Postnatal Depression Screening among Postpartum Women Attending Postnatal Care at Selected Community Health Centres Situated in the Nkangala District of South Africa

Abstract

Background: The postnatal period represents a time of risk for the emergence of Postnatal Depression (PND), a common maternal mental health problem affecting the well-being of the mother, the newborn and the entire family. Previously, it was postulated that African women were not affected by PND, due to traditional rituals and other cultural factors. However, the assumption has been refuted because of the existence of empirical evidence of PND in Africa and beyond, particularly among women living in socio-economic disadvantaged regions. Despite the growing magnitude of PND reported in South Africa, the country continues to focus more on reducing maternal and infant mortality and promoting infant physical health with limited efforts made to address PND among postpartum women. Objective: To screen for PND and determine the associated risk factors among postpartum women in selected community health centres situated in the Nkangala District, South Africa. Methods: The study was cross-sectional in design and applied a quantitative approach. Random sampling was used to select the three community health centres in the Nkangala District. A sample of 228 women who had delivered a live infant within 12 weeks of the time of data collection was selected using purposive sampling from the three community health centres. Trained research assistants administered a questionnaire to obtain information on demography and obstetric history, while the Edinburgh Postnatal Depression Scale (EDPS) was used to screen for postnatal depression. An EDPS score of 13+ confirmed the probability of PND. Data was analysed using STATA 14. Results: The mean age of women was 28±7 years. The majority of women were single (61%), living in large households (77%), and living in households with a monthly income of less than $291.10 (63%). Most women had normal (i.e., vaginal) delivery (83%) and reported unplanned pregnancies (65%). The probability of developing PND among women was 22%. The odds of developing PND were 3.17 times more likely in women with babies aged six weeks and above (AOR=3.17, CI; 1.39 - 7.23) and 4.50 times more likely in women living in households with an income of less than $115.55 (AOR=4.50, CI; 1.03 - 19.74). Partner/husband violence increased the odds of developing PND (AOR = 6.89, CI; 1.49 - 31.93), as well as a stressful life event (AOR= 3.73, CI: 1.52 - 9.17). Having partner/husband support (AOR=0.10, CI: 0.03 - 0.37) and receiving social support (AOR=0.28, CI: 0.09 - 0.93) reduced the risk of developing PND. A chi-square test showed significant associations between the EDPS scores and partner/husband support, partner/husband having another sexual partner, receiving social support, having a person who offers social support, partner/husband violence, and stressful life events. Conclusion: The probability of PND was high among postpartum women in the Nkangala District of the Mpumalanga Province, South Africa. The key determinants for the probability of PND were the age of a baby, household income, partner/husband violence, partner/husband support and receiving social support. Routine screening to identify women who are at risk of PND should be integrated into postnatal care settings for immediate intervention to protect the mother and her baby from different forms of morbidity.