Prevalence of postpartum depression among women delivering at Kenyatta national hospital

Abstract

Postpartum depression is a common occurrence which is often undiagnosed when symptoms are not severe and may progress into severe or chronic state if unrecognized and untreated. Being the most frequent form of mental illness in the postpartum period, It can begin as early as two weeks after delivery and can persist indefinitely if untreated. There is no routine screening of PPD at the postnatal clinic. Its effects are not only on the mother but also on the infant and the family at large. A depressed mother will have difficulties in taking and following postpartum advice from a health care provider such as: Recognizing postpartum danger signs, self care and care of infant, attending scheduled hospital visits and compliance to other medications. The impact of this would be increased maternal and perinatal morbidity and may be mortality from direct or indirect causes of PPD. Study objective: To determine the prevalence of postpartum depression among women delivering at Kenyatta National Hospital six Weeks after delivery. Study design: Descriptive cross-sectional study. Setting: The postnatal clinic at Kenyatta National Hospital. Study population: 183 consenting postnatal mothers at the postnatal clinic at KNH, six weeks after delivery during the study period. Study period: September to November 2012. Method: Participants were recruited from the postnatal clinic at KNH using set criteria. Eligible participants were approached and requested to consent voluntarily to participate into this study. Inclusion into the study was by consecutive sampling until the required sample size of 183 was attained. Data was collected using a structured, pre designed questionnaire and analyzed using SPSS software. RESULTS A total of 183 postnatal mothers were recruited into this study but 180 were analysed. This study found a prevalence of PPD six week after delivery at KNH at 10.6%. 23.3% were aged ≤24 years. 13.3 % were single, 11.7% had schooled up to primary level and 28.3% were not in any form of employment. Household income was ≤ ksh 40,000 in 37.2% and 42.2% had delivered once. Recent pregnancy was reported as unwanted by 20% and partner’s support was perceived as inadequate by 10% of the respondents. Caesarian section was the commonest mode of delivery at 76.7% and 13.3% were not satisfied with the sex of the infant. Almost all, 96.7 % exclusively breast fed their infants and minor illnesses had occurred to 3.3% of the infants. Symptoms of maternity blues were found in 12.6%. Lack of employment (p< 0.0001), household income of ≤ksh40,000(p= 0.05) were statistically significantly associated with PPD. No significant statistical association between the marital status (p=0.739), mode of delivery (p=0.745) religion (p=0.487), partners’ support (p=0.412) and prior symptoms of maternity blues (p=0.162) and PPD was found. Conclusion The prevalence of PPD six weeks after delivery of 10.6% is high and necessitates routine screening of mothers at the postnatal clinics. Economic factors are highly associated with PPD. Mode of delivery, desired sex of infant and marital status did not appear to be significantly associated. The findings in this study compared well with findings of other similar studies. Recommendations Introduction of routine screening for PPD especially in mothers of low socio economic status and Midwives/ Obstetrician to be retrained in this field. This will help to indentify affected mothers to avert the effects that may be associated with this condition. More studies to be done using different study design, different settings to asses other factors such as bad obstetric outcomes and maternal chronic illnesses.