Impact of parental perinatal depressive and anxiety symptoms trajectories on early parent-infant impaired bonding: a cohort study in east and west coasts of Malaysia.

The association between maternal depressive and anxiety symptoms and impaired bonding with infants were widely studied, but not in fathers and none in Malaysia. We investigated the impact of different trajectories of perinatal depressive and anxiety symptoms on parent-infant impaired bonding during 2-3 months postpartum in both mothers and fathers in two areas of Malaysia. This study originated from a psychiatric morbidity cohort study carried out in health clinics in east and west Malaysia. Edinburgh Postnatal Depression Scale and anxiety subscale of Depression, Anxiety, and Stress Scale at late pregnancy and 2-3 months postpartum and Postpartum Bonding Questionnaire were completed by 566 mothers and 457 fathers. About 11.7% mothers and 16.1% fathers reported depressive symptoms during pregnancy, 6.5% mothers and 10.5% fathers during 2-3 months postpartum, and 3-4% mothers and fathers both depressive and anxiety symptoms 2-3 months postpartum. The mean impaired bonding score was highest in mothers and fathers who had both depressive and anxiety symptoms 2-3 months postpartum. Impaired bonding is associated with higher EPDS and DASS (anxiety subscale) scores 2-3 months postpartum in both parents. Physical partner violence and deteriorated marital relationship were associated with increased risk of impaired bonding in mothers. The association between depressive, anxiety, and comorbidity of depressive and anxiety symptoms in both mothers and fathers and parent-infant impaired bonding during 2-3 months postpartum urges for screening and treatment of depressive and anxiety symptoms in both parents during early parenthood.

Impact of maternal antepartum depressive and anxiety symptoms on birth outcomes and mode of delivery: a prospective cohort study in east and west coasts of Malaysia.

BACKGROUND: Antepartum depressive and anxiety symptoms (ADS and AAS) are prevalent in Malaysia. Prior evidence linking maternal ADS and AAS with adverse birth outcomes and caesarean section (CS) or instrumental delivery is conflicting. There is no research in Malaysia on the association between maternal mental disorders and adverse birth outcomes and mode of delivery. This study aims to investigate the independent effect of maternal ADS and AAS on low birth weight (LBW), preterm birth (PTB) and CS or instrumental delivery among women in east and west coasts of Malaysia. METHODS: We used data from a prospective cohort study of 799 pregnant women from health clinics of two states in east and west coasts of Malaysia. Baseline data were measured at the third trimester of pregnancy on ADS, AAS, socioeconomic condition, anthropometric status, reproductive history and intimate partner violence. Birth outcomes and mode of delivery were determined at the time of delivery. Univariate and multiple Cox's regressions were applied to assess the association between ADS and AAS and LBW, PTB and CS or instrumental delivery. RESULTS: ADS was significantly associated with an increased risk of giving birth to LBW babies in both east coast (RR = 3.64; 95% CI 1.79-7.40) and west coast (RR = 3.82; 95% CI 1.86-7.84), but not with PTB. AAS was associated with increased risk of both LBW (RR = 2.47; 95% CI 1.39-4.38) and PTB (RR = 2.49; 95% CI 1.16-5.36) in the east coast, but not in west coast. The risk of CS or instrumental delivery was evident among women with ADS (RR = 2.44; 95% CI 1.48-4.03) in west coast only. CONCLUSION: ADS predicts LBW in both coasts, AAS predicts LBW and PTB in east coast, and ADS predicts CS or instrumental delivery in west coast. Policies aimed at detection and management of ADS and AAS during antenatal check-up in health clinics may help improve birth outcomes and reduce obstetric interventions.

Prevalence and determinants of antepartum depressive and anxiety symptoms in expectant mothers and fathers: results from a perinatal psychiatric morbidity cohort study in the east and west coasts of Malaysia.

