Assessing factors associated with poor maternal mental health among mothers of children born small and sick at 24–47 months in rural Rwanda

Abstract

Background Global investments in neonatal survival have resulted in a growing number of children with morbidities surviving and requiring ongoing care. Little is known about the caregivers of these children in low- and middle-income countries, including maternal mental health which can further negatively impact child health and development outcomes. We aimed to assess the prevalence and factors associated with poor maternal mental health in mothers of children born preterm, low birthweight (LBW), and with hypoxic ischemic encephalopathy (HIE) at 24–47 months of age in rural Rwanda. Methods Cross-sectional study of children 24–47 months born preterm, LBW, or with HIE, and their mothers discharged from the Neonatal Care Unit (NCU) at Kirehe Hospital between May 2015–April 2016 or discharged and enrolled in a NCU follow-up program from May 2016–November 2017. Households were interviewed between October 2018 and June 2019. Mothers reported on their mental health and their child’s development; children’s anthropometrics were measured directly. Backwards stepwise procedures were used to assess factors associated with poor maternal mental health using logistic regression. Results Of 287 total children, 189 (65.9%) were born preterm/LBW and 34.1% had HIE and 213 (74.2%) screened positive for potential caregiver-reported disability. Half (n = 148, 51.6%) of mothers reported poor mental health. In the final model, poor maternal mental health was significantly associated with use of violent discipline (Odds Ratio [OR] 2.29, 95% Confidence Interval [CI] 1.17,4.45) and having a child with caregiver-reported disability (OR 2.96, 95% CI 1.55, 5.67). Greater household food security (OR 0.80, 95% CI 0.70–0.92) and being married (OR = 0.12, 95% CI 0.04–0.36) or living together as if married (OR = 0.13, 95% CI 0.05, 0.37) reduced the odds of poor mental health. Conclusions Half of mothers of children born preterm, LBW and with HIE had poor mental health indicating a need for interventions to identify and address maternal mental health in this population. Mother’s poor mental health was also associated with negative parenting practices. Specific interventions targeting mothers of children with disabilities, single mothers, and food insecure households could be additionally beneficial given their strong association with poor maternal mental health.

Maternal Common Mental Disorders and childhood malnutrition in two rural provinces of Zimbabwe: A case-control study

“…We found a high burden of maternal CMDs in Zimbabwe in our study population (29.5%). This nding is in keeping with a study conducted in two rural districts in Zimbabwe which reported maternal depression prevalence of 21% in Chipinge and 34% in Mutasa district (18) .Much higher prevalence of maternal mental health outcomes were reported in studies conducted in Rwanda (51.6%), and Nigeria (40.7%) (25,32). However, the high prevalence in these reviewed studies may be attributed to selection bias as a result of interviewing inpatients, health facility clients, and mothers of children with known morbidity as well as a difference in the validity and speci city of the tools used in assessing for the maternal CMDs.…”

“…This is further strengthened by our nding whereby CMD were signi cantly higher among mothers of children who experienced frequent appetite loss. In contrast a study conducted in USA found mothers presenting with common mental disorders to more likely have overweight children attributing such to poor watching of diet and children being exposed to more takeaway as opposed to home cooked meals (37) The presence of a partner was associated with a decreased odds of maternal CMDs, with one study arguing that this is because spousal support generates a better life satisfaction which in turn improves maternal health outcomes (32). A study in Sub-Saharan Africa that assessed the effect of spousal support on maternal burnout, depression and anxiety reported that perceived spousal support reduced both burnout and depression (38).…”

Low husband involvement in maternal and child health services and intimate partner violence increases the odds of postpartum depression in northwest Ethiopia: A community-based study

“…This might be due to women with low socioeconomic status may face difficulties to fulfill their needs and newborns during the postpartum period. Low socioeconomic status has been connected with a high rate of different mental health problems [ 51 , 52 ].…”

Factors associated with recovery from stunting at 24 months of age among infants and young children enrolled in the Pediatric Development Clinic (PDC): A retrospective cohort study in rural Rwanda

“…Feeding difficulties among children with disabilities are associated with high rates of malnutrition and early life mortality [45]. Previous studies conducted in Rwanda among children born small and sick reported high rates of potential disabilities at ages 2 to 4 years [46] and higher rates of malnutrition among children with feeding difficulties [47], thus additional specialized nutrition interventions are likely required to address these children's needs. Based on this challenge, in 2019, the PDC program integrated early intervention using the Baby Ubuntu model [48], a group participatory early intervention program starting from 6 months for young children with disability and their families.…”