Antenatal depression across trimesters as a risk for postpartum depression and estimation of the fraction of postpartum depression attributable to antenatal depression: A systematic review and meta-analysis of cohort studies.

OBJECTIVE: This meta-analysis aimed at estimating the prevalence of postpartum depression (PPD) at different postpartum timepoints in women with antenatal depression (AD) in the three trimesters. We also examined the association between AD and PPD, and estimated the population attributable fraction of PPD to AD. METHODS: This systematic review and meta-analysis identified cohort studies that determined the prevalence of PPD in women who had AD, and those that examined the association between AD and PPD from PubMed, Embase, MEDLINE, CINAHL and PsycINFO. Articles were appraised using the modified Newcastle Ottawa Scale and data were analyzed using Comprehensive Meta-Analysis. RESULTS: Eighty-eight (88) cohort studies with a combined sample size of 1,042,448 perinatal women contributed to the meta-analysis. About 37% pregnant women who had AD, later had PPD. Those with AD had four times higher odds of developing PPD (OR: 4.58; 95% CI = 3.52-5.96). The odds of having PPD were higher when AD was observed in the first or third trimester compared to the second trimester. About 12.8% of PPD cases were attributable to AD. CONCLUSION: The findings should inform future clinical guidelines on the screening, the frequency of screening, and follow-up care in maternal-mental health.

"Our parents kiss in front of us": Reasons for early sexual debut among in-school youth in the Manzini Region in Eswatini.

BACKGROUND: Early sexual debut (i.e., sex before the age of 15 years), especially if it is unprotected, may increase the risk of acquiring HIV, sexually transmitted infections, and unwanted pregnancies. We investigated the reasons for early sexual debut among in-school youth in Eswatini, a setting with high HIV incidence among youth. METHODS: This was a qualitative, exploratory-descriptive study whereby data were collected from 81 sexually active in-school youth through seven focus group discussions (FGDs) in four purposively selected public high schools (two urban and two rural) in the Manzini region, Eswatini. In each school, except one, two FGDs (one for boys and one for girls) were conducted. Qualitative data were coded and analyzed thematically in Dedoose version 8.2.14. RESULTS: Nearly 40% of the participants reported having initiated sexual activity before 18 years. Six major themes emerged from the data: i) Intrapersonal factors (feeling mature, religiosity, nutritional or dietary patterns); ii) Parenting and household factors (living arrangement, lack of sexuality education, working parents, negative role-modeling from adults); iii) Peer and partner pressure (pressure from friends, threats from sexual partners, intergenerational sexual partnerships and transactional sex, testing sexual prowess, desire to fit in); iv) Contextual factors (neighborhood, location); v) Mass media (cell phone ownership, social media, and television shows or movies); and vi) Cultural factors (attending traditional ceremonies, loss of cultural norms, values, and traditions, and dress code). CONCLUSION AND RECOMMENDATIONS: The poor monitoring and negative role-modeling by elders highlight the importance of involving parents or guardians as key stakeholders when designing interventions targeting risky sexual behavior among youth. The multifaceted nature of the cited reasons for early sexual debut calls for interventions aimed at curbing risky sexual behavior to be culturally sensitive and responsive to the themes identified in this study.

Maternal Self-Efficacy as a Mediator in the Relationship Between Postpartum Depression and Maternal Role Competence: A Cross-Sectional Survey.

