Mental Health and Quality of Life of Women One Year after Maternal Near-Miss in Low and Middle-Income Countries: The Case of Zanzibar, Tanzania

Abstract

Women who experienced a maternal near-miss are at risk of mental health complications and lower quality of life, but long-term consequences are largely unknown. The aim of this study is to assess whether mental health symptoms and quality of life change over time and to examine associations with risk factors among post-partum women. In this cohort study, women with maternal near-miss were matched to women without or with mild complications at Mnazi Mmoja Hospital in Zanzibar. Depressive and post-traumatic stress disorder symptoms, and quality of life were measured at three, six, and twelve-months follow-up. A linear mixed-effects model was used for data analysis. Postpartum women in Zanzibar reported low levels of depressive and post-traumatic stress disorder symptoms. While depressive symptoms and quality of life trajectories were similar among women with and without maternal near-miss, differences for trajectories of post-traumatic stress disorder symptoms and physical quality of life were found. Social support, perinatal loss, and intercurrent illness were strongly associated with both depressive symptoms and quality of life in this group of Islamic women. These findings suggest that social support, embedded in the cultural context, should be considered in helping women cope with mental health issues in the aftermath of severe maternal complications.

Impact of maternal morbidities on the longitudinal health-related quality of life trajectories among women who gave childbirth in four hospitals of Northwest Ethiopia: a group-based trajectory modelling study

“…The finding of our study also showed that women who had vaginal delivery were more likely to belong to the lower HRQOL trajectories in all HRQOL domains relative to the highest trajectories. This is in line with the study finding in Tanzania which reported that women who had caesarean delivery were more likely to have better physical HRQOL scores than their counterparts 62. Another study in Asia also reported that women who had planned caesarean sections have higher scores in all the domains of HRQOL than mothers who had spontaneous delivery or instrument-assisted delivery 67.…”

“…Some of these complications the authors reported were hypertensive disorders and postpartum haemorrhages. It has been also reported by other studies that intercurrent illness and gestational hypertension lead to lower HRQOL in postpartum women 61 62…”

“…This is in line with the study finding in Tanzania which reported that women who had caesarean delivery were more likely to have better physical HRQOL scores than their counterparts. 62 Another study in Asia also reported that women who had planned caesarean sections have higher scores in all the domains of HRQOL than mothers who had spontaneous delivery or instrument-assisted delivery. 67 The possible reason might be that women who had caesarean delivery may have received more family support because of their surgery than those women with vaginal delivery.…”

“…A study conducted in Tanzania agreed with the finding of our study, in which women with higher levels of social support were more likely to have higher HRQOL. 62 This might be because positive social environment and support in the form of provision of resources and assurance can act as a stress-buffering mechanism, protecting the mental health and QOL of individuals.…”

Health-related quality of life measured by SF-36 among postdelivery mothers attending maternal and child health clinic in Eastern Nepal: a cross-sectional study

“…Also, lower income was associated with poorer HRQoL after childbirth 21 , 22 . Level of education also affects the HRQoL 16 , 23 , with lower education levels in women significantly associated with a lower HRQoL 16 . In contrast, some studies have reported that higher education was significantly associated with a lower HRQoL 14 , 24 .…”