Risk factors for postpartum depression in women living with HIV attending prevention of mother-to-child transmission clinic at Kenyatta National Hospital, Nairobi

Abstract

Mothers with HIV are at high risk of a range of psychosocial issues that may impact HIV disease progression for themselves and their children. Stigma has also become a substantial barrier to accessing HIV/AIDS care and prevention services. The study objective was to determine the prevalence and severity of postpartum depression (PPD) amongst women living with HIV and to further understand the impact of stigma and other psychosocial factors in 123 women living with HIV attending Prevention of Mother to Child transmission (PMTCT) clinic at Kenyatta National Hospital (KNH) located in Nairobi, Kenya. We used the EPDS scale and HIV/AIDS Stigma Instrument – PLWHA (HASI – P). Forty-eight percent (N=59) of women screened positive for elevated depressive symptoms. Eleven (9%) of the participants reported high levels of stigma. Multivariate analyses showed that lower education (OR=0.14, 95% CI [0.04 – 0.46], p=0.001) and lack of family support (OR=2.49, 95% CI [1.14 – 5.42], p=0.02) were associated with presence of elevated depressive symptoms. The presence of stigma implied more than 9 fold risk of development of PPD (OR=9.44, 95% CI [1.132–78.79], p=0.04). Stigma was positively correlated with an increase in PPD. PMTCT is an ideal context to reach out to women to address mental health problems especially depression screening and offering psychosocial treatments bolstering quality of life of the mother-baby dyad.

British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018

“…In the studies that include an HIV‐negative comparison group, there was no evidence of an association between HIV status and PND . Factors associated with PND in women living with HIV include past history of mental health issues, financial, immigration and housing concerns, lack of social support, HIV‐related stigma, intimate partner violence, substance misuse and lack of support from a partner . However there remains an absence of data on perinatal mental health among women living with HIV within a UK setting.…”

“…Referral to peer support workers, psychology support and telephone contact may all be considered . Adherence can sometimes be suboptimal postpartum, resulting in viral load rebound ; early engagement in HIV care in the postpartum period has been shown to improve adherence .…”

Maternal Morbidity and Co-morbidity During and After Pregnancy in Women in Low- and Middle-Income Countries: A Systematic Literature Review

“…The total number of women assessed across the 36 studies was 71,229 (60,911 during and 10,318 after pregnancy). Nine studies assessed <500 women per study ; [22][23][24][25][26][27][28][29][30][31][32][33][34] thirteen studies assessed 500-999 women per study. 13,16,18,19,[35][36][37][38][39][40][41][42] Nine studies assessed 1000-1999 women per study; 17,20,25,26,[43][44][45][46][47] and five studies had a sample size of ≥2000 women ( Supplementary Table 2).…”

“…In studies that collected primary data (n=32), data collection took place during a visit for routine antenatal or postnatal care at the outpatient department of a healthcare facility: tertiary/provincial hospitals;21, 29,34,37,40,43,45 secondary level or district hospital, 30,32,42 and primary healthcare facility level. 13,16,35,38,46 For four studies the site was unclear.…”

“…All three types of maternal morbidity including physical, psychological and social ill-health were assessed in 12 studies; 6,13,14,18,38,40,31,42,45,47 psychological and social ill-health were assessed in nine studies; 16,23,27,29,30,33,34,38,41 physical and psychological ill-health in 11 studies; 17,19,20,22,25,27,30,31,48 and physical and social ill-health assessed in six studies ( Supplementary Table 2). 15,43,44,46,49…”