Perinatal death triples the prevalence of postpartum depression among women in Northern Uganda: A community-based cross-sectional study

Arach, Anna Agnes Ojok; Nakasujja, Noeline; Nankabirwa, Victoria; Ndeezi, Grace; Kiguli, Juliet; Mukunya, David; Odongkara, Beatrice; Achora, Vincentina; Tongun, Justin Bruno; Musaba, Milton W.; Napyo, Agnes; Zalwango, Vivian; Tylleskär, Thorkild; Tumwine, James

doi:10.1371/journal.pone.0240409

Cited by 14 publications

(12 citation statements)

References 42 publications

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“…Any pregnant mother with any three of the level-three correlates should be regarded as candidate for early detection and pre-emptive interventions. Consistent with Arach et al, 23 our study shows that mothers who had experienced perinatal death were approximately 3 times as likely to develop PPD as mothers who had not experienced perinatal death. Chronic sadness characterized with spells of pervasive melancholy, sorrow, or other grief-related experiences could explain why women who experienced perinatal loss had an increased risk of postnatal depression.…”

Section: Discussionsupporting

confidence: 92%

Characterization and stratification of the correlates of postpartum depression in sub-Saharan Africa: A systematic review with meta-analysis

Nweke

Ukwuoma

Adiuku-Brown

et al. 2022

Womens Health (Lond Engl)

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Postpartum depression (PPD) is a common mental health challenge in resource-constrained sub-Saharan Africa (SSA). Characterizing its correlates will aid prediction, early detection, and pre-emptive interventions. This review aimed to systematically synthesize and stratify PPD correlates in sub-Saharan Africa. The review was structured as per the Preferred Reporting Item for Systematic Reviews and Meta-Analyses. We included studies that reported the correlates of PPD in SSA. We searched PubMed, Medline, CINAHL, Academic Search Complete, and PsycINFO for relevant peer-reviewed literature. The correlates of PPD constituted the primary outcome. A random effect model was fitted to estimate the pooled correlation coefficient per correlate. The clinical relevance of correlates was stratified based on strength of correlation (r) and recurrence (f). The mean age of the participants was 27.0 ± 6.0 years, and 68.6% of participants had completed at least secondary education. The correlates of PPD in SSA were intimate partner violence (IPV) ((risk weight (rw) = 2.8; r = 0.212 (confidence interval (CI): 0.11–0.31), poor social support (PSS) (rw = 1.9; r = 0.250 (0.133–0.361)), unwanted pregnancy (UP) (rw = 1.6; r = 0.279 (CI: 0.14–0.41); I2 = 95.89), and maternal age (MA) (rw = 0.96; r = 0.27 (CI: 0.154–0.37)), among others. A cumulative risk weight of ⩾0.95 was predictive of PPD and marks the critical point at which preemptive interventions should be instituted. The stratification of risk PPD factors and computation of risk stability index are useful in identifying the clinical significant risk factors. The provision of critical risk point will simplify early detection thus facilitating cost-effectiveness. Of the correlates of PPD in SSA, IPV, PSS, UP, and MA are the most important. Targeted screening and pre-emptive interventions for women with high risk weight may be a reasonable strategy both in the short and long term.

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Section: Discussionsupporting

confidence: 92%

Characterization and stratification of the correlates of postpartum depression in sub-Saharan Africa: A systematic review with meta-analysis

Nweke

Ukwuoma

Adiuku-Brown

et al. 2022

Womens Health (Lond Engl)

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“…Depression was screened or diagnosed in the following study groups in Uganda: (i) individuals living with HIV ( n = 43) [ 15 , 34 , 60 , 64 , 68 , 70 – 73 , 79 , 81 , 82 , 85 – 91 , 93 – 96 , 98 – 105 , 112 – 114 , 117 , 119 , 123 , 127 , 128 , 130 , 132 , 133 , 136 , 141 – 143 , 145 , 148 – 150 , 160 ], (ii) females only ( n = 25) [ 16 , 31 , 35 , 52 , 59 , 73 , 79 , 97 , 113 , 116 , 134 , 139 , 144 , 158 , 166 , 170 ], including seven studies among pregnant or postpartum women [ 53 , 59 , 73 , 97 , ...…”

