Risk factors associated with maternal depression in rural Uganda: A case of Kamuli District

Abstract

The objective of the study was to assess factors associated with maternal depression among pregnant women in rural Uganda. A cross sectional study design was used, the demographic, socio-economic and predisposing factors were assessed using primary data of pregnant women seeking antenatal care in Kamuli general hospital, Nankandulo and Namwendwa HC IV as well as Namasagali and Balawoli HC III, Kamuli district in the month of December, 2015. Analysis was based on a sample of 505 women using frequency distributions, kruskal wallis test and the ordered logistic regression. Qualitative data was collected using a checklist of key thematic questions. Six Key Informant Interviews (KII) and two Focus Group Discussions with pregnant mothers (FDS) were conducted, the data was analyzed using a framework analysis approach. In the results, almost 13% of the pregnant women had a depressive disorder. The factors associated with depression at the multivariate level (p<0.05) were HIV/AIDS, domestic violence and age. HIV positive women (OR=0.42, p-value=0.04), victims of domestic violence (OR=12.11, p-value=0.00) and women of advanced age (OR=1.05, p-value=0.02) had a higher likelihood of having severe depression. The two focus group discussions revealed that maternal mental healthcare in this district is not yet well organized and integrated into Primary Health Care. Domestic violence, HIV and AIDS, pregnancy in advanced age and history of mental illness were identified as the risk factors for maternal depression. Stock out of anti-depressants, stigma and discrimination and inability of health workers to identify and manage depressive disorders were identified as major barriers to professional health care for maternal depression. The study recommends provision of routine psychosocial support to HIV positive pregnant women, victims of domestic violence and expectant mothers of advanced age. Health care workers at MCH clinics as well as HIV clinics should be trained in management of depressive disorders and close mental health care support supervision should be availed to improve management of depressive disorders among pregnant women. Health workers should also devise mechanisms for management of domestic violence cases. The study further recommends mass sensitization on dangers of advanced age pregnancy, availability of psychosocial support and domestic violence to empower women to resist and report domestic violence.