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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

01-12-2020 | Mood Disorders | Research article

Epidemiology of antenatal depression in Africa: a systematic review and meta-analysis

Authors: Abel Fekadu Dadi, Haileab Fekadu Wolde, Adhanom Gebreegziabher Baraki, Temesgen Yihunie Akalu

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

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Abstract

Background

Antenatal depression is a serious problem worldwide that has devastating consequences not only for the mother but also for the child and family. The pooled evidence regarding the prevalence and associated factors of antenatal depression is rare in Africa. Hence this review aimed to investigate the prevalence and associated factors of antenatal depression in Africa.

Methods

We searched CINHAL, MEDLINE, PsycINFO, Psychiatry online, PubMed, SCOPES, and Emcare databases for English written observational studies conducted in Africa from 2007 to 2018.Quality of studies was assessed using the Newcastle Ottawa Scale (NOS), and studies with good quality were included in the final review. Heterogeneity across studies was assessed using the I2 and Higgins test. Publication bias was checked using Funnel plot symmetry, and Egger’s regression test and adjustment was made by using Duval and Tweedie’s Trim and Fill analysis. A random effect Meta-analysis was employed to determine the pooled estimates with 95% confidence interval (CI). Stata 14 was used for analysis. The review protocol has been registered in PROSPERO number CRD42018106717.

Result

Of the 175 studies identified, 28 studies with an overall sample size of 17,938 were included. According to the random effect model following trim and fill analysis, the pooled prevalence of antenatal depression in Africa was 26.3% (95%CI: 22.2, 30.4%). Economic difficulties [POR = 1.87;95%CI:1.25,2.78,I2 = 88.1%], unfavorable marital condition [POR = 4.17;95% CI:1.75, 9.94, I2 = 81.2%], poor support from relatives [POR = 1.36;95% CI:1.18, 1.56, I2 = 78.0%], bad obstetric history [POR = 2.30;95% CI:1.81, 2.92), I2 = 81.7%], and history of mental health problem [POR = 2.97; 95% CI:1.74, 5.06, I2 = 92.0%]were the factors associated with antenatal depression.

