Research Article: Prevalence and determinants of antenatal depression in Ethiopia: A systematic review and meta-analysis

Date Published: February 19, 2019

Publisher: Public Library of Science

Author(s): Getinet Ayano, Getachew Tesfaw, Shegaye Shumet, Astrid M. Kamperman.

http://doi.org/10.1371/journal.pone.0211764

Abstract

Maternal depression is the most prevalent psychiatric disorder during pregnancy, can alter fetal development and have a lasting impact on the offspring’s neurological and behavioral development. However, no review has been conducted to report the consolidated magnitude of antenatal depression (AND) in Ethiopia. Therefore, this review aimed to systematically summarize the existing evidence on the epidemiology of AND in Ethiopia.

Using PRISMA guideline, we systematically reviewed and meta-analyzed studies that examined the prevalence and associated factors of AND from three electronic databases (PubMed, EMBASE, and SCOPUS). We used predefined inclusion criteria to screen identified studies. A qualitative and quantitative analysis was employed. Heterogeneity across the studies was evaluated using Q and the I² test. Publication bias was assessed by funnel plot and Egger’s regression test.

In this review, a total of 193 studies were initially identified and evaluated. Of these, five eligible articles were included in the final analysis. In our meta-analysis, the pooled prevalence of AND in Ethiopia was 21.28% (95% CI; 15.96–27.78). The prevalence of AND was highest in the third trimester of pregnancy at 32.10% and it was 19.13% in the first trimester and 18.86% in the second trimester of pregnancy. The prevalence of AND was 26.48% and 18.28% as measured by Beck depression inventory (BDI) and the Edinburgh Postnatal Depression Scale (EPDS), respectively. Moreover, the prevalence of AND was 15.50% for the studies conducted in the community setting and it was 25.77% for the studies conducted in the institution-based setting. In our qualitative synthesis, we found that those pregnant women who had a history of stillbirth, complications during pregnancy, previous history of depression, no ANC follow-up, irregular ANC follow-up, not satisfied by ANC follow-up, and monthly income <1500 Ethiopian birr were linked with a greater risk of developing ANC. We also found that those women who experienced partner violence during pregnancy, food insecurity, medium and low social support, and those who were unmarried, age group 20–29, house wives and farmers were associated with a higher risk of developing ANC. Our meta-analysis found that the pooled prevalence of AND in Ethiopia was 21.28%. The prevalence of AND was high in the third trimester of pregnancy as compared to the first and second trimesters of pregnancy. The prevalence of AND was high in studies conducted using BDI than EPDS. Studies on the magnitude of AND as well as the possible determinants in each trimester of pregnancy with representative sample size are recommended. Screening of depression in a pregnant woman in perinatal setting might be considered backed by integration of family planning and mental health services. The use of validated and a standard instrument to assess AND is warranted. The protocol for this systematic review and meta-analysis was registered at PROSPERO (record ID=CRD42017076521, 06 December 2017)

Partial Text

Pregnancy is the period of great joy and positive expectations, but also physical and mental stress and difficulties. Pregnancy is associated with a range of physiological as well as psychological changes for the mothers and they are expected to face numerous new challenges in this period. As a result, the perinatal period is associated with a considerably greater risk of experiencing mental health problems for all women [1, 2]. Of the varies mental health problems, maternal depression is the most prevalent psychiatric disorder during pregnancy [1, 3, 4], can alter fetal development and have a lasting impact on the offspring’s neurological and behavioral development [5, 6].

This systematic review and meta-analysis was conducted following “the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines [38]. We conducted an extensive search of the literature in three databases (EMBASE, MEDLINE, and Scopus). The following terms and keywords were applied for PubMed search: (prevalence OR magnitude) AND (Antenatal OR Pregnancy OR prenatal OR women) AND (Depression OR depressive symptoms OR depressive disorder OR depressive) AND (Ethiopia). For the other two electronic databases (EMBASE and SCOPUS) we used database specific subject headings linked with the above terms and keywords used in PubMed. We also screened at the reference lists of the remaining papers to identify additional relevant studies to this review. This review protocol was written and presented according to PRISMA-P 2015 guidelines [39].

In this systematic review and meta-analysis, we explored the prevalence and determinants of AND in Ethiopia. Five cross-sectional studies were included in the final analysis. Based on the meta-analysis a significant proportion (more than 1 in 5) of women had AND in Ethiopia. This shows that AND is a significant public health problem in Ethiopia. We also identified 23 determinants that were significantly associated with antenatal depression in Ethiopia.

In summary, in our meta-analysis, the pooled prevalence of AND in Ethiopia was 21.28% (