BACKGROUND: Research on antepartum psychiatric morbidities investigating depressive and anxiety symptoms in expectant mothers and fathers is lacking in low- and middle-income countries. This study aimed to estimate the prevalence of antepartum depressive, anxiety and co-occurring significant symptoms and explore the associated factors in a cross-section of Malaysian expectant mothers and fathers. METHODS: We used cross-sectional data from a prospective cohort study of 911 expectant mothers and 587 expectant fathers during their third trimester of pregnancy, from health clinics of two states in the east and west coasts of Malaysia. The validated Malay version of Edinburgh Postnatal Depression Scale and the anxiety sub-scale of Depression, Anxiety and Stress Scale were used to measure the depressive and anxiety symptoms. Multiple logistic regression analyses identified the determinants of antepartum depressive and anxiety symptoms (ADS and AAS). RESULTS: Prevalence of ADS was 12.2% in expectant mothers and 8.4% in expectant fathers, while AAS was 28.8% in expectant mothers and 13.3% in expectant fathers, and co-occurring significant symptoms was 8.0% in expectant mothers and 4.0% in expectant fathers. Expectant mothers and fathers having perceived social/family support were less likely to suffer from ADS. Intimate partner violence, poor relationship with husbands, depression in earlier pregnancy and husband's depression in current pregnancy in expectant mothers, and living in rented house, sex preference for the unborn child, stressful life events and wife's depression in current pregnancy in expectant fathers were associated with a greater likelihood of ADS. The determinants for AAS were living in rented house and with parents/in-laws, poor relationship with husbands, restrictions during pregnancy and stressful life events for expectant mothers, and stressful life events and being unsupportive towards wives in household chores for expectant fathers. CONCLUSION: Both ADS and AAS are prevalent in expectant mothers and fathers, and largely an undetected problem in Malaysia. Administration of couple-based screening and referral program during antenatal check-up should be universal practices to identify and treat the psychiatric morbidities.

Community perceptions of behaviour change communication interventions of the maternal neonatal and child health programme in rural Bangladesh: an exploratory study.

BACKGROUND: This qualitative study explored community perceptions of the components of the behaviour change communication (BCC) intervention of the BRAC Improving Maternal, Neonatal and Child Survival (IMNCS) programme in rural Bangladesh. METHODS: Semi-structured interviews, key informant interviews, focus group discussions and informal group discussions were conducted to elicit community views on interpersonal communication (IPC), printed materials, entertainment education (EE) and mass media, specifically (a) acceptance of and challenges presented by different forms of media, (b) comprehensibility of terms; printed materials and entertainment education and (c) reported influence of BCC messages. RESULTS: IMNCS BCC interventions are well accepted by the community people. IPC is considered an essential aspect of everyday life and community members appreciate personal interaction with the BRAC community health workers. Printed materials assisted in comprehension and memorization of messages particularly when explained by community health workers (CHW) during IPC. Enactment of maternal, neonatal and child health (MNCH) narratives and traditional musical performances in EE helped to give deep insight into life's challenges and the decision making that is inherent in pregnancy, childbirth and childcare. EE also improved memorization of the messages. Some limitations were identified in design of illustrations which hampered message comprehension. Some respondents were unable to differentiate between pregnancy, delivery and postpartum danger signs. Furthermore some women were afraid to view the illustrations of danger signs as they believed seeing that might be associated with the development of these complications in their own lives. Despite these barriers, participants stated that the IMNCS BCC interventions had influenced them to take health promoting decisions and seek MNCH services. CONCLUSIONS: Community based maternal and newborn programmes should revise BCC interventions to strengthen IPC, using rigorously tested print materials as aids and stand-alone media. Messages about birth preparedness (especially savings), recognition of danger signs and immediate self-referral to biomedical health services should be carefully aligned and effectively delivered to women, men and older members of the community. Messaging should utilize gendered storyline and address the seasonal cycles of conception, birth, antenatal, post-natal care and childhood illnesses. Future research should identify how best to combine IPC, printed materials, traditional cultural forms, and incorporate use of social media and mass media in different field situations.

Prevalence and Associated Factors of Depressive Symptoms Among Disadvantaged Adolescents: Results from a Population-Based Study in Bangladesh.

