Postpartum depression (PPD) is a serious pubic health concern and known to have the adverse effects on mother’s perinatal wellbeing; and child’s physical and cognitive development. There were limited literatures on PPD in Bangladesh, especially in urban slum context. The aim of this study was to assess the burden and risk factors of PPD among the urban slum women. A cross-sectional study was conducted between November-December 2017 in three urban slums on 376 women within first 12 months of postpartum. A validated Bangla version of Edinburgh Postnatal Depression Scale was used to measure the depression status. Respondent’s socio-economic characteristics and other risk factors were collected with structured validated questionaire by trained interviewers. Unadjusted Prevalence Ratio (PR) and Adjusted Prevalence Ratio (APR) were estimated with Generalized Linear Model (GLM) and Generalized Estimating Equation (GEE) respectively to identify the risk factors of PPD. The prevalence of PPD was 39.4% within first 12 months following the child birth. Job involvement after child delivery (APR = 1.9, 95% CI = 1.1, 3.3), job loss due to pregnancy (APR = 1.5, 95% CI = 1.0, 2.1), history of miscarriage or still birth or child death (APR = 1.4, 95% CI = 1.0, 2.0), unintended pregnancy (APR = 1.8, 95% CI = 1.3, 2.5), management of delivery cost by borrowing, selling or mortgaging assets (APR = 1.3, 95% CI = 0.9, 1.9), depressive symptom during pregnancy (APR = 2.5, 95% CI = 1.7, 3.8) and intimate partner violence (APR = 2.0, 95% CI = 1.2, 3.3), were identified as risk factors. PPD was not associated with poverty, mother in law and any child related factors. The burden of postpartum depression was high in the urban slum of Bangladesh. Maternal mental health services should be integrated with existing maternal health services. Research is required for the innovation of effective, low cost and culturally appropriate PPD case management and preventive intervention in urban slum of Bangladesh.

BackgroundUptake matters for evaluating the health impact of water, sanitation and hygiene (WASH) interventions. Many large-scale WASH interventions have been plagued by low uptake. For the WASH Benefits Bangladesh efficacy trial, high uptake was a prerequisite. We assessed the degree of technology and behavioral uptake among participants in the trial, as part of a three-paper series on WASH Benefits Intervention Delivery and Performance.MethodsThis study is a cluster randomized trial comprised of geographically matched clusters among four districts in rural Bangladesh. We randomly allocated 720 clusters of 5551 pregnant women to individual or combined water, sanitation, handwashing, and nutrition interventions, or a control group. Behavioral objectives included; drinking chlorine-treated, safely stored water; use of a hygienic latrine and safe feces disposal at the compound level; handwashing with soap at key times; and age-appropriate nutrition behaviors (pregnancy to 24 months) including a lipid-based nutrition supplement (LNS). Enabling technologies and behavior change were promoted by trained local community health workers through periodic household visits. To monitor technology and behavioral uptake, we conducted surveys and spot checks in 30–35 households per intervention arm per month, over a 20-month period, and structured observations in 324 intervention and 108 control households, approximately 15 months after interventions commenced.ResultsIn the sanitation arms, observed adult use of a hygienic latrine was high (94–97% of events) while child sanitation practices were moderate (37–54%). In the handwashing arms, handwashing with soap was more common after toilet use (67–74%) than nonintervention arms (18–40%), and after cleaning a child’s anus (61–72%), but was still low before food handling. In the water intervention arms, more than 65% of mothers and index children were observed drinking chlorine-treated water from a safe container. Reported LNS feeding was > 80% in nutrition arms. There was little difference in uptake between single and combined intervention arms.ConclusionsRigorous implementation of interventions deployed at large scale in the context of an efficacy trial achieved high levels of technology and behavioral uptake in individual and combined WASH and nutrition intervention households. Further work should assess how to achieve similar uptake levels under programmatic conditions.Trial registrationWASH Benefits Bangladesh: ClinicalTrials.gov, identifier: NCT01590095. Registered on April 30, 2012.

25Postpartum depression (PPD) is a serious pubic health concern and known to have 26 the adverse effects on mother 's perinatal wellbeing; and child 's physical and codnitive 27 development. There were limited literatures on PPD in Bangladesh, especially in urban slum 28 context. The aim of this study was to assess the burden and risk factors of PPD among the 29 urban slum women. A cross-sectional study was conducted between November-December 30 2017 in three urban slums on 376 women within first 12 months of postpartum. A validated 31 Bangla version of Edinburgh Postnatal Depression Scale was used to measure the depression 32 status. Respondent's socio-economic characteristics and other risk factors were collected with 33 structured validated questionaire by trained interviewers . Unadjusted Prevalence Ratio (PR) 34 and Adjusted Prevalence Ratio (APR) were estimated with Generalized Linear Model(GLM) 35 and Generalized Estimating Equation (GEE) respectively to identify the risk factors of PPD. 36 The prevalence of PPD was 39.4% within first 12 months following the child birth. Job 37 involvement after child delivery (APR=1.9, 95% CI= 1.1, 3.3), job loss due to pregnancy 38 (APR=1.5, 95% CI= 1.0, 2.1), perinatal and postnatal death (APR=1.4, 95% CI= 0.97, 2.0), 39 unintended pregnancy (APR=1.8, 95% CI= 1.3, 2.5), management of delivery cost by 40 borrowing, selling or mortgaging assets (APR=1.3, 95% CI= 0.94, 1.9), depressive symptom 41 during pregnancy (APR=2.5, 95% CI= 1.7, 3.8) and intimate partner violence (APR=2.0, 95% 42 CI= 1.2, 3.3), were identified as risk factors.PPD was not associated with poverty, mother in 43 law and any child related factors. The burden of postpartum depression is high in the urban 44 slum of Bangladesh. Maternal mental health services should be integrated with existing 45 maternal health services. Research is required for the innovation of effective, low cost and 46 culturally appropriate PPD case management and preventive intervention in urban slum of 47 Postpartum depression (PPD) is a common, non-psychotic mood or mental disorder 51 which typically manifests in mothers within one year of delivery (first year postpartum) [1, 2]. 52Globally, the prevalence of PPD among mothers ranges from 0.5% to 60.8% [3]. In 53 comparison to women of developed countries, women of developing countries showed higher 54 rates of PPD [4]. A systematic review of 28 developed countries reported that the prevalence 55 PPD symptom (PPDS) was 6-13% among women in high income nations [5]. An independent 56 systematic review on low and middle income countries (LMIC) found the prevalence of 57 postpartum common mental disorder was approximately 20% [6]. Asian countries reported 58 between 3.5-63.3% prevalence rates of depression in postpartum women [7]. In India the 59 prevalence of depression varied from 11% to 16% within fourteen weeks of delivery [8]. 60Several studies conducted in rural Bangladesh found the prevalence of PPD ranged from 18% 61 to 35% among rural women [1, 2, 9]. 62 63 ...