Background Previous Kenyan studies suggest postnatal depression (PND) may negatively impact infant growth. However these studies are limited to Nairobi and no research has explored the effects of PND in the neonatal period. Aim To explore the impact of PND on neonatal feeding practices, weight gain, illness episodes and identify key maternal caregiving challenges. Methods A mixed methods study of mothers and newborns <72 hours post-delivery from postnatal wards and clinics across 5 facilities in Kisumu County. At baseline, the Edinburgh Postnatal Depression Scale (EPDS) identified mothers with depressive features (EPDS ≥12) and infant feeding practices were assessed by questionnaire. 24 mothers were followed up 2 weeks later with a questionnaire and interview to further explore caregiving practices. Quantitative data was analysed using descriptive statistics. A thematic framework was used to identify and analyse emerging themes from the interviews. Results 56 (37%) out of 150 mother-infant pairs screened at baseline had an EPDS score ≥12. These mothers practiced exclusive breastfeeding less frequently (76.9% vs 90.9% p = 0.6) and a smaller proportion of their infants gained weight at 2 weeks (23.1% vs 36.4% p = 0.75). Key stressors were financial insecurity and lack of social support. Mothers described the benefits of social support on their mood and caregiving abilities. Conclusion Adverse growth and feeding outcomes are already apparent in the first 2 weeks of life among infants of mothers with features of PND. Early screening and intervention through community support structures could mitigate against the impact of PND on maternal mood and caregiving ability.

Background: Postnatal depression (PND) is associated with adverse infant neurodevelopmental outcomes. Evidence is limited on how PND influences neonatal (<28 days old) outcomes in low- and middle-income countries, such as Kenya, which bear the global burden of neonatal morbidity and mortality. Objectives: To explore how PND influences neonatal feeding and care practices among women in the early postnatal period in rural Western Kenya. Design: A cross-sectional study. Methods: Semi-structured interviews were conducted at 2-weeks postpartum among mothers of newborn infants identified <72 h old from the postnatal wards and clinics across five health facilities in Kisumu County of Western Kenya. They were all screened for features suggestive of postnatal depression using the Edinburgh Postnatal Depression Scale. Results: Twenty-four mothers were interviewed, 13 of whom had features suggestive of PND. All mothers experienced health or socio-economic adversities in the perinatal period, including traumatic deliveries, financial constraints, and challenging relationships with partners/other family members. Feeding difficulties due to perceived insufficient breastmilk were a particular challenge for mothers with features of PND, who were more likely to introduce complementary feeds. Maternal health-seeking decisions were influenced by high financial cost, long waiting times and poor interactions with health care providers that induced stress and fear among mothers. Maternal caregiving capacity was influenced by her ability to juggle other household duties, which was difficult for mothers with features suggestive of PND. Support from friends and relatives positively impacted maternal mood and caregiving ability. Conclusion: Mothers experienced many stress-inducing events in the perinatal period which potentially exacerbated features of PND in the immediate postnatal period. Women with features of PND were particularly vulnerable to these stressors that influenced infant caregiving practices. Addressing the socio-economic challenges and health system gaps that include scale up of compassionate and respectful care for women during pregnancy and childbirth, as well as early screening and intervention of PND, through enhanced referral pathways between health facilities and community support structures, could mitigate against the impact of PND on neonatal caregiving.