PROBLEM: Few studies have examined the adolescents' depression in low-income countries and no research has yet been carried out in Bangladesh. This study estimated the prevalence of depressive symptoms and explored the associated factors and help seeking behavior among adolescents in Bangladesh. METHODS: Data originated from a cross section of 2,440 randomly selected boys and girls aged 13-19 years in a rural district and urban slums of Dhaka city, Bangladesh, during October-November 2012. Beck Depression Inventory (BDI), a 21-item scale, measured the prevalence of depressive symptoms using a cut-off 16 or higher. FINDINGS: The prevalence of depressive symptoms among adolescents was 14%, with predominance in urban slums and among girls. Older age (15-19 years), poverty, and poor parental relation were found to be associated with depressive symptoms of both sexes; family history of depressive symptoms for boys; and reproductive illness and sexual abuse for girls. More than 80% of depressed adolescents sought no help. CONCLUSIONS: Adolescent depressive symptoms are common and largely undetected public health problem in Bangladesh. Policies aimed at concerted efforts for implementing a school-based counseling program with components of cognitive behavioral therapy and developing referral systems for those who scored at least 30 at BDI may ameliorate the potential harmful consequences of depressive symptoms in adolescents.

Pesticides Exposure and Cardiovascular Hemodynamic Parameters Among Male Workers Involved in Mosquito Control in East Coast of Malaysia.

BACKGROUND: Research findings have linked exposure to pesticides to an increased risk of cardiovascular (CVS) diseases. Therefore, this study aimed to assess the impact of chronic mix-pesticides exposure on CVS hemodynamic parameters. METHODS: A total of 198 male Malay pesticide-exposed and 195 male Malay nonexposed workers were examined. Data were collected through exposure-matrix assessment, questionnaire, blood analyses, and CVS assessment. Explanatory variables comprised of lipid profiles, paraoxonase 1 (PON1), and oxidized low-density lipoprotein (ox-LDL). Outcome measures comprised of brachial and aortic diastolic blood pressure (DBP) and systolic BP (SBP), heart rate, and pulse wave velocity (PWV). Linear regressions identified the B coefficient showing how many units of CVS parameters are associated with each unit of covariates. RESULTS: Diazoxonase was significantly lower and ox-LDL was higher among pesticide-exposed workers than the comparison group. The final multivariate linear regression model revealed that age, body mass index (BMI), smoking, and pesticide exposure were independent predictors of brachial and aortic DBP and SBP. Pesticide exposure was also associated with heart rate, but not with PWV. Lipid profiles, PON1 enzymes, and ox-LDL showed no association with any of the CVS parameters. CONCLUSIONS: Chronic mix-pesticide exposure among workers involved in mosquito control has possible association with depression of diazoxonase and the increase in ox-LDL, brachial and aortic DBP and SBP, and heart rate. This study raises concerns that those using pesticides may be exposed to hitherto unrecognized CVS risks among others. If this is confirmed by further studies, greater efforts will be needed to protect these workers.

"I can't stop worrying about everything"­experiences of rural Bangladeshi women during the first postpartum months.

Over recent years, researchers have found evidence which indicates that the prevalence of postpartum depressive symptoms crosses cultural boundaries and is reported to be at least as high in non-Western countries as in Western countries. However, qualitative studies about new mothers' experiences from non-Western countries, such as Bangladesh, are rare, particularly in rural areas. This study aims to describe the experiences and concerns of rural Bangladeshi mothers with postpartum depressive symptoms. Open narrative interviews were conducted with 21 mothers with depressive symptoms 2-3 months postpartum, consecutively selected from a longitudinal study about prevalence and risk factors of perinatal depressive symptoms. Inductive content analysis was used to analyse data and three themes emerged: family dynamics, living at the limits of survival, and role of the cultural context after childbirth. These themes were based on six categories and 15 subcategories. The findings show that troublesome family relationships, including intimate partner violence and violence in the family, influenced the mothers' mental well-being. They and their families lived at the limit of survival and the mothers expressed fear and worries about their insecure situation regarding economic difficulties and health problems. They felt sorry for being unable to give their infants a good start in life and sad because they could not always follow the traditional norms related to childbirth. Thus, it is important to focus on the depressive symptoms among new mothers and offer counselling to those showing depressive symptoms, as the cultural traditions do not always alleviate these symptoms in the changing Bangladeshi society today.

