed using STATA version 14. Heterogeneity was assessed using the standard I2 and visual inspection of forest plots. To check publication bias, both objective and subjective (funnel plot) methods were used. Mainly, objective methods such as Eggers’ and Beggs’ tests (p-value < 0.05) were used to assess publication bias [53, 54]. The result of Eggers’ test revealed statistically significant publication bias (p-value < 0.001). Finally, Duval and Tweedie’s nonparametric trim and fill analysis was performed to account for this publication bias. The pooled prevalence and effect size was expressed as standardized mean differences and their 95% confidence intervals were calculated using the DerSimonian and Laird method. Moreover, odds ratios and their 95% confidence intervals were calculated.

Izinto zokwakha

N/A

Emisha

Based on the provided information, it seems that the study focused on assessing the effect of postpartum depression on exclusive breastfeeding practices in sub-Saharan African countries. The study used a systematic review and meta-analysis approach to analyze the data. The researchers conducted a comprehensive search across multiple databases and used specific keywords to identify relevant articles. They included observational study designs that examined exclusive breastfeeding practices in women with postpartum depression compared to women without postpartum depression. The quality of each original study was assessed using the Newcastle-Ottawa Scale (NOS) quality assessment tool. The data were analyzed using STATA version 14, and measures of heterogeneity and publication bias were assessed. The results indicated that postpartum depression had no significant effect on exclusive breastfeeding practices in sub-Saharan Africa. The researchers recommended conducting primary studies using strong study designs in sub-Saharan Africa to further investigate this topic.

AI Innovations Description

Based on the provided information, the recommendation to improve access to maternal health is to conduct primary studies using strong study designs in sub-Saharan Africa. This recommendation is based on the findings of the systematic review and meta-analysis, which revealed that postpartum depression has no significant effect on exclusive breastfeeding practices in sub-Saharan Africa.

To implement this recommendation, researchers should focus on designing and conducting high-quality observational studies, including prospective, retrospective follow-up studies, and cross-sectional studies. These studies should specifically examine the association between postpartum depression and exclusive breastfeeding practices in sub-Saharan African countries.

In terms of study settings, the research should be conducted in sub-Saharan Africa, and the study participants should be exclusive breastfeeding mothers. The publication condition should include all published articles and gray literature, with a focus on English language publications. The time frame for publication should be from January 2001 to the present, as there is a lack of studies on this topic from sub-Saharan Africa before 2001.

To ensure the quality of the studies, the Newcastle-Ottawa Scale (NOS) quality assessment tool can be used to assess the quality of each original study. Studies with a score of 5 or higher out of 10 should be considered as achieving high quality.

In terms of data analysis, STATA version 14 can be used to calculate the pooled odds ratio with 95% confidence intervals. Heterogeneity should be assessed using the I2 test statistics and visual inspection of forest plots. Publication bias should be assessed using objective methods such as Egger’s and Begg’s tests.

Overall, conducting primary studies using strong study designs in sub-Saharan Africa will provide more accurate and specific information on the effect of postpartum depression on exclusive breastfeeding practices. This will contribute to improving access to maternal health in the region.

AI Innovations Methodology

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

1. Increase awareness and education: Implement comprehensive education programs that focus on maternal mental health, including postpartum depression, and its impact on exclusive breastfeeding practices. This can be done through community workshops, antenatal classes, and healthcare provider training.

2. Strengthen healthcare systems: Improve access to mental health services by integrating mental health screening and support into routine antenatal and postnatal care. This can involve training healthcare providers to identify and manage postpartum depression, as well as ensuring the availability of appropriate resources and referral pathways.

3. Provide social support: Establish support networks for new mothers, such as peer support groups or online communities, where they can share experiences, receive emotional support, and access information about exclusive breastfeeding practices.

4. Address cultural and social barriers: Recognize and address cultural beliefs, stigma, and social norms that may hinder exclusive breastfeeding practices and discourage seeking help for postpartum depression. This can involve community engagement and collaboration with local leaders and influencers.

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

1. Baseline data collection: Gather data on the current prevalence of postpartum depression, exclusive breastfeeding practices, and access to maternal health services in the target population.

2. Define indicators: Identify specific indicators to measure the impact of the recommendations, such as the percentage of women screened for postpartum depression, the percentage of women receiving appropriate mental health support, and the percentage of women practicing exclusive breastfeeding.

3. Intervention implementation: Implement the recommended interventions, such as education programs, strengthening healthcare systems, providing social support, and addressing cultural and social barriers.

4. Monitoring and evaluation: Continuously monitor the implementation of the interventions and collect data on the identified indicators. This can involve surveys, interviews, and record reviews.

5. Data analysis: Analyze the collected data to assess the impact of the interventions on the identified indicators. This can be done using statistical methods, such as calculating changes in percentages or conducting regression analyses.

6. Interpretation and reporting: Interpret the findings and report on the impact of the recommendations on improving access to maternal health. This can involve presenting the results in a clear and concise manner, highlighting any significant changes or trends observed.

7. Feedback and adjustment: Use the findings to provide feedback and make adjustments to the interventions as needed. This can involve refining strategies, reallocating resources, or implementing additional measures to further improve access to maternal health.

By following this methodology, it is possible to simulate the impact of the recommended innovations on improving access to maternal health and assess their effectiveness in addressing postpartum depression and exclusive breastfeeding practices in sub-Saharan African countries.

Umbhali

Dima Health

Statistics:

Citations: 11

Identifiers:

DOI: 10.1186/s12884-020-03535-1

Research Areas:

Disparities, Genetics and Genomics, Health System and Policy, Maternal Access, Maternal and Child Health, Mental Health, Quality of Care, Social Determinants

Study Countries:

Ethiopia

Study Design:

Cohort Study, Cross Sectional Study

Study Approach:

Mixed-methods, Quantitative, Systematic Review

Participants Gender:

Female

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