POSTPARTUM DEPRESSION AND ITS ASSOCIATION WITH BREASTFEEDING PRACTICES AND INFANT DEVELOPMENT IN THE BUEA HEALTH DISTRICT, CAMEROON

Abstract

According to the World Health Organization (WHO), Maternal Mental Health is “a state of well being in which a mother realizes her own capabilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make contributions to her community”. The presence of “Mother” is a core feature in child survival strategies because she is the one who is supposed to begin health promotive and preventive measures such as breast-feeding, weaning, hygiene and sanitation. The state of the mother’s mental health largely determines how she performs these functions, which are all important for a child’s physical, cognitive and emotional development. A child with developmental delay is more likely to have academic difficulties and become less productive as an adult leading to a vicious cycle described in the literature as intergenerational transmission of poverty. We, therefore, sought to, determine the prevalence and correlates of depression in mothers in the postpartum period, characterize the developmental profile and prevalence of under-nutrition in their infants and ascertain the association between maternal depression, infant development and breastfeeding practices Methods: This was a descriptive cross-sectional study carried out in selected Infant Welfare Clinics (IWCs) in the Buea Health District (BHD) in Cameroon. One (1) Private and one (1) public health facility was randomly selected from the 4 health areas. Consecutive recruitment of 408 mother-infant pair was then carried out at the selected health facilities. The Edinburgh Post-Natal Depression Scale (EPDS) was used to screen mothers for depression. Mothers who scored seven (7) and above on the EPDS were administered the Composite International Diagnostic Interview (WMH-CIDI) to make a definitive diagnosis of depression. The Ages and Stages Questionnaire was used to assess child development and the Breastfeeding Practices and Intent Questionnaire explored breastfeeding practices. Data were analyzed using SPSS version 21. Categorical variables were described using frequencies and proportions, continuous variables were described using means. Chi-square was used to determine associations between maternal depression, infant development and breastfeeding practices. Logistic regression was used to determine the predictors of postpartum depression and developmental delay. The level of significance was set at 5%. Results: Four hundred and eight (408) mother-infant pairs who presented at the IWCs for immunization were recruited into this study. The mean age of the mothers was 27 ± 5.2years while that of their infants was 5 ± 3.2 months. The prevalence of postpartum depression (PPD) was 26.7% with peak prevalence during the first 10 weeks postpartum. The predictors found to be independently associated with postpartum depression were being an adolescent (aOR=3.47, CI=1.07-11.36), having an unplanned pregnancy (aOR=2.67, CI=1.05-6.73), exposure to the socio-political crisis (aOR=2.69, CI:1.46-4.95) and marital conflict (aOR=11.04, CI=4.9-24.82) in the last 6 months. Also, having a male child (aOR=0.49, CI=0.29-0.89) and being married (aOR=0.31, CI=0.29- 0.87) were protective. The prevalence of developmental delay was 23.8% while 44.8% of the mothers reported they carried out the optimum practice of breastfeeding. There was no association between postpartum depression and developmental delay (x2= 2.56, p=0.11) and neither was there any association between postpartum depression and breastfeeding practice (x2= 0.45, p=0.57). The mean duration of breastfeeding of mothers who were depressed was 8.37 ± 3.9 months while the mean duration of breastfeeding for mothers who were not depressed was 9.64 ± 3.8 months. This difference was statistically significant (t-value= -3.05, p-value= 0.003). Conclusion: This study contributes to filling the knowledge gap regarding the adverse effects of PPD on infant health and breastfeeding practices. The prevalence of PPD in the BHD is quite high with 3 out of every 10 women diagnosed with depression in the postpartum period. The study identifies the need for CAMH training of health care providers by the government in a primary health care setting to ensure routine screening, early identification, and management of cases of PPD and developmental delay. Our study also found a strong cross-sectional association between the well-being of mothers, duration of breastfeeding, and health of their babies. This emphasizes the need to provide mothers with the psychosocial support they require to carry out their roles as mothers. Thus consideration should be given to the integration of maternal mental health into the child survival and feeding programs.