Intimate partner violence and its association with maternal depressive symptoms 6-8 months after childbirth in rural Bangladesh.

BACKGROUND: The prevalence of intimate partner violence (IPV), a gross violation of human rights, ranges widely across the world with higher prevalence reported in low- and middle-income countries. Evidence related mainly to physical health shows that IPV has both direct and indirect impacts on women's health. Little is known about the impact of IPV on the mental health of women, particularly after childbirth. OBJECTIVE: To describe the prevalence of IPV experienced by women 6-8 months after childbirth in rural Bangladesh and the factors associated with physical IPV. The study also aims to investigate the association between IPV and maternal depressive symptoms after childbirth. DESIGN: The study used cross-sectional data at 6-8 months postpartum. The sample included 660 mothers of newborn children. IPV was assessed by physical, emotional, and sexual violence. The Edinburgh Postnatal Depression Scale assessed maternal depressive symptoms. RESULTS: Prevalence of physical IPV was 52%, sexual 65%, and emotional 84%. The husband's education (OR: 0.41, CI: 0.23-0.73), a poor relationship with the husband (OR: 2.64, CI: 1.07-6.54), and emotional violence by spouse (OR: 1.58, CI: 1.35-1.83) were significantly associated with physical IPV experienced by women. The perception of a fussy and difficult child (OR: 1.05, CI: 1.02-1.08), a poor relationship with the husband (OR: 4.95, CI: 2.55-9.62), and the experience of physical IPV (OR: 2.83, CI: 1.72-4.64) were found to be significant predictors of maternal depressive symptoms among women 6-8 months after childbirth. Neither forced sex nor emotional violence by an intimate partner was found to be significantly associated with maternal depressive symptoms 6-8 months postpartum. CONCLUSIONS: It is important to screen for both IPV and depressive symptoms during pregnancy and postpartum. Since IPV and spousal relationships are the most important predictors of maternal depressive symptoms in this study, couple-focused interventions at the community level are suggested.

"Can community level interventions have an impact on equity and utilization of maternal health care" - evidence from rural Bangladesh.

BACKGROUND: Evidence from low and middle income countries (LMICs) suggests that maternal mortality is more prevalent among the poor whereas access to maternal health services is concentrated among the rich. In Bangladesh substantial inequities exist both in the use of facility-based basic obstetric care and for home births attended by skilled birth attendant. BRAC initiated an intervention on Improving Maternal, Neonatal, and Child Survival (IMNCS) in the rural areas of Bangladesh in 2008. One of the objectives of the intervention is to improve the utilization of maternal and child health care services among the poor. This study aimed to look at the impact of the intervention on utilization and also on equity of access to maternal health services. METHODS: A quasi-experimental pre-post comparison study was conducted in rural areas of five districts comprising three intervention (Gaibandha, Rangpur and Mymensingh) and two comparison districts (Netrokona and Naogaon). Data on health seeking behaviour for maternal health were collected from a repeated cross sectional household survey conducted in 2008 and 2010. RESULTS: Results show that the intervention appears to cause an increase in the utilization of antenatal care. The concentration index (CI) shows that this has become pro-poor over time (from CI: 0.30 to CI: 0.04) in the intervention areas. In contrast the use of ANC from medically trained providers has become pro-rich (from, CI: 0.18 to CI: 0.22). There was a significant increase in the utilisation of trained attendants for home delivery in the intervention areas compared to the comparison areas and the change was found to be pro-poor. Use of postnatal care cervices was also found to be pro-poor (from CI: 0.37 to CI: 0.14). Utilization of ANC services provided by medically trained provider did not improve in the intervention area. However, where the intervention had a positive effect on utilization it also seemed to have had a positive effect on equity. CONCLUSIONS: To sustain equity in health care utilization, the IMNCS programme needs to continue providing free home based services. In addition to this, the programme should also continue to provide funding to bear the cost to those mothers who are not able to have the comprehensive ANC from medically trained providers.

Factors influencing stillbirth in bangladesh: a case-control study.

