Postpartum depression and child growth in Tanzania: a cohort study.

OBJECTIVE: To examine the association between postpartum depression and child growth in a Tanzanian birth cohort. DESIGN: Prospective cohort study. SETTING: Moshi, Tanzania. POPULATION: Pregnant women over the age of 18 who sought antenatal care at two health clinics in Moshi, and the children they were pregnant with, were assessed for inclusion in this study. METHODS: The women were interviewed twice during pregnancy and three times after birth, the final follow up taking place 2-3 years postpartum. Signs of postpartum depression were assessed approximately 40 days postpartum with the Edinburgh Postnatal Depression Scale. MAIN OUTCOME MEASURES: Child growth was assessed with anthropometric measurements at 2-3 years of age and expressed as mean z-scores. RESULTS: In all, 1128 mother-child pairs were followed throughout the duration of the study. In total, 12.2% of the mothers showed signs of postpartum depression. Adjusted mean height-for-age z-score (HAZ) was significantly lower at 2-3 years follow up for children of mothers with postpartum depression than for children of mothers without (difference in HAZ: -0.32, 95% CI-0.49 to -0.15). Adjusted mean weight-for-height z-score (WHZ) was significantly increased for the children exposed to postpartum depression (difference in WHZ: 0.21, 95% CI 0.02-0.40), whereas there was no significant difference in adjusted weight-for-age z-score (WAZ; difference in WAZ: -0.04, 95% CI -0.20 to 0.12). CONCLUSIONS: We found that postpartum depressive symptoms predicted decreased linear height in children at 2-3 years of age and slightly increased weight-for-height. TWEETABLE ABSTRACT: Postpartum depression in Tanzanian mothers is associated with impaired child growth at 2-3 years of age.

Mobile phones as a health communication tool to improve skilled attendance at delivery in Zanzibar: a cluster-randomised controlled trial.

OBJECTIVE: To examine the association between a mobile phone intervention and skilled delivery attendance in a resource-limited setting. DESIGN: Pragmatic cluster-randomised controlled trial with primary healthcare facilities as the unit of randomisation. SETTING: Primary healthcare facilities in Zanzibar. POPULATION: Two thousand, five hundred and fifty pregnant women (1311 interventions and 1239 controls) who attended antenatal care at one of the selected primary healthcare facilities were included at their first antenatal care visit and followed until 42 days after delivery. All pregnant women were eligible for study participation. METHODS: Twenty-four primary healthcare facilities in six districts in Zanzibar were allocated by simple randomisation to either mobile phone intervention (n = 12) or standard care (n = 12). The intervention consisted of a short messaging service (SMS) and mobile phone voucher component. MAIN OUTCOME MEASURES: Skilled delivery attendance. RESULTS: The mobile phone intervention was associated with an increase in skilled delivery attendance: 60% of the women in the intervention group versus 47% in the control group delivered with skilled attendance. The intervention produced a significant increase in skilled delivery attendance amongst urban women (odds ratio, 5.73; 95% confidence interval, 1.51-21.81), but did not reach rural women. CONCLUSIONS: The mobile phone intervention significantly increased skilled delivery attendance amongst women of urban residence. Mobile phone solutions may contribute to the saving of lives of women and their newborns and the achievement of Millennium Development Goals 4 and 5, and should be considered by maternal and child health policy makers in developing countries.

Pregnancy planning and acceptance among Danish pregnant women.

OBJECTIVE: To study how living conditions influence pregnancy planning and acceptance among Danish women. METHOD: A cross-sectional questionnaire study performed among 3516 pregnant women attending Odense University Hospital, Denmark. The study population consisted of women with spontaneous abortion, women with ectopic pregnancies, women attending antenatal care and women with induced abortion. They were divided into four groups: women with planned and accepted pregnancies (accepting planners, n=2137), women who accepted an initially unplanned pregnancy (accepting non-planners, n=1006), women who rejected an initially planned pregnancy (rejecting planners, n=31), and women with unplanned and rejected pregnancies (rejecting non-planners, n=342). The association between socio-economic characteristics and pregnancy planning and acceptance was evaluated by comparing accepting non-planners with accepting planners and by comparing rejecting planners with rejecting non-planners. The variables studied comprise age, number of children, partner relationship, education, occupation, economic situation and contraceptives. RESULTS: The characteristics of accepting non-planners and accepting planners were in accordance and in contrast to those of rejecting planners and in particular of rejecting non-planners. The contraceptive prevalence rate among accepting non-planners was 15%. Among rejecting non-planners the same figure was 51%. CONCLUSION: Accepting non-planners seemed to be in a situation which could be considered appropriate for childbirth. The contraceptive prevalence rate among accepting non-planners was low and might reflect that these women were not entirely against the thought of having a child, although they did not actively plan to have one.

Adolescent girls, illegal abortions and "sugar-daddies" in Dar es Salaam: vulnerable victims and active social agents.

Adolescent girls' early sexual activity, early pregnancy, induced abortions and the increase in HIV infections have become major concerns in Sub-Saharan Africa. Efforts, though, to understand their sexual behaviour and to prevent reproductive health problems are almost non-existent. Adolescent girls are normally seen as victims and easy preys of (often older and married) men's sexual exploitation. This article, which is based on a qualitative study of 51 adolescent girls who had just had an illegal abortion in Dar es Salaam, Tanzania, reveals that these girls are not only victims but also willing preys and active social agents engaging in high-risk sexual behaviour. In order to get material benefits they expose themselves to serious health risks, including induced abortion - without realising their own vulnerability. In our study, one out of four girls had more than one partner at the time they became pregnant, and many counted on an illegally induced abortion if they got pregnant. Even if adolescents are now allowed free access to family planning information, education and services, our study shows that this remains in the realm of theory rather than practice. Moreover, most adolescent girls are not aware about their right to such services. The paper concludes that the vulnerability of adolescent girls increases without the recognition that sexuality education and contraceptive services do not constitute a licence to practice illicit sex - but rather a means to create more mature and responsible attitudes and to increase sexual and reproductive health.

