The effect of maternal near miss on the prevalence of post natal depression compared to normal pregnancy within one year of delivery at the Kenyatta National Hospital.

Abstract

BACKGROUND Maternal morbidity is not as well studied and documented as maternal mortality. One of the new frontiers in quality of care assessment and improvement in maternal and new-born health is conducting Maternal Near Miss (MNM) reviews or audits. Maternal near miss refers to a woman who nearly died but survived a complication that occurred during pregnancy or within 42 days of delivery. Among the things that can be reviewed during MNM audits are the consequences of MNM on women’s health including psychosocial well-being. The landscape of maternal mortality and morbidity is changing with an increase in the incidence of non-communicable diseases including mental health disorders. The commonest psychiatric disorder of pregnancy is post-natal-depression (PND) but it is seldom screened for, diagnosed and managed (2). This is despite its far reaching effects on women, new-borns and their families. AIM To assess the effect of MNM on the prevalence of PND in women who survive MNM episodes compared to those with a normal pregnancy. METHODOLOGY Study design: This study used a comparative cross-sectional design. Study setting: The study was conducted at the Kenyatta National Hospital (KNH). Study population: The exposed were women who had suffered MNM after 28 weeks of gestation or within 42 days of delivery at KNH. The un-exposed group were women who had had a normal pregnancy without complications with delivery after 28 weeks of gestation at KNH. Both arms involved women who were within 1 year of delivery. Matching was done for gestation at delivery and time (date) of delivery. Sample size: The study recruited 74 women with MNM and 140 women with uncomplicated pregnancies. Data collection and analysis: Both arms were interviewed via telephone and screened for PND using the Edinburgh Post-Natal Depression scale (EPDS) after collection of sociodemographic and other medical information from medical records. The data was then analysed and a comparison made between women with MNM and those with a normal pregnancy in terms of the prevalence of PND. The characteristics of women in both groups suffering PND were also analysed and compared. RESULTS: The main study findings were that there was a higher prevalence of PND after MNM (35.1%) compared to those with a normal pregnancy at 10.7%. The odds ratio for developing PND after MNM was 4.5 (2.07-8.74) with a p value <0.0001. A low level of education (adjusted OR 3.11 p value 0.048) and presence of an underlying medical complication (Adjusted OR 2.89 p value 0.02) were also found to increase the risk of PND once MNM occurred. CONCLUSION: This study showed that there was an increased risk of developing PND after MNM compared to after a normal pregnancy. An underlying medical condition and having a low level of education further elevated this risk. KEY WORDS: Maternal Near Miss; Post-Natal Depression; Edinburgh Post-Natal Depression Scale; Post-Natal care; Quality of Care