EFFECT OF A TRAINING PROGRAMME ON KNOWLEDGE AND ATTITUDE OF NURSES ON MATERNAL DEPRESSION AND ITS LINKAGE WITH CHILD HEALTH IN IBADAN, NIGERIA

Abstract

Background: Approximately, 10-20% of women experience depression either during pregnancy or in the first 12 months after delivery, severe enough to compromise the health of their children. Depression is a major mood disorder that causes persistent feelings of sadness and loss of interest in activities that are normally pleasurable. Research has also indicated that children of depressed mothers are at an increased risk of developing depression themselves. Nurses as first-line caregivers play important roles in the identification and management of this group of patients. It is not known if the training of nurses in Ibadan will improve their abilities to perform these roles. This study was therefore designed to assess the effect of a training programme on knowledge and attitude of nurses about maternal depression and its linkage with child health in Ibadan, Nigeria. Methodology: This was a hospital-based intervention study involving 2 groups of 102 nurses each, from two purposively selected secondary health facilities in Ibadan metropolis. The study was done in four phases: baseline, intervention, immediate and one month post-intervention. The instrument consisted of a pre-tested and semi-structured questionnaire adapted from Mental Health Gap Action Programme (mhGap) which was used to assess the nurses’ baseline and post-intervention knowledge and attitude, using the module on depression, for the two groups. Participants in the intervention group received a two-hour training session followed by immediate post-intervention data collection and another survey of the group after one month. It was expected that after one week of training, Nurses in the intervention group would have internalized the training content. The control group was exposed to the intervention by giving them the training manual four weeks after the last data collection, as an ethical obligation of beneficence. Data were analyzed using Chi-square test for test of association between quantitative variables and the t-test to compare means. The level of significance was set at 5%. Results: Respondents’ mean age was 45years; nurses in the age group 50-59 years made up the highest proportion (43.2%). The majority (98%) were females; 81% were married; and 99% were Yorubas. There was an improvement in knowledge of respondents with the mean score rising from 37.06 [SD: 5.84] at baseline to 41.41[SD: 4.07] at post-intervention (p <0.001). The findings also showed that there was a statistically significant decline to 37.45 [SD: 12.34]) in the improved knowledge of the nurses four weeks after training (p = 0.003). The wide dispersion of scores one month after intervention showed that some nurses retained a lot of the new knowledge while others did not. Most importantly, the knowledge score one month after intervention in the experimental group, although higher, showed no statistically significant difference from the baseline score. The training also did not improve nurses’ attitudes towards maternal depression and mothers who may have this problem, whether immediately after training or one month afterward, compared to baseline. In the experimental group, the mean attitude scores were 16.23 [SD: 2.31], 16.19 [SD: 2.56] and 15.42 [SD: 5.19] at baseline, immediately post-intervention and one month after intervention, respectively. The younger respondents (24-43 years) seemed to have better knowledge of maternal depression compared to the older respondents (44-59 years), but this did not reach the level of statistical significance. Conclusion: Training was found to be effective in increasing the knowledge of nurses about maternal depression and its linkage with child health but this knowledge declined over time. However, attitudinal change may require more sessions of training, and coaching on the job. Continuous training and retraining of health workers is very important in order for them to retain the knowledge gained