INTRODUCTION: This study aimed to (1) examine the relationships among postpartum depression, maternal self-efficacy, and maternal role competence, and to (2) test whether maternal self-efficacy mediates the relationship between postpartum depression and maternal role competence. METHODS: Using a cross-sectional design, we conveniently sampled 343 postpartum mothers from 3 primary health care facilities in Eswatini. Data were collected using the Edinburgh Postnatal Depression Scale, Maternal Self-Efficacy Questionnaire, and Perceived Competence Scale. Multiple linear regression models and structural equation modeling were performed in IBM SPSS and SPSS Amos to examine the studied associations and to test the mediation effect. RESULTS: The participants were aged 18 to 44 (mean, 26.4; SD, 5.86) years, and the majority were unemployed (67.1%), had an unintended pregnancy (61.2%), received education during antenatal classes (82.5%), and fulfilled the cultural norm of the maiden home visit (58%). Adjusting for covariates, postpartum depression was negatively associated with maternal self-efficacy (ß = -.24, P < .001) and maternal role competence (ß = -.18, P = .001), whereas maternal self-efficacy was positively associated with maternal role competence (ß = .41, P < .001). In the path analysis, postpartum depression only related to maternal role competence indirectly through maternal self-efficacy (ß = -.10, P = .003). DISCUSSION: High maternal self-efficacy was associated with high maternal role competence and fewer postpartum depression symptoms, suggesting that improving maternal self-efficacy may help reduce postpartum depression and may improve maternal role competence.

Prevalence and factors associated with intergenerational sexual partnerships among undergraduate health science students in Eswatini.

Background: Intergenerational sexual partnerships (IGSPs) put young people at an increased risk of sexually transmitted infections (STIs) including HIV and AIDS. However, their burden and predictors remain poorly understood. Objective: To describe the prevalence and factors associated with IGSPs among undergraduate health science students at a selected tertiary institution in Eswatini (formerly Swaziland). Methods: Data were collected through a cross-sectional survey of 148 conveniently sampled undergraduate health science students at the University of Eswatini. Multiple logistic regression analysis was performed to determine predictors of IGSPs (i.e. a 10-year or greater age disparity between heterosexual partners). Results: There was equal participation of males and females in this study (50%, n=74). The prevalence of IGSPs among the sample was 31.8% (n=47). Females (adjusted odds ratio, AOR = 0.08, 95% CI: 0.03-0.24) and those who received money from sexual partners (AOR = 0.08, 95% CI: 0.01-0.62) had lower odds of being in IGSPs. Conclusion: Being female and being a recipient of money from a sexual partner were negatively associated with IGSPs. The relatively high prevalene of IGSPs calls for health education campaigns targeting university students on the negative consequences associated with IGSPs, especially among young women.

Factors associated with HIV testing among youth in a generalised hyperendemic setting: findings from a national survey in Eswatini.

Aim: Even though Eswatini was the first country in Africa to achieve the UNAIDS 95-95-95 targets among people living with HIV nationally, youth aged 15-24 years lag behind in HIV testing. This study determined the overall prevalence of HIV testing among the youth and the factors associated with HIV testing.Methods: Data were analysed for 1 834 young people from the 2016-2017 Swaziland HIV Incidence Measurement Survey (SHIMS2) using multivariable logistic regression.Results: Overall, 66% of the young people had tested for HIV in the past 12 months before SHIMS2. Lower odds of HIV testing were observed among males, among those aged 15-17 years, the never married/cohabited, those with primary and secondary education, and among those who had high perceived stigma towards people living with HIV and AIDS. Youth from households classified in the poor and middle quintiles had higher odds of testing for HIV compared to those from rich households.Conclusion: Efforts to increase HIV testing should consider the sociodemographic and behavioural factors identified as determinants of HIV non-testing in this age group.

Factors associated with poor maternal health care services utilization in Eswatini: A secondary analysis of a nationally representative household survey.