Conclusion

The prevalence of antenatal depression is high in Africa, which showed that one in four pregnant women had depression. Pregnant mothers who had economic difficulties, bad obstetric history, poor support from relatives, previous mental health problems, and unfavorable marital conditions were at higher risk of antenatal depression. Therefore these factors should be considered while designing mental health care services for pregnant mothers.
Literature
1.
Understanding mental illness; a guide to brain disorders, medication, and therapy. 2011.
2.
WHO Guidelines Approved by the Guidelines Review Committee. MhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings: Mental Health Gap Action Programme (mhGAP). Geneva: World Health Organization World Health Organization; 2010.
3.
WHO. Depression and Other Common Mental Disorders, Global Health Estimates. 2017.
4.
GBD. Disease and Injury Incidence and Prevalence Collaborators, and others. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:10053.
5.
Mersha AG, Abebe SA, Sori LM, Abegaz TM. Prevalence and associated factors of perinatal depression in Ethiopia: a systematic review and meta-analysis. Depress Res Treat. 2018.
6.
Abujilban SK, Abuidhail J, Al-Modallal H, Hamaideh S, Mosemli O. Predictors of antenatal depression among Jordanian pregnant women in their third trimester. Health Care Women Int. 2014;35(2):200–15.PubMedCrossRef
7.
Deecher D, Andree TH, Sloan D, Schechter LE. From menarche to menopause: exploring the underlying biology of depression in women experiencing hormonal changes. Psychoneuroendocrinology. 2008;33(1):3–17.PubMedCrossRef
8.
Abdelhai R, Mosleh H. Screening for antepartum anxiety and depression and their association with domestic violence among Egyptian pregnant women. J Egypt Public Health Assoc. 2015;90(3):101–8.PubMedCrossRef
9.
Rahman A, Iqbal Z, Bunn J, Lovel H, Harrington R. Impact of maternal depression on infant nutritional status and illness: a cohort study. Arch Gen Psychiatry. 2004;61(9):946–52.PubMedCrossRef
10.
Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol. 2004;103(4):698–709.PubMedCrossRef
11.
Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67.
12.
Fisher J. Cabral de Mello M, Patel V, Rahman a, Tran T, Holton S, et al. prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ. 2012;90(2):139–49H.CrossRef
13.
Bindt C, Guo N, Bonle MT, Appiah-Poku J, Hinz R, Barthel D, et al. No association between antenatal common mental disorders in low-obstetric risk women and adverse birth outcomes in their offspring: results from the CDS study in Ghana and cote D'Ivoire. PLoS One. 2013;8(11):e80711.PubMedPubMedCentralCrossRef
14.
Assefa GW. Prevalence and factors associated with antenatal depression among women following antenatal care at Shashemane health facilities, South Ethiopia. Ann Glob Health. 2015;81(1):90.
15.
Adewuya AO, Ola BA, Aloba OO, Dada AO, Fasoto OO. Prevalence and correlates of depression in late pregnancy among Nigerian women. Depression Anxiety. 2007;24(1):15–21.PubMedCrossRef
16.
Mahenge B, Stockl H, Likindikoki S, Kaaya S, Mbwambo J. The prevalence of mental health morbidity and its associated factors among women attending a prenatal clinic in Tanzania. Int J Gynaecol Obstet. 2015;130(3):261–5.PubMedCrossRef
17.
Bitew T, Hanlon C, Kebede E, Medhin G, Fekadu A. Antenatal depressive symptoms and maternal health care utilisation: a population-based study of pregnant women in Ethiopia. BMC Pregnancy Childbirth. 2016;16(1):301.PubMedPubMedCentralCrossRef
18.
Hartley M, Tomlinson M, Greco E, Comulada WS, Stewart J, le Roux I, et al. Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health. 2011;8(1):9.PubMedPubMedCentralCrossRef
19.
Alder J, Fink N, Bitzer J, Hösli I, Holzgreve W. Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med. 2007;20(3):189–209.PubMedCrossRef
20.
Chang HY, Keyes KM, Lee KS, Choi IA, Kim SJ, Kim KW, et al. Prenatal maternal depression is associated with low birth weight through shorter gestational age in term infants in Korea. Early Hum Dev. 2014;90(1):15–20.PubMedCrossRef
21.
