STATUS AND CORRELATES OF MENTAL AND PHYSICAL HEALTH OF UNDER-FIVES AND THEIR MOTHERS IN KROO BAY COMMUNITY IN FREETOWN, SIERRA LEONE

Abstract

Background: Over 200 million children under five fail to reach their potential in cognitive development because of poverty, poor health and nutrition and deficient care. The discrepancy between their current developmental levels and what they would have achieved in a more nurturing environment with adequate stimulation and nutrition indicates the degree of loss of potential. Twenty percent of children would have a recognizable and treatable mental disorder and it has been shown that severe mental disorders in adulthood often start in childhood or adolescence with less severe disorders that were not treated or presented for clinical attention. Maternal and child undernutrition is highly prevalent in low-income and middle-income countries, resulting in substantial increases in mortality and overall disease burden and in countries with a large proportion of disadvantaged children, national development is likely to be affected. Depression remains the leading cause of disease burden among women aged 15 to 44 years worldwide and recent estimates report higher rates in women from low-income and middle-income countries compared to previous estimates with higher rates from high-income countries. The negative impact of depression in mothers on the physical and mental health of their children has been established in other parts of the world. There is a paucity of data in this environment necessitating this study. Methodology: This was a descriptive cross-sectional study conducted to examine the physical and mental health, development and nutrition of under-fives in the Kroo Bay Community and their correlates including depression in mothers. Three hundred apparently healthy under-fives who met the inclusion criteria and their mothers were recruited. Socio-demographic and other health information were obtained from the mothers using an adapted questionnaire, and childhood developmental problems were screened for using the ten-question screen for childhood disability. The nutritional status of the children were assessed following weight and height measurements and the findings compared with the National Centre for Health Statistics and the World Health Organisation (NCHS/WHO) reference standards. Maternal body mass index (BMI) was also assessed and the mothers that screened positive for depression were administered the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (WMH-CIDI). Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 16.0 for windows. Continuous variables were summarized using mean and standard deviation while categorical data were summarized using frequencies and proportions. Socio-demographic, child health and maternal health characteristics were presented in frequency tables. The Chi-square test and logistic regression analysis were done to determine the association between the child’s general health, the child’s nutritional status, the mother’s physical health, depression in the mother, socio-demographic characteristics and mental and developmental problems in the child. Level of significance was set at p<0.05. Results: Most (47.3%) of the children were aged 12 to 35 months with a mean of 22.7 months. The majority (35.7%) of the mothers were aged 27 to 32 years with a mean of 28.9 years. There were more males (51.3%) than females (48.7%) and Islam was the predominant religion (68.3%). About 68.0% of the children had presented for one or more health problems at a healthcare facility in the last 6 months: episodes of persistent vomiting (5.7%), one or more episodes of diarrhoeal disease (14.7%), febrile illness (49.0%) or acute respiratory infection (40.0%). A third (33.0%) of the children were undernourished and 34.3% had one or more problems with development with learning difficulties accounting for most (11.0%) of the delays and sight problems accounting for the least proportion (2.3%). Most (55.7%) of the mothers had abnormal BMI measurements and 22.3% of them met the DSM IV criteria for the diagnosis of depression. Febrile illness, undernutrition, level of social support the mother received and whether the child lived with either or both parents were independent predictors of developmental problems in the child. Diarrhoeal disease in the last 6 months and gross motor difficulties were independent predictors of nutritional problems in the child. Abnormal speech in the child and the level of social support the mother received were independent predictors of maternal depression. The duration of breastfeeding and planning of pregnancy were also independent predictors of BMI in the mother. Conclusion: Developmental delays, physical health and nutritional problems in under-fives and depression in mothers were prevalent in this community. Services providing holistic care for under-fives and their mothers are needed to tackle the mental and physical health concerns simultaneously.