The problem of illegally induced abortion: results from a hospital-based study conducted at district level in Dar es Salaam.

Illegal abortion is known to be a major contributor to maternal mortality. The objective of the study was firstly to identify women with illegally induced abortion, (IA) and to compare them with women admitted with a spontaneous abortion (SA) or receiving antenatal care (AC), and secondly to describe the circumstances which characterized the abortion. The population of this cross-sectional questionnaire study comprised patients from Temeke District Hospital, Dar es Salaam, Tanzania. After an in-depth confidential interview, 603 women with incomplete abortion were divided into two groups: 362 women with IA and 241 with SA. They were compared with 307 AC women. IA women were significantly younger, more often better educated, unmarried, nulliparous and students than AC women. Regarding civil-status, educational level, proportion of nullipara and proportion of students, SA patients were similar to AC women. These results lend support to the assumption that the in-depth confidential interview made it possible to distinguish IA women from SA women.

Self-reports of induced abortion: an empathetic setting can improve the quality of data.

OBJECTIVES: This study estimated the proportion of incomplete abortions that are induced in hospital-based settings in Tanzania. METHODS: A cross-sectional questionnaire study was conducted in 2 phases at 3 hospitals in Tanzania. Phase 1 included 302 patients with a diagnosis of incomplete abortion, and phase 2 included 823 such patients. RESULTS: In phase 1, in which cases were classified by clinical criteria and information from the patient, 3.9% to 16.1% of the cases were classified as induced abortion. In phase 2, in which the structured interview was changed to an empathetic dialogue and previously used clinical criteria were omitted, 30.9% to 60.0% of the cases were classified as induced abortion. CONCLUSIONS: An empathetic dialogue improves the quality of data collected among women with induced abortion.

Adolescent girls with illegally induced abortion in Dar es Salaam: the discrepancy between sexual behaviour and lack of access to contraception.

This article reports on a study of induced abortion among adolescent girls in Dar es Salaam, Tanzania, who were admitted to a district hospital in Dar es Salaam because of an illegally induced abortion in 1997. In the quantitative part of the study, 197 teenage girls (aged 14-19) were asked for socio-economic details, contraceptive knowledge/use, age at first intercourse and number of sexual partners. In the qualitative part, 51 teenage girls were interviewed in-depth about their relationships with their partners, sexual behaviour, contraceptive use and reasons for non-use, and why they became pregnant. The girls were sexually active at an early age and having sex mainly with men older than themselves. Although most of the girls were in love with and enjoyed sex with their partners, they also entered these relationships to obtain money or gifts in exchange for sex. Most were not using contraception or condoms though they were also at risk of STDs and HIV. These girls were getting pregnant expecting their boyfriends to marry them, or because they did not think they could become pregnant or failed to use contraception correctly. Most adolescent girls are not aware of the 1994 Tanzanian policy that gave them the right to seek family planning services and in practice these services are not being provided. There is a need for youth-friendly family planning services and to make abortion safe and legal, in order to reduce unwanted pregnancies and abortion-related complications and deaths among adolescent girls.

Sexual history and contraception among women with induced and spontaneous abortion in Dar es Salaam.

The objective of this study was to create sexual history profiles of women with illegally induced abortion (IA) and women with spontaneous abortion (SA) and describe the women's knowledge of, attitude to, and practice of contraception. The study was carried out in two settings, Temeke District Hospital (TDH) and Muhimbili Medical Centre (MMC) in Dar es Salaam. At TDH 362/603 (60 per cent) were identified as IA and 241/603 (40 per cent) as SA. At MMC the figures were 68/220 (31 per cent) IA and 152/220 (69 per cent) SA. Both groups were well informed about modern contraception. As a contrast the rate of ever users of contraception was low in both groups, although significantly lower among IA women than among SA women. Outcome of first pregnancy had been an induced abortion in significantly higher proportion of IA than of SA women. In conclusion, sexual intercourse before marriage is common in the setting studied and contraceptive use in comparatively uncommon.

Sexual History and Contraception among Women with Indused and Spontaneous Abortion in Dar es Salaam

The objective of this study was to create sexual history profiles of women with illegally induced abortion (IA) and women with spontaneous abortion (SA) and describe the women's knowledge of; attitude to; and practice of contraception. The study was carried out in two settings; Temeke District Hospital (TDH) and Muhimbili Medical Centre (MMC) in Dar es Salaam. At TDH 362/603 (60 per cent) were identified as IA and 241/603 (40 per cent) as SA. At MMC the figures were 68/220 (31 per cent) IA and 152/220 (69 per cent) SA. Both groups were well informed about modern contraception. As a contrast the rate of ever users of contraception was low in both groups; although significantly lower among IA women than among SA women. Outcome of first pregnancy had been an induced abortion in significantly higher proportion of IA than of SA women. In conclusion; sexual intercourse before marriage is common in the setting studied and contraceptive use in comparatively uncommon