Nasreen HE, Kabir ZN, Forsell Y, Edhborg M. Low birth weight in offspring of women with depressive and anxiety symptoms during pregnancy: results from a population based study in Bangladesh. BMC Public Health. 2010;10(1):515.PubMedPubMedCentralCrossRef
22.
Rao D, Kumar S, Mohanraj R, Frey S, Manhart LE, L. Kaysen D. The impact of domestic violence and depressive symptoms on preterm birth in South India. Soc Psychiatry Psychiatr Epidemiol. 2016;51(2):225–32.PubMedCrossRef
23.
Saeed A, Raana T, Saeed AM, Humayun A. Effect of antenatal depression on maternal dietary intake and neonatal outcome: a prospective cohort. Nutr J. 2016;15(1):64.PubMedPubMedCentralCrossRef
24.
Lee AM, Lam SK, Lau SMSM, Chong CSY, Chui HW, Fong DYT. Prevalence, course, and risk factors for antenatal anxiety and depression. Obstet Gynecol. 2007;110(5):1102–12.PubMedCrossRef
25.
Orr ST, James SA, Blackmore PC. Maternal prenatal depressive symptoms and spontaneous preterm births among African-American women in Baltimore, Maryland. Am J Epidemiol. 2002;156(9):797–802.PubMedCrossRef
26.
Evans J, Heron J, Patel RR, Wiles N. Depressive symptoms during pregnancy and low birth weight at term: longitudinal study. Br J Psychiatry. 2007;191.
27.
Biratu A, Haile D. Prevalence of antenatal depression and associated factors among pregnant women in Addis Ababa, Ethiopia: a cross-sectional study. Reprod Health. 2015;12:99.PubMedPubMedCentralCrossRef
28.
Black MM, Baqui AH, Zaman K, McNary SW, Le K, Arifeen SE, et al. Depressive symptoms among rural Bangladeshi mothers: implications for infant development. J Child Psychol Psychiatry. 2007;48(8):764–72.PubMedCrossRef
29.
Ajinkya S, Jadhav PR, Srivastava NN. Depression during pregnancy: prevalence and obstetric risk factors among pregnant women attending a tertiary care hospital in Navi Mumbai. Ind Psychiatry J. 2013;22(1):37–40.PubMedPubMedCentralCrossRef
30.
Bisetegn TA, Mihretie G, Muche T. Prevalence and predictors of depression among pregnant women in debretabor town, northwest Ethiopia. PLoS One. 2016;11(9).
31.
Dibaba Y, Fantahun M, Hindin MJ. The association of unwanted pregnancy and social support with depressive symptoms in pregnancy: evidence from rural southwestern Ethiopia. BMC Pregnancy Childbirth. 2013;13.
32.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100.PubMedPubMedCentralCrossRef
33.
Wells G, Shea B, O’connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute, 2014. oxford. ASp; 2015.
34.
Borenstein M, Hedges LV, Higgins JP, Rothstein HR. Introduction to meta-analysis: John Wiley & Sons; 2011.
35.
Duval S, Tweedie R. A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis. J Am Stat Assoc. 2000;95(449):89–98.
36.
Stata A. Stata Base reference manual release 14. 2015.
37.
Dailey DE, Humphreys JC. Social stressors associated with antepartum depressive symptoms in low-income African American women. Public Health Nurs. 2011;28(3):203–12.PubMedCrossRef
38.
Jallo N, Elswick RK Jr, Kinser P, Masho S, Price SK, Svikis DS. Prevalence and predictors of depressive symptoms in pregnant African American women. Issues Mental Health Nurs. 2015;36(11):860–9.CrossRef
39.
Luke S, Salihu HM, Alio AP, Mbah AK, Jeffers D, Berry EL, et al. Risk factors for major antenatal depression among low-income African American women. J Women's Health. 2009;18(11):1841–6.CrossRef
40.
Jackson FM, Rowley DL, Curry OT. Contextualized stress, global stress, and depression in well-educated, pregnant, African-American women. Women's Health Issues. 2012;22(3):e329–e36.PubMedCrossRef
41.
Luiza JW, Gallaher MJ, Powers RW. Urinary cortisol and depression in early pregnancy: role of adiposity and race. BMC Pregnancy Childbirth. 2015;15(1):30.PubMedPubMedCentralCrossRef
42.
Shen JJ, Lin F, Jackson T. Risk of prenatal depression: differences by race. Ethnicity Dis. 2010;20(1):35–9.
43.
Bennett IM, Schott W, Krutikova S, Behrman JR. Maternal mental health, and child growth and development, in four low-income and middle-income countries. J Epidemiol Community Health. 2015;70(2):168–73.PubMedPubMedCentralCrossRef
44.
Jebena MG, Taha M, Nakajima M, Lemieux A, Lemessa F, Hoffman R, et al. Household food insecurity and mental distress among pregnant women in Southwestern Ethiopia: A cross sectional study design. BMC Pregnancy Childbirth. 2015;15(1).