BACKGROUND: Studies on a limited scale in urban settings of Bangladesh report stillbirth rates that do not specifically provide information on the situation of underprivileged slum populations. This study aims to estimate the prevalence of, and risk factors associated with, stillbirth in a developing population. METHODS: A case-control study was conducted on women having a singleton birth between November 2008 and April 2009 in 34 slum areas in Dhaka. Data were collected on 231 women with stillbirth (cases) and 464 women having livebirth (controls). This study utilised the records of the Manoshi programme and supplemented it with data obtained through interview of the women. RESULTS: The stillbirth rate was 26 per 1000 total births, of which 62% occurred during the intrapartum period. Obstetrical complications contributed to 61.4% of stillbirths. Illiterate women [odds ratio (OR) 1.6 [95% confidence interval (CI) 1.1, 2.2]], women aged ≥35 years (OR 2.9 [95% CI 1.5, 25.5]), preterm delivery (OR 5.2 [95% CI, 3.2, 8.5]), prolonged labour (OR 2.8 [95% CI 1.6, 4.6]) and failure of labour progress (OR 2.4 [95% CI 1.1, 5.5]) were significant maternal risk factors, while decreased fetal movement, fetal malpresentation and fetal distress were the fetal risk factors associated with stillbirth. CONCLUSIONS: Risk factors associated with stillbirths are amenable to intervention. There is an urgent need to educate pregnant women about risk factors for stillbirths during antenatal visits. Encouraging women to deliver at health facilities and better management of obstetrical complications may help reduce the burden of stillbirths in Bangladesh.

Impact of maternal depressive symptoms and infant temperament on early infant growth and motor development: results from a population based study in Bangladesh.

BACKGROUND: Evidence linking maternal depressive symptoms with infant's growth and development in low-income countries is inadequate and conflicting. This study investigated the independent effect of maternal perinatal depressive symptoms on infant's growth and motor development in rural Bangladesh. METHODS: A cohort of 720 pregnant women was followed from the third trimester of pregnancy to 6-8 months postpartum. For growth and developmental outcomes, 652 infants at 2-3 months and 6-8 months were assessed. Explanatory variables comprised maternal depressive symptoms, socioeconomic status, and infant's health and temperament. Outcome measures included infant's underweight, stunting and motor development. Multiple linear regression analyses identified predictors of infant growth and development. RESULTS: Maternal postpartum depressive symptoms independently predicted infant's underweight and impaired motor development, and antepartum depressive symptoms predicted infant's stunting. Infant's unadaptable temperament was inversely associated with infant's weight-for-age and motor development, and fussy and unpredictable temperament with height-for-age and motor development. LIMITATIONS: Repeated measures design might threaten the internal validity of the results 8.3% of the participant does not participate in the measurements at different times. As the study was conducted in two sub-districts of rural Bangladesh, it does not represent the urban scenario and cannot be generalized even for other rural areas of the country. CONCLUSION: This study provides evidence that maternal ante- and postpartum depressive symptoms predict infant's growth and motor development in rural Bangladesh. It is recommended to integrate psychosocial components in maternal and child health interventions in order to counsel mothers with depressive symptoms.

Men's knowledge and awareness of maternal, neonatal and child health care in rural Bangladesh: a comparative cross sectional study.

BACKGROUND: The status of men's knowledge of and awareness to maternal, neonatal and child health care are largely unknown in Bangladesh and the effect of community focused interventions in improving men's knowledge is largely unexplored. This study identifies the extent of men's knowledge and awareness on maternal, neonatal and child health issues between intervention and control groups. METHODS: This cross sectional comparative study was carried out in six rural districts of Bangladesh in 2008. BRAC health programme operates 'improving maternal, neonatal and child survival' intervention in four of the above-mentioned six districts. The intervention comprises a number of components including improving awareness of family planning, identification of pregnancy, providing antenatal, delivery and postnatal care, newborn care, under-5 child healthcare, referral of complications and improving clinical management in health facilities. In addition, communities are empowered through social mobilization and advocacy on best practices in maternal, neonatal and child health. Three groups were identified: intervention (2 years exposure); transitional (6 months exposure) and control. Data were collected by interviewing 7,200 men using a structured questionnaire. RESULTS: Men prefer to gather in informal sites to interact socially. Overall men's knowledge on maternal care was higher in intervention than control groups, for example, advice on tetanus injection should be given during antenatal care (intervention = 50%, control = 7%). There were low levels of knowledge about birth preparedness (buying delivery kit = 18%, arranging emergency transport = 13%) and newborn care (wrapping = 25%, cord cutting with sterile blade = 36%, cord tying with sterile thread = 11%) in the intervention. Men reported joint decision-making for delivery care relatively frequently (intervention = 66%, control = 46%, p < 0.001). CONCLUSION: Improvement in men's knowledge in intervention district is likely. Emphasis of behaviour change communications messages should be placed on birth preparedness for clean delivery and referral and on newborn care. These messages may be best directed to men by targeting informal meeting places like market places and tea stalls.

