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• W2765433032 abstract "BackgroundMaternal Mortality in Low and Middle Income Countries (LMICs) remains a major publichealth challenge despite the encouraging achievement of the fifth Millennium DevelopmentGoal (MDG-5). Almost all (99.0%) of the global maternal deaths occur in LMICs wherethere are high resource constraints and low access to health care services. In Sub-SaharanAfrica, more than half of perinatal women have no access to maternal healthcare services.The situation is reflected in Ethiopia where only 34% of women attended for antenatal care(ANC) and skilled practitioners attended only 26% of deliveries in 2015. Mental disorders,especially depressive disorders, are also common affecting about one in seven perinatalwomen. Perinatal depression has been shown to be an independent risk factor for maternalhealthcare service utilisation on behalf of the child but there has been little exploration of itspotential impact on utilisation of maternal healthcare services.ObjectiveThe main objective of this study was to investigate the impact of antenatal depressivesymptoms on utilisation of maternal healthcare services (antenatal care, uptake ofinstitutional delivery and postnatal care use) and its effect on perinatal complications.MethodsStudy Design: The study that formed the basis of this thesis was a population-based studythat comprises three sub-studies linked to three main outcomes. Sub-study-I was a crosssectional study carried out at the initiation of the prospective study. Sub-study-II and III wereprospective follow-ups of participants identified with probable depression in sub-study-I toassess impact of depressive symptoms on (a) institutional delivery and postnatal care use; b)perinatal complications respectively.Participants: The participants were pregnant women in their second and third trimesterresiding in Sodo District, Gurage Zone, Southern Nations, Nationalities and Peoples Regionof Ethiopia. Eligibility Criteria included: (1) Age 15 years and above; (2) permanentresidence as defined by continuous residence in the area for at least the preceding six months;(3) Able to provide informed consent; (4) Not having hearing or cognitive impairment to theextent of impairing capacity to give informed consent or to communicate adequately.Assessments: During baseline assessment, at the second and third trimesters of pregnancy,participants were screened for antenatal depressive symptoms and background demographicand socio-economic information along with other potential confounders such as intimatepartner violence, social support, history of chronic medical conditions and adverse perinataloutcomes. Antenatal depressive symptoms were assessed using a locally validated version ofthe Patient Health Questionnaire-9 (PHQ-9). Participants scoring five or more on the PHQ-9were considered to have probable antenatal depression. ANC attendance and pregnancyrelated emergency healthcare visits were cross-sectional outcomes that were assessed as partof the initial baseline assessment. At a median of eight weeks after childbirth, theparticipants were re-interviewed about their place of delivery, attendance of postnatal careservices and whether they had experienced an of perinatal and postpartum complications.Statistical Analysis: Poisson and Negative binomial regression models were used for crosssectional evaluation of the association of antenatal depressive symptoms with antenatalservice use and pregnancy related emergency healthcare provider visits. Binary logisticregression was used to examine the association of antenatal depressive symptoms with earlyinitiation and adequacy of ANC services. Binary logistic regression was also used toexamine association of antenatal depressive symptoms with uptake of institutional delivery,having assisted delivery and women’s experience of perinatal complications.ResultsParticipant Characteristics: Among study participants, 98.7% were married, 67.5% werenon-literate, 92.2% were rural residents and the mean age of the participants was 26.8 years.The majority (64.8%) of women initiated ANC visits (37.0% by 16 weeks gestation) andnearly two-thirds (62.3%) delivered in healthcare institutions.Baseline (Cross-sectional) Study: At PHQ-9 cut-off of five or more, 29.5% of baselineparticipants and 28.7% of followed up participants had probable antenatal depression.Women with depressive symptoms had an increased risk of having greater number of unscheduled ANC visits (adjusted Risk Ratio (aRR)=1.41, 95% CI: 1.20, 1.65). These group ofwomen also had an increased number of emergency healthcare provider visits to bothtraditional healthcare providers (aRR=1.64, 95% CI: 1.17, 2.31) and biomedical healthcareproviders (aRR=1.31, 95% CI: 1.04, 1.69) for pregnancy-related emergencies.Prospective Studies: Women with probable antenatal depression also had increased odds ofreporting institutional birth [adjusted Odds Ratio (aOR) =1.42, 95% Confidence Interval(CI): 1.06, 1.92] and increased odds of reporting having had an assisted delivery (aOR=1.72,95% CI: 1.10, 2.69) than women without these symptoms. In sub-group analysis of womenwith institutional deliveries, the increased odds of institutional delivery was associated withemergency reasons during labour (aOR = 1.62, 95% CI: 1.09, 2.42) rather than pre-planningto deliver in healthcare institutions. Furthermore, there was increased odds of pregnancy(OR=2.44, 95% CI: 1.84, 3.23), labour (OR= 1.84 95% CI: 1.34, 2.53) and postpartum(OR=1.70, 95% CI: 1.23, 2.35) complications among these group of women compared towomen without antenatal depressive symptoms. However, antenatal depressive symptomswere not significantly associated with early initiation of ANC or postnatal care visits,pregnancy loss or neonatal mortality.ConclusionEstablishment of a system for detection, referral and treatment of antenatal depression,integrated within existing antenatal care, has the potential to reduce treatment costs andpromote efficiency of the health care system through increased use of scheduled ANC andplanned uptake of institutional delivery. It also has potential to reduce perinatalcomplications, thus contributing to a reduction in maternal morbidity and mortality, as wellas improved neonatal health. But, further studies should ensure whether early detection andtreatment of depressive symptoms may reduce the risk of perinatal complications." @default.
• W2765433032 created "2017-11-10" @default.
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• W2765433032 date "2017-03-01" @default.
• W2765433032 modified "2023-09-23" @default.
• W2765433032 title "Effect of Antenatal Depressive Symptoms on Women’s Access to Healthcare and Perinatal Complications: A Population-Based Study in Rural Ethiopia" @default.
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