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Antenatal depressive symptoms and utilisation of delivery and postnatal care: a prospective study in rural Ethiopia

  • Bitew, Tesera1, 2
  • Hanlon, Charlotte1, 3
  • Kebede, Eskinder4
  • Honikman, Simone5
  • Onah, Michael N.5
  • Fekadu, Abebaw1, 6, 7
  • 1 Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia , Addis Ababa (Ethiopia)
  • 2 Debre Markos University, Institute of Educational and Behavioural Sciences, Department of Psychology, Debre Markos, Ethiopia , Debre Markos (Ethiopia)
  • 3 King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK , London (United Kingdom)
  • 4 Addis Ababa University, College of Health Sciences, Department of Obstetrics and Gynecology, Addis Ababa, Ethiopia , Addis Ababa (Ethiopia)
  • 5 University of Cape Town, Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, Perinatal Mental Health Project, Cape Town, South Africa , Cape Town (South Africa)
  • 6 King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK , London (United Kingdom)
  • 7 Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia , Addis Ababa (Ethiopia)
Published Article
BMC Pregnancy and Childbirth
Springer (Biomed Central Ltd.)
Publication Date
Jun 29, 2017
DOI: 10.1186/s12884-017-1383-8
Springer Nature


BackgroundUptake of delivery and postnatal care remains low in Low and Middle-Income Countries (LMICs), where 99% of global maternal deaths take place. However, the potential impact of antenatal depression on use of institutional delivery and postnatal care has seldom been examined. This study aimed to examine whether antenatal depressive symptoms are associated with use of maternal health care services.MethodsA population-based prospective study was conducted in Sodo District, Southern Ethiopia. Depressive symptoms were assessed during pregnancy with a locally validated, Amharic version of the Patient Health Questionnaire (PHQ-9). A cut off score of five or more indicated possible depression. A total of 1251 women were interviewed at a median of 8 weeks (4–12 weeks) after delivery. Postnatal outcome variables were: institutional delivery care utilization, type of delivery, i.e. spontaneous or assisted, and postnatal care utilization. Multivariate logistic regression was used to examine the association between antenatal depressive symptoms and the outcome variables.ResultsHigh levels of antenatal depressive symptoms (PHQ score 5 or higher) were found in 28.7% of participating women. Nearly two-thirds, 783 women (62.6%), delivered in healthcare institutions. After adjusting for potential confounders, women with antenatal depressive symptoms had increased odds of reporting 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) as compared to women without these symptoms. However, the increased odds of institutional delivery among women with antenatal depressive symptoms was associated with unplanned delivery care use mainly due to emergency reasons (aOR = 1.62, 95% CI: 1.09, 2.42) rather than planning to deliver in healthcare institutions.ConclusionImproved detection and treatment of antenatal depression has the potential to increase planned institutional delivery and reduce perinatal complications, thus contributing to a reduction in maternal morbidity and mortality.

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