BACKGROUND: This study investigated the prevalence and factors associated with poor maternal health care services utilization (MHCSU) i.e., having < 4 antenatal care (ANC) visits, not delivering at a health facility, and not receiving institutional postnatal care (PNC). METHODS: We conducted a secondary analysis of data from the 2014 Eswatini Multiple Cluster Indicator Survey, a cross-sectional, nationally representative household survey. Participants were childbearing women (15-49 years) who had a live birth in the past two years preceding the survey. Multivariable logistic regression analyses were performed for each outcome variable. RESULTS: The prevalence of poor MHCSU was 22.1% (202/903) for ANC, 10.4% (102/899) for institutional delivery or intrapartum care (IPC), and 26.9% (123/598) for PNC. Being younger, having a low education level, being never married, having no access to mass media, being a household head of low education, coming from a household of poor/middle wealth index, being a primipara, having an unintended pregnancy, and having a longer length of stay in the postpartum ward were significantly associated with poor MHCSU. CONCLUSION: Midwives should pay special attention to women who present with the factors associated with poor MHCSU identified in this study, as early as the first booking for ANC to intervene early.

Suicidal Ideation and Predictors of Psychological Distress during the COVID-19 Pandemic in Eswatini: A Population-Based Household Telephone Survey.

The unpredictability of the COVID-19 pandemic can induce psychological distress in individuals. We investigated perceived stressors, prevalence of psychological distress and suicidal ideation, and predictors of psychological distress among adults during the COVID-19 pandemic in Eswatini. This study was a cross-sectional, population-based household telephone survey of 993 conveniently sampled adults (18+ years) from all the four administrative regions of Eswatini. Data were collected between 9 June and 18 July 2020 during the first wave of the COVID-19 pandemic, when the country was under a partial lockdown. COVID-19-related psychological distress was assessed using the Kessler 6-item Psychological Distress Scale (K6). We performed weighted modified Poisson regression analyses to identify significant predictors of moderate/severe psychological distress (K6 scores: ≥5). The weighted prevalences of moderate (K6 scores: 5-12) and severe psychological distress (K6 scores: ≥13) were 41.7% and 5.4%, respectively. Participants reported several perceived COVID-19-related stressors, including worries and fears of the contagion-specific death, serious need for food and money, and concerns about loss of income or business. The weighted prevalence of suicidal ideation was 1.5%. Statistically significant predictors of increased risk for moderate/severe psychological distress included living in the Hhohho and Manzini regions; feeling not well informed about COVID-19; feeling lonely; having received COVID-19 food or financial relief from the government; feeling burdened by the lockdown; being married; and being youth (18-24 years). The results call for the government to urgently augment the provision of mental health services during the pandemic. Mental health practitioners and programs may use several stressors and risk factors identified in this study to inform interventions and government policies aimed at reducing psychological distress induced by the pandemic.

Does parenting style moderate the relationship between parent-youth sexual risk communication and premarital sexual debut among in-school youth in Eswatini?

BACKGROUND: Based on propositions of the contextual model of parenting style, we examined whether there is a relationship between parent-youth sexual risk communication (PYSRC) and premarital sexual debut, and whether this relationship is moderated by the parenting style. METHODS: A cross-sectional study design was employed, and data were collected using a self-reported questionnaire from 462 youth (211 boys and 251 girls) aged 15-24 years in senior grades of three public high schools (two rural and one urban) in Eswatini (formerly Swaziland). A hierarchical binary regression analysis was conducted to examine the association between PYSRC and premarital sexual debut, and to test whether parenting style moderates this relationship. RESULTS: The mean age of participants was 18.9 (±1.85) years, and a slight majority were females (54.3%). About 35.9% of participants reported having had sex (i.e., premarital sexual debut). After adjusting for age, gender, living arrangement, school location, and peer sexual activity, neither PYSRC (adjusted odds ratio [AOR] = 1.01, 95% confidence interval [CI]: 1.00, 1.03) nor parenting style (AOR = 0.81, 95% CI: 0.64, 1.04) significantly predicted premarital sexual debut in the sample. Likewise, parenting style did not significantly moderate the relationship between PYSRC and premarital sexual debut (AOR = 1.01, 95% CI: 1.00, 1.02). CONCLUSION: Contrary to propositions of the contextual model of parenting style, in this study, parenting style (authoritativeness) did not moderate the studied relationship, indicating the need for more studies to test the applicability of the contextual model of parenting style in African settings.