Another Perspective On The Relationship Between Breastfeeding, Newborn Care And Maternal Perinatal Depression In A Rural African Setting

BackgroundMaternal postpartum depression (PPD) is still one of the major health challenges across the globe with detrimental consequences on newborn bonding, growth and feeding. However, the bidirectional pathways between breastfeeding and PPD have not been sufficiently characterized. This study investigated the risk factors of poor maternal mental health and its relationship with breastfeeding initiation, in a remote community in East Africa. Subject and methodsThis was a cross-sectional secondary analysis of the baseline data collected for a 2019 prospective cohort study on infant growth in a rural community in East Africa. Healthy, 529 mother-singleton infant pairs were recruited consecutively from Gitwe district hospital. Maternal peri-partum depression score was obtained using the Edinburgh post-partum depression scale. The cut-off point on the depression scale, used in this study was 6.5. ResultsThe burden of maternal perinatal depression was 59.7%. Elderly mothers >35years of age (75.9%; p<0.001), poor antenatal visits of less than 4 (74.4%; p<0.001), vaginal delivery (74.7%; p<0.001; OR 5.26; 95% CI 3.57, 7.69), did not give prelacteal feeds (62.4%; p<0.001; OR 7.14; 95% CI 2.94, 16.7), primary education (69.5%, p<0.001), engaged in semi-skilled or skilled jobs (71.8%, p<0.001), poor socioeconomic class (74.8%, p<0.001), Christians (60.9%; p<0.001; OR 8.33; 95% CI 1.89, 33.3), HIV negative (61.6%; p<0.001; OR 4.57; 95% CI 1.90, 11.02), lack of water (82.0%; p<0.001; OR 27.1; 95% CI 16.39, 44.80) and toilet facilities (81.9%; p<0.001; OR 5.68; 95% CI 3.76, 8.58) in their home yard, not being exposed to potentially harmful social habits such as tobacco, alcohol (63.3%; p<0.001; OR 3.22; 95% CI 1.89, 5.56) significantly characterized mothers with high depression score. Peripartum depression was more common among mothers with small for gestational age babies (p=0.004; OR 3.12; 95%CI 1.44, 6.73) and those who initiated breastfeeding early (p<0.001; OR 9.17; 95%CI 5.21, 16.13). Conclusion and RecommendationsThe burden of maternal peripartum depression was high in this community and is still on the increase. Therefore, PPD and its risk factors require early recognition, intervention and follow up during the antenatal period up till at least 12 months postpartum, in order to prevent lactation failure and decline in exclusive breastfeeding and continued breastfeeding rates and duration. The poor WASH situation and difficult road access to health facilities in the community requires urgent attention.