Prevalence of postpartum depression, mothers’ experiences and barriers and facilitators to seeking postpartum depression care among postpartum mothers attending the postnatal clinic in Jinja regional referral hospital

Abstract

Background: Postpartum depression (PPD) is a major depression episode associated with child birth and common within 4-6 weeks after child birth. Globally, postpartum depression affects approximately 900000 women annually with only about 6% of women with PPD seeking psychological help. PPD is three times more prevalent in low and middle-income countries. Over 70 per 300 women in Uganda suffer from postpartum depression. Despite the availability of PPD services in Jinja regional referral hospital, the uptake is still low. This is due to limited screening services because they are only available at the mental health unit, perceived stigma, poor social support and discrimination. These barriers must be addressed to decrease the negative effects of postpartum depression on maternal and child outcome. Designing appropriate interventions for PPD and mitigating its negative effects required establishing the burden and barriers and facilitators to accessing postpartum depression health care among those affected. Objective: The study assessed the prevalence of postpartum depression, women’s experiences and barriers and facilitators to seeking postpartum depression health care among women attending the postnatal and young child clinic at Jinja Regional Referral Hospital Methodology: A facility based cross-sectional study was conducted at Jinja Regional Referral Hospital using a mixed methods approach. The prevalence of postpartum depression was measured using Edinburgh postnatal depression scale (EPDS) based on the presence of depressive symptoms. According to this tool, the scores range from zero to thirty and this study used the score of 10 as the cut-off point to determine postpartum depression and the data was captured using kobo collect tool and analysed using STATA. The experiences of mothers with depressive symptoms were collected using In-depth interviews while the barriers and facilitators were collected using focus group discussions (FGDs) and key informants (KIs) interviews. All interviews were audio taped, transcribed verbatim and analyzed using thematic analysis. Results: A total of 377 mothers who were within six months postpartum were screened for depressive symptoms at the postnatal and young child clinic from 13th July to 14th August 2020. Out of 377 mothers, 16.2% (61) had postpartum depression. The mothers with PPD experienced hopelessness, lack of confidentiality and lack of financial support. The study found that the barriers and facilitators to seeking formal care were; stigmatization, inadequate support from the partner, low income levels, community’s attitude, low screening levels at the health facility and availability xi of other health care options while psychological support, Place of delivery and knowledge of health workers facilitated seeking for care. Conclusion: The prevalence of postpartum depression in this study is high meaning 70 per 300mothers in Uganda suffer from postpartum depression. These mothers with postpartum depression undergo unfavorable experiences like helplessness and lack of confidentiality. As a result they fail to access PPD health care due stigmatization, low staffing, low screening, poor health workers attitude and inadequate social support. However a few uptake PPD health care with the help of some psychosocial support and health education provided. Recommendations: The ministry of health should provide screening tools to the health workers in order to improve screening and also allocate fulltime psychosocial therapist at the postnatal clinic to screen all visiting mothers for PPD and support mothers who experience postpartum depression. The health workers should sensitize mothers on the risk factors of PPD and available support at facility and community level to reduce stigmatization and encourage health care seeking. And there is need for future research in the community to explore the experiences of mothers who do not seek postpartum depression health care.