Section: Resultsmentioning

confidence: 99%

Prevalence of depression in Uganda: A systematic review and meta-analysis

Kaggwa

Najjuka²,

Bongomin³

et al. 2022

PLoS ONE

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Background Depression is one of the most studied mental health disorders, with varying prevalence rates reported across study populations in Uganda. A systematic review and meta-analysis was carried out to determine the pooled prevalence of depression and the prevalence of depression across different study populations in the country. Methods Papers for the review were retrieved from PubMed, Scopus, PsycINFO, African Journal OnLine, and Google Scholar databases. All included papers were observational studies regarding depression prevalence in Uganda, published before September 2021. The Joanna Briggs Institute Checklist for Prevalence Studies was used to evaluate the risk of bias and quality of the included papers, and depression pooled prevalence was determined using a random-effects meta-analysis. Results A total of 127 studies comprising 123,859 individuals were identified. Most studies were conducted among individuals living with HIV (n = 43; 33.9%), and the most frequently used instrument for assessing depression was the Depression sub-section of the Hopkins Symptom Checklist (n = 34). The pooled prevalence of depression was 30.2% (95% confidence interval [CI]: 26.7–34.1, I2 = 99.80, p<0.001). The prevalence of depression was higher during the COVID-19 pandemic than during the pre-pandemic period (48.1% vs. 29.3%, p = 0.021). Refugees had the highest prevalence of depression (67.6%; eight studies), followed by war victims (36.0%; 12 studies), individuals living with HIV (28.2%; 43 studies), postpartum or pregnant mothers (26.9%; seven studies), university students (26.9%; four studies), children and adolescents (23.6%; 10 studies), and caregivers of patients (18.5%; six studies). Limitation Significantly high levels of heterogeneity among the studies included. Conclusion Almost one in three individuals in Uganda has depression, with the refugee population being disproportionately affected. Targeted models for depression screening and management across various populations across the country are recommended. Trial registration Protocol registered with PROSPERO (CRD42022310122).

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“…Several authors assert that persons with a perinatal death, if not attended to, may experience disorders such as anxiety, complicated grief, depression and posttraumatic stress disorders [ 26 – 30 ]. These complications are reported to have an adverse outcome that may extend into the next pregnancy or may become prolonged [ 31 – 34 ] resulting in a disorganized mother-infant attachment, marital break-up and financial hardship [ 10 , 11 , 35 , 36 ].…”

Section: Introductionmentioning

confidence: 99%

“Your heart keeps bleeding”: lived experiences of parents with a perinatal death in Northern Uganda

Arach

Kiguli

Nankabirwa

et al. 2022

BMC Pregnancy Childbirth

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Background Worldwide, two million babies are stillborn and 1.8 million babies die before completing seven days of life. Approximately 4% of pregnant women in Uganda experience perinatal death. The response following a perinatal death tends to be socio-culturally constructed. Investigating the unique personal experiences of parents from a low-income setting with unique cultural beliefs and practices is crucial for the design and implementation of appropriate interventions. Objective To describe the lived experiences of parents following perinatal death in Lira district, Northern Uganda. Methods A qualitative study was carried out drawing on the tenets of descriptive phenomenology. We conducted 32 in-depth interviews in Lira district, Northern Uganda between August 2019 and September 2020 with 18 women and 14 men who had experienced a stillbirth or an early neonatal death within the preceding 2 years. Participants were selected from different families and interviewed. A local IRB approved the study. All in-depth interviews were audio-recorded, transcribed, translated, and data were analysed using a content thematic approach. Key findings were discussed based on Worden’s Four Tasks of Mourning theory. Results The themes that emerged from the analyses included reaction to the perinatal loss and suggestions for support. The participants’ immediate reactions were pain, confusion, and feelings of guilt which were aggravated by the unsupportive behaviour of health care providers. Men cumulatively lost financial resources in addition to facing multiple stressful roles. Delayed reactions such as pain and worries were triggered by the sight of similar-age-babies, subsequent pregnancy losses, and marital challenges. Participants recommended emotional support and management of postnatal complications for parents faced with perinatal loss. Conclusion Losing a baby during the perinatal period in a resource-constrained setting negatively affected both gender. In addition, men suffered the loss of financial resources and the burden of multiple stressful roles. Acknowledging the pain and offering support to the grieving parents reinforce their coping with a perinatal loss. In addition to family and community members, health care providers need to provide emotional support and postnatal care to parents who experience perinatal death.

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Perinatal death triples the prevalence of postpartum depression among women in Northern Uganda: A community-based cross-sectional study

Cited by 14 publications

References 42 publications

Characterization and stratification of the correlates of postpartum depression in sub-Saharan Africa: A systematic review with meta-analysis

Characterization and stratification of the correlates of postpartum depression in sub-Saharan Africa: A systematic review with meta-analysis

Prevalence of depression in Uganda: A systematic review and meta-analysis

“Your heart keeps bleeding”: lived experiences of parents with a perinatal death in Northern Uganda

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