45.
Bitew T, Hanlon C, Kebede E, Honikman S, Fekadu A. Antenatal depressive symptoms and perinatal complications: a prospective study in rural Ethiopia. BMC Psychiatr. 2017;17(1):301.CrossRef
46.
Glover V. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):25–35.PubMedCrossRef
47.
Gerardin P. Characteristics and clinical consequences of prenatal depression. Main results of a prospective case-control study on perinatal depression from pregnancy to one year-old infant. Neuropsychiatrie de l'Enfance et de l'Adolescence. 2012;60(2):138–46.CrossRef
48.
Freeman MP. Perinatal psychiatry: risk factors, treatment data, and specific challenges for clinical researchers. J Clin Psychiatry. 2008;69(4):633–4.PubMedCrossRef
49.
Hurst J, Zeanah P, Lewis L, Mills K. Examining the association between nutrition and psychosocial factors in first-time pregnant women: a cross-sectional pilot study. Int J Disabil Hum Dev. 2012;11(4):343–50.CrossRef
50.
Hwa-Froelich DA, Loveland Cook CA, Flick LH. Maternal sensitivity and communication styles: Mothers with depression: Journal of Early Intervention. 31 (1) (pp 44–66), 2008. Date of Publication: December 2008.; 2008.
51.
Fuller-Tyszkiewicz M, Skouteris H, Watson BE, Hill B. Body dissatisfaction during pregnancy: a systematic review of cross-sectional and prospective correlates. J Health Psychol. 2013;18(11):1411–21.PubMedCrossRef
52.
Leung BM, Kaplan BJ. Perinatal depression: prevalence, risks, and the nutrition link--a review of the literature. J Am Diet Assoc. 2009;109(9):1566–75.PubMedCrossRef
53.
54.
Rochat T, Tomlinson M, Newell M, Stein A. Depression among pregnant women testing for HIV in rural South Africa: Implications for VCT. 9th International AIDS Impact Conference; Botswana. 2009.
55.
Osok J, Kigamwa P, Vander Stoep A, Huang K-Y, Kumar M. Depression and its psychosocial risk factors in pregnant Kenyan adolescents: a cross-sectional study in a community health Centre of Nairobi. BMC Psychiatry. 2018;18(1):136.PubMedPubMedCentralCrossRef
56.
Tsai AC, Tomlinson M, Comulada WS, Rotheram-Borus MJ. Food insufficiency, depression, and the modifying role of social support: evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa. Soc Sci Med. 2016;151:69–77.PubMedPubMedCentralCrossRef
57.
Rochat TJ, Tomlinson M, Barnighausen T, Newell ML, Stein A. The prevalence and clinical presentation of antenatal depression in rural South Africa. J Affect Disord. 2011;135(1–3):362–73.PubMedPubMedCentralCrossRef
58.
Weobong B, Soremekun S, Ten Asbroek AH, Amenga-Etego S, Danso S, Owusu-Agyei S, et al. Prevalence and determinants of antenatal depression among pregnant women in a predominantly rural population in Ghana: the DON population-based study. J Affect Disord. 2014;165:1–7.PubMedCrossRef
59.
Ayele TA, Azale T, Alemu K, Abdissa Z, Mulat H, Fekadu A. Prevalence and associated factors of antenatal depression among women attending antenatal Care Service at Gondar University Hospital, Northwest Ethiopia. PLoS One. 2016;11(5):e0155125.PubMedPubMedCentralCrossRef
60.
Mossie TB, Sibhatu AK, Dargie A, Ayele AD. Prevalence of antenatal depressive symptoms and associated factors among pregnant women in Maichew, North Ethiopia: an institution based study. Ethiop J Health Sci. 2017;27(1):59–66.PubMedPubMedCentralCrossRef
61.
Sahile MA, Segni MT, Awoke T, Bekele D. Prevalence and predictors of antenatal depressive symptoms among women attending Adama hospital antenatal clinic, Adama, Ethiopia. Int J Nurs Midwifery. 2017;9(5):58–64.CrossRef
62.
Gemta WA. Prevalence and factors associated with antenatal depression among women following antenatal care at Shashemane health facilities, South Ethiopia. Ann Glob Health. 2015;1(81):90.CrossRef
63.
Manikkam L, Burns JK. Antenatal depression and its risk factors: an urban prevalence study in KwaZulu-Natal. S Afr Med J. 2012;102.
64.
Heyningen TV, Myer L, Onah M, Tomlinson M, Field S, Honikman S. Antenatal depression and adversity in urban South Africa. J Affect Disord. 2016;203:121–9.PubMedPubMedCentralCrossRef
65.