Impact of postpartum depressive and anxiety symptoms on mothers' emotional tie to their infants 2-3 months postpartum: a population-based study from rural Bangladesh.

The purpose of this study was to investigate the impact of depressive and anxiety symptoms on maternal bonding to the infant 2-3 months postpartum and the influence of the mother's bonding to the infant during pregnancy and to her own caregiver during her childhood on maternal bonding 2-3 months postpartum. This study originated from a community-based cohort study carried out in rural Bangladesh. Trained staff collected data and administrated the questionnaires during the third trimester of pregnancy, at childbirth and 2-3 months postpartum. Maternal depressive and anxiety symptoms were assessed with the Edinburgh Postnatal Depression Scale and the State Anxiety Inventory and the mother's emotional bonding to the infant with the Postpartum Bonding Questionnaire. The results showed that 11% of the women reported depressive symptoms, 35% anxiety symptoms, 3.4% both depressive and anxiety symptoms and 51% neither depressive nor anxiety symptoms. Mothers with depressive symptoms were older, were poorer, fewer were literate, reported more intimate partner violence and showed lower emotional bonding to their infants 2-3 months postpartum compared to mentally well and anxious mothers. Approximately 11% of the mothers reported mild bonding disturbances and nearly one third of them showed depressive symptoms. Depressive symptoms and giving birth to a girl were negatively associated to a mother's emotional bonding to her infant, while maternal anxiety symptoms and high bonding to the foetus during pregnancy were positively associated to the mother's emotional bonding to the infant 2-3 months postpartum.

Prevalence and associated factors of depressive and anxiety symptoms during pregnancy: a population based study in rural Bangladesh.

BACKGROUND: Few studies have examined the associated factors of antepartum depressive and anxiety symptoms (ADS and AAS) in low-income countries, yet the World Health Organization identifies depressive disorders as the second leading cause of global disease burden by 2020. There is a paucity of research on mental disorders and their predictors among pregnant women in Bangladesh. This study aims to estimate the prevalence of depressive and anxiety symptoms and explore the associated factors in a cross-section of rural Bangladeshi pregnant women. METHODS: The study used cross-sectional data originating from a rural community-based prospective cohort study of 720 randomly selected women in their third trimester of pregnancy from a district of Bangladesh. The validated Bangla version of the Edinburgh Postnatal Depression Scale was used to measure ADS, and a trait anxiety inventory to assess general anxiety symptoms. Background information was collected using a structured questionnaire at the respondents' homes. RESULTS: Prevalence of ADS was 18% and AAS 29%. Women's literacy (OR 0.59, 95% CI 0.37-0.95), poor partner relationship (OR 2.23, 95% CI 3.37-3.62), forced sex (OR 1.95, 95% CI 1.01-3.75), physical violence by spouse (OR 1.69, 95% CI 1.02-2.80), and previous depression (OR 4.62 95% CI 2.72-7.85) were found to be associated with ADS. The associated factors of AAS were illiteracy, poor household economy, lack of practical support, physical partner violence, violence during pregnancy, and interaction between poor household economy and poor partner relationship. CONCLUSION: Depressive and anxiety symptoms are found to occur commonly during pregnancy in Bangladesh, drawing attention to a need to screen for depression and anxiety during antenatal care. Policies aimed at encouraging practical support during pregnancy, reducing gender-based violence, supporting women with poor partner relationships, and identifying previous depression may ameliorate the potentially harmful consequences of antepartum depression and anxiety for the women and their family, particularly children.

