A Retrospective Mixed Methods Analysis of COVID-19's Impact on Maternal Psychosocial Health in Ghana: Lessons for Future Public Health Crises

BackgroundObserved impacts of the COVID-19 pandemic in countries in the global north include increasing rates of maternal anxiety and depression. However, little research has been done in sub-Saharan Africa assessing the impact of the pandemic on maternal psychosocial stress. This study aimed to examine COVID-related psychosocial impacts among Ghanaian women who were pregnant during the pandemic. MethodsAn online survey was administered to Ghanaian mothers with children 0-15 months old from June 2021 to January 2022. Demographic and health information, health literacy (HL) information measured by the All Aspects of Health Literacy scale (AAHL), and COVID-19 health and well-being were collected. Using the Coronavirus Anxiety Scale (CAS) and the Obsession with Coronavirus Scale (OCS), mothers were asked to recall their levels of anxiety and worry while they were pregnant during the pandemic. Generalized linear models were used to assess the association between COVID-related impacts and maternal CAS and OCS scores. In-depth interviews were conducted to gather information from participants about their experiences of pregnancy and childbirth during the COVID-19 pandemic, and thematic analyses were performed using the social support networks in health framework. ResultsA total of 221 mother-child dyads were analyzed. Eleven women participated in the in-depth interviews. We observed a rate of 11% for probable dysfunctional coronavirus-related anxiety and 33% for probable dysfunctional thinking about COVID-19. In adjusted models for baseline characteristics, we observed that higher HL scores corresponded with reduced CAS scores ({beta}=-0.43, 95% CI [-0.80, -0.05] for every point increase in AAHLS scores). For COVID-related health and well-being, loss of jobs and wages predicted higher CAS scores when adjusted for HL as a main covariate ({beta}=1.30, 95% CI [0.07, 2.53]). Participants who reported exercising during COVID had higher OCS scores compared to those who reported not exercising, when adjusting for HL ({beta}=1.08, 95% CI [-0.01, 2.16], p=0.05). Themes emerging were categorized into three domains: COVID-19 Pandemic Impacts, COVID-19 Adaptations, and Social Support Networks. Conclusions and RecommendationsThis study assessing the impacts of the COVID-19 pandemic on maternal health and well-being provides valuable insights into the pandemics short-and medium-term effects. Given the complexity of the pandemics stress response, including potential intersections between psychosocial health, social support, and health literacy, public health policies must incorporate these needs into future pandemic responses. This includes leveraging telehealth and mHealth platforms for maternal mental health screening as well as providing community-based health literacy resources. Further studies examining the longer-term effects of the pandemic are also warranted.