PhD VIVA VOCE for Atuhaire Catherine.

  • March 29, 2024

Ms. Catherine Atuhaire, Department of Nursing Faculty of Medicine will defend her PhD thesis on 15th June 2022.

The PhD Title: Postpartum Depression in Southwestern Uganda: Prevalence, Associated Factors, Lived Experiences of Mothers Who Recovered from a Clinical Diagnosis and Validation of Screening Tool.

Supervisors:

  1. Dr Grace Nambozi, Mbarara University of Science and Technology
  2. Dr Godfrey Zari Rukundo, Mbarara University of Science and Technology
  3. Assoc. Prof. Laura Brennaman, RWJF Nursing and Health Fellow, Mbarara University of Science and Technology 

 Examiners:

  1. Professor Julie Jomeen, Southern Cross University, Australia
  2. Professor Jerome Kabakyenga, Mbarara University of Science and Technology
  3. Prof. Rose C. Nanyonga, Clarke International University

ABSTRACT

Background: Postpartum depression (PPD) continues to become one of the major maternal health challenges across the globe that significantly causes maternal morbidity with severe consequences on the well-being of mothers, new-borns, families, and communities. The birth of a newborn baby is normally considered a joyful event, inhibiting mothers from expressing their depressive feelings. If PPD is not detected using appropriate validated tools, well understood and managed, mothers with PPD are at greater risk of suffering from postpartum psychosis in severe cases, experiencing suicidal ideation or even committing suicide. Although the Edinburgh Postnatal Depression Scale (EPDS) has been recognized as a reliable screening scale for PPD worldwide, no study has validated this scale in Uganda. The burden of this disorder is highest in low-income countries and there is absence of pooled data in Africa to provide a summary of PPD burden. This study therefore aimed at determining the prevalence and factors associated with PPD in south western Uganda, exploring lived experiences of Ugandan women with a previous clinical PPD diagnosis and validating the EPDS in the Ugandan context to determine its appropriateness in detecting PPD among women in south-western Uganda.

 

Methods: To meet objective I, a cross-sectional study was conducted between November 2019 and June 2020 among 292 mothers who were at six weeks’ postpartum. Mothers were selected from three health facilities in southwestern Uganda and enrolled using stratified consecutive sampling. Postpartum depression was clinically diagnosed using the MINI 7.0.2 based on criteria from the DSM-5. The factors associated with PPD were assessed by using a structured interviewer-administered questionnaire and these data were analyzed using bivariate chi square analyses and multivariate logistic regression. The phenomenological investigation adopted an explorative approach through in-depth interviews to meet objective II. Data were collected from 30 postpartum mothers who were purposively selected, between 9th December 2019 and 25th September 2020. This work was analyzed using thematic data analysis that was steered by Colaizzi’s six-step phenomenological approach of inquiry. A descriptive, cross-sectional study that targeted mothers six weeks’ postpartum mothers to meet the third objective was conducted. During data collection, mothers were first screened using the EPDS in a private room and then clinically diagnosed in another private room using the MINI 7.0.2.

 

Results: In objective I, overall prevalence of PPD was 27.1% (95% CI: 22.2-32.5) in southwestern Uganda. Factors associated with PPD were low perceived social support, HIV positive status, rural residence, obstetrical complications and the baby crying excessively. In objective II, five themes emerged from the qualitative analysis: 1) somatic experiences including insomnia and headache, breast pain, poor breast milk production, weight loss and lack of energy; 2) difficulties in home and family life including overwhelming domestic chores, lack of social support from other family members, fighting at home and financial constraints due to COVID-19 pandemic; 3) negative emotions including anger, self-blame, despondency and feelings of loneliness and regrets of conceiving or marriage; 4) feelings of suicide, homicide and self-harm including suicidal ideation and attempt, homicidal ideations and attempt and feelings of self-harm and 5) coping with postpartum depression including spirituality, termination of or attempt to leave their marital relationships, acceptance, counselling and seeking medical treatment, and perseverance. In objective III, the sensitivity, specificity, positive predictive value and negative predictive value of the EPDS established by this study were 86.8%, 92.1%, 80.5% and 94.9% respectively. The cut-off point ≥10 was the most acceptable point as it was 86.8% sensitive and 92.1% specific in detecting mothers suffering from PPD.

 

Conclusion and Recommendations: Despite the limited dearth of literature in Africa (there are only reports from nine countries out of 54 on the continent), the PPD prevalence remains high, which suggests that it is still a neglected illness and calls for immediate interventions. Prevalence of PPD in Mbarara and Rwampara districts is higher than what has previously been reported in Uganda, indicating an urgent need to identify pregnant women who are at increased risk of PPD to mitigate their risk or implement therapies to manage the condition. Midwives who attend to these mothers need to be empowered with available methods of mitigating prevalence and consequences of PPD. Suicidal and homicidal thoughts are important parts of the postpartum depression experience, and these may put the lives of the mothers, their spouses and their babies at a great risk. Poor relationship quality, intimate partner violence and lack of financial resources contribute significantly to the negative emotional experiences of mothers with PPD. The EPDS is a valid screening tool if used at a cutoff score of ≥10 in southwestern Uganda. It has a good diagnostic performance to correctly detect PPD among postpartum mothers.

 

List of Publications from the Thesis:

  1. Atuhaire C, Cumber SN. Factors associated with postpartum depression among adolescents in Uganda. Pan Afr Med J. 2018 Jun 25;30:170. doi: 10.11604/pamj.2018.30.170.15333. eCollection 2018.PMID: 30455799 Free PMC article
  2. Atuhaire C, Brennaman L, Cumber SN, Rukundo GZ, Nambozi G. The magnitude of postpartum depression among mothers in Africa: a literature review. Pan Afr Med J. 2020 Sep 25;37:89. doi: 10.11604/pamj.2020.37.89.23572. eCollection 2020.PMID: 33244352 Free PMC article.
  3. Atuhaire C, Rukundo GZ, Nambozi G, Ngonzi J, Atwine D, Cumber SN, Brennaman L. Prevalence of postpartum depression and associated factors among women in Mbarara and Rwampara districts of south-western Uganda. BMC Pregnancy Childbirth. 2021 Jul 12;21(1):503. doi: 10.1186/s12884-021-03967-3.PMID: 34247576 Free PMC article.
  4. Atuhaire C, Rukundo GZ, Brennaman L, Cumber SN, Nambozi G. Lived Experiences of Ugandan Women who had recovered from a Clinical Diagnosis of Postpartum Depression: A Phenomenological Study. BMC Pregnancy Childbirth. 2021 Dec 2021 Dec 13;21(1):826. doi: 10.1186/s12884-021-04287-2 Free PMC article.
  5. Atuhaire C, Brennaman L, Nambozi G, Ngonzi J, Atwine D, Rukundo GZ. Validating the Edinburgh Postnatal Depression Scale (EPDS) against the Mini-International Neuropsychiatric Interview (MINI 7.0.2) for use in Uganda. BMC Pregnancy Childbirth. [Under Review, round 2].

EVENT INFO :

  • Start Date:March 29, 2024
  • End Date:March 29, 2024