Predictors of postnatal depression in the slums Nairobi, Kenya: a cross-sectional study.

BACKGROUND: Postnatal depression (PND) is a universal mental health problem that prevents mothers' optimal existence and mothering. Although research has shown high PND prevalence rates in Africa, including Kenya, little research has been conducted to determine the contributing factors, especially in low-resource communities. OBJECTIVE: This study aimed to investigate the PND risk factors among mothers attending Lang'ata and Riruta Maternal and Child Health Clinics (MCH) in the slums, Nairobi. METHODS: This study was cross-sectional. It is part of a large study that investigated the effectiveness of a brief psychoeducational intervention on PND. Postnatal mothers (567) of 6-10 weeks postanatal formed the study population. Depression rate was measured using the original 1961 Beck's Depression Inventory (BDI). In addition, a sociodemographic questionnaire (SDQ) was used to collect hypothesized risk variables. Multivariable logistic regression analysis was used to explore predictors of PND. RESULTS: The overall prevalence of PND in the sample of women was 27.1%. Women aged 18-24 (ß = 2.04 95% C.I.[0.02; 4.05], p = 0.047), dissatisfied with body image (ß = 4.33 95% C.I.[2.26; 6.41], p < 0.001), had an unplanned pregnancy (ß = 2.31 95% C.I.[0.81; 3.80], p = 0.003 and felt fatigued (ß = - 1.85 95% C.I.[- 3.50; 0.20], p = 0.028) had higher odds of developing PND. Participants who had no stressful life events had significantly lower depression scores as compared to those who had stressful life events (ß = - 1.71 95% C.I.[- 3.30; - 0.11], p = 0.036) when depression was treated as a continuous outcome. Sensitivity analysis showed that mothers who had secondary and tertiary level of education had 51 and 73% had lower likelihood of having depression as compared to those with a primary level of education (A.O.R = 0.49 95% C.I.[0.31-0.78], p = 0.002) and (A.O.R = 0.27 95% C.I.[0.09-0.75], p = 0.013) respectively. CONCLUSION: This study reveals key predictors/risk factors for PND in low-income settings building upon the scanty data. Identifying risk factors for PND may help in devising focused preventive and treatment strategies.

Effectiveness of a brief psychoeducational intervention on postnatal depression in the slums, Nairobi: a longitudinal study.

Research has shown that postnatal depression (PND) is higher in low- and middle-income countries as compared to higher-income countries. Despite this, little is known about practical interventions in these poorly resourced countries. This research investigated the effectiveness of a brief, prophylactic and therapeutic psychoeducational intervention in a low-resourced community in Nairobi. Two closely similar Maternal and Child Health (MCH) clinics in urban slums in Nairobi were identified and randomly selected. A total of 567 mothers formed the study population. The experimental group (284) mothers received the intervention, which included psychoeducation on PND, coping skills, healthy way of mother/child interaction and infant stimulation in addition to routine treatment, while the control group (283) mothers received treatment as usual. Data was collected using a social-demographic questionnaire and the English version of Becks Depression Inventory (BDI) at baseline. At 6 months, we reassessed both groups using BDI only. Within group comparison, the percentage reduction of depression was 35.6% among the experimental as compared to 2.3% in the control group. Between group comparison, the mean BDI depression score was significantly low in the experimental arm compared to the control arm at endline (p = 0.025). When all variables were adjusted, using a generalized linear model, BDI depression score reduction among the participants was significantly associated with the intervention (p = 0.040). A brief, psychoeducational intervention that targets the mother and her infant may reduce PND even in poorly resourced environments. Therefore, it can be integrated into existing MCH services.