Tsai AC, Tomlinson M, Comulada WS, Rotheram-Borus MJ. Intimate partner violence and depression symptom severity among south African women during pregnancy and postpartum: population-based prospective cohort study. PLoS Med. 2016;13(1):e1001943.PubMedPubMedCentralCrossRef
66.
Esimai O, Fatoye F, Quiah A, Vidal O, Momoh R. Antepartum anxiety and depressive symptoms: a study of Nigerian women during the three trimesters of pregnancy. J Obstet Gynaecol. 2008;28.
67.
Kaaya SF, Mbwambo JK, Kilonzo GP, Van Den Borne H, Leshabari MT, Fawzi MC, et al. Socio-economic and partner relationship factors associated with antenatal depressive morbidity among pregnant women in Dar Es Salaam, Tanzania. Tanzan J Health Res. 2010;12(1):23–35.PubMed
68.
Stewart RC, Umar E, Tomenson B, Creed F. A cross-sectional study of antenatal depression and associated factors in Malawi. Arch Women’s Mental Health. 2014;17(2):145–54.CrossRef
69.
Rwakarema M, Premji SS, Nyanza EC, Riziki P, Palacios-Derflingher L. Antenatal depression is associated with pregnancy-related anxiety, partner relations, and wealth in women in northern Tanzania: a cross-sectional study. BMC Womens Health. 2015;15:68.PubMedPubMedCentralCrossRef
70.
Thompson O, Ajayi I. Prevalence of antenatal depression and associated risk factors among pregnant women attending antenatal clinics in Abeokuta north local government area, Nigeria Depression Research and Treatment 2016;2016:4518979.
71.
Guo N, Bindt C, Te Bonle M, Appiah-Poku J, Hinz R, Barthel D, et al. Association of antepartum and postpartum depression in Ghanaian and Ivorian women with febrile illness in their offspring: a prospective birth cohort study. Am J Epidemiol. 2013;178(9):1394–402.PubMedCrossRef
72.
Mochache K, Mathai M, Gachuno O, Vander Stoep A, Kumar M. Depression during pregnancy and preterm delivery: a prospective cohort study among women attending antenatal clinic at Pumwani maternity hospital. Ann General Psychiatry. 2018;17(1):31.CrossRef
73.
Målqvist M, Clarke K, Matsebula T, Bergman M, Tomlinson M. Screening for antepartum depression through community health outreach in Swaziland. J Community Health. 2016;41(5):946–52.PubMedPubMedCentralCrossRef
74.
Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry. 2016;3(10):973–82.PubMedPubMedCentralCrossRef
75.
Sawyer A, Ayers S, Smith H. Pre-and postnatal psychological wellbeing in Africa: a systematic review. J Affect Disord. 2010;123(1–3):17–29.PubMedCrossRef
76.
Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol. 2010;202(1):5–14.PubMedPubMedCentralCrossRef
77.
Getinet W, Amare T, Boru B, Shumet S, Worku W, Azale T. Prevalence and risk factors for antenatal depression in Ethiopia: systematic review. Depress Res Treat 2018;2018.
78.
Verbeek T, Bockting C, Beijers C, Meijer J, Van Pampus M, Burger H. Low socio-economic position increases the adverse effect of negative life events on anxiety and depression during pregnancy. Eur Psychiatr. 2015;30:742.CrossRef
79.
Abrahams Z, Lund C, Field S, Honikman S. Factors associated with household food insecurity and depression in pregnant south African women from a low socio-economic setting: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol. 2018;53(4):363–72.PubMedPubMedCentralCrossRef
80.
Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord. 2016;191:62–77.PubMedPubMedCentralCrossRef
81.
Elsenbruch S, Benson S, Rücke M, Rose M, Dudenhausen J, Pincus-Knackstedt MK, et al. Social support during pregnancy: effects on maternal depressive symptoms, smoking and pregnancy outcome. Hum Reprod. 2006;22(3):869–77.PubMedCrossRef
82.
Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry. 2004;26(4):289–95.PubMedCrossRef
83.
Altshuler LL, Hendrick V, Cohen LS. Course of mood and anxiety disorders during pregnancy and the postpartum period. J Clin Psychiatr. 1998.
Metadata
Title
Epidemiology of antenatal depression in Africa: a systematic review and meta-analysis
Authors
Abel Fekadu Dadi
Haileab Fekadu Wolde
Adhanom Gebreegziabher Baraki
Temesgen Yihunie Akalu
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-02929-5

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