Women-focused development intervention reduces delays in accessing emergency obstetric care in urban slums in Bangladesh: a cross-sectional study.

BACKGROUND: Recognizing the burden of maternal mortality in urban slums, in 2007 BRAC (formally known as Bangladesh Rural Advancement Committee) has established a woman-focused development intervention, Manoshi (the Bangla abbreviation of mother, neonate and child), in urban slums of Bangladesh. The intervention emphasizes strengthening the continuum of maternal, newborn and child care through community, delivery centre (DC) and timely referral of the obstetric complications to the emergency obstetric care (EmOC) facilities. This study aimed to assess whether Manoshi DCs reduces delays in accessing EmOC. METHODS: This cross-sectional study was conducted during October 2008 to January 2009 in the slums of Dhaka city among 450 obstetric complicated cases referred either from DCs of Manoshi or from their home to the EmOC facilities. Trained female interviewers interviewed at their homestead with structured questionnaire. Pearson's chi-square test, t-test and Mann-Whitney test were performed. RESULTS: The median time for making the decision to seek care was significantly longer among women who were referred from home than referred from DCs (9.7 hours vs. 5.0 hours, p < 0.001). The median time to reach a facility and to receive treatment was found to be similar in both groups. Time taken to decide to seek care was significantly shorter in the case of life-threatening complications among those who were referred from DC than home (0.9 hours vs.2.3 hours, p = 0.002). Financial assistance from Manoshi significantly reduced the first delay in accessing EmOC services for life-threatening complications referred from DC (p = 0.006). Reasons for first delay include fear of medical intervention, inability to judge maternal condition, traditional beliefs and financial constraints. Role of gender was found to be an important issue in decision making. First delay was significantly higher among elderly women, multiparity, non life-threatening complications and who were not involved in income-generating activities. CONCLUSIONS: Manoshi program reduces the first delay for life-threatening conditions but not non-life-threatening complications even though providing financial assistance. Programme should give more emphasis on raising awareness through couple/family-based education about maternal complications and dispel fear of clinical care to accelerate seeking EmOC.

Low birth weight in offspring of women with depressive and anxiety symptoms during pregnancy: results from a population based study in Bangladesh.

BACKGROUND: There is a high prevalence of antepartum depression and low birth weight (LBW) in Bangladesh. In high- and low-income countries, prior evidence linking maternal depressive and anxiety symptoms with infant LBW is conflicting. There is no research on the association between maternal mental disorders and LBW in Bangladesh. This study aims to investigate the independent effect of maternal antepartum depressive and anxiety symptoms on infant LBW among women in a rural district of Bangladesh. METHODS: A population-based sample of 720 pregnant women from two rural subdistricts was assessed for symptoms of antepartum depression, using the Edinburgh Postpartum Depression Scale (EPDS), and antepartum anxiety, using the State Trait Anxiety Inventory (STAI), and followed for 6-8 months postpartum. Infant birth weight of 583 (81%) singleton live babies born at term (≥ 37 weeks of pregnancy) was measured within 48 hours of delivery. Baseline data provided socioeconomic, anthropometric, reproductive, obstetric, and social support information. Trained female interviewers carried out structured interviews. Chi-square, Fisher's exact, and independent-sample t tests were done as descriptive statistics, and a multiple logistic regression model was used to identify predictors of LBW. RESULTS: After adjusting for potential confounders, depressive (OR = 2.24; 95% CI 1.37-3.68) and anxiety (OR = 2.08; 95% CI 1.30-3.25) symptoms were significantly associated with LBW (≤ 2.5 kg). Poverty, maternal malnutrition, and support during pregnancy were also associated with LBW. CONCLUSIONS: This study provides evidence that maternal depressive and anxiety symptoms during pregnancy predict the LBW of newborns and replicates results found in other South Asian countries. Policies aimed at the detection and effective management of depressive and anxiety symptoms during pregnancy may reduce the burden on mothers and also act as an important measure in the prevention of LBW among offspring in Bangladesh.