Giving women WOICE postpartum: Prevalence of maternal morbidity using the WHO-WOICE instrument

Abstract

BackgroundThere are no accurate estimates of the prevalence of non-severe maternal morbidities. Given the lack of instruments to fully assess these morbidities, the World Health Organization (WHO) developed an instrument called WOICE.ObjectiveTo evaluate the prevalence of non-severe maternal morbidities in puerperal women and analyses factors associated to impaired clinical, social and mental health conditions.MethodA cross-sectional study with 519 postpartum women in a single encounter 6 to 12 weeks postpartum. The WOICE questionnaire included three sections: the first with maternal and obstetric history, sociodemographic data, risk and environment factors, violence and sexual health; The second considers functionality and disability, general symptoms and mental health; and the third includes data on physical and laboratory tests. Data collection was supported by Tablets with REDCAP software. Initially, a descriptive analysis was performed, with general prevalence of all variables contained in the WOICE, including scales on anxiety and depression (GAD-7 and PHQ-9- altered if ≥ 10), functionality (WHODAS- altered when ≥ 37.4) and data on violence and substance use. Subsequently, an evaluation of cases with alterations was performed, with a logistic regression to investigate factors associated to impaired non-clinical and clinical conditions.Results517 women were included, majority (54.3%) multiparous, ages between 20 and 34 years (65.4%) and with partner (75,6%). Over a quarter had (26.2%) preterm birth, however good perinatal outcomes. Around a third (30.2%) reported health problems informed by the physician, although more than 80% considered having good or very good health. About 10% reported any substance and 5.9% suffered violence. Anxiety was identified in 19.8% of cases, depression in 36.9% and altered functioning in 4.4% of women. Logistic regression identified that poor overall health rating was associated to increased anxiety/depression and impaired functioning. Having a partner reduces the perception of women on the presence of clinical morbidities.ConclusionDuring postpartum care, women presented high frequency of anxiety and depression and relevant frequency of substance use and violence. These aspects of women´s health need further evaluation and specific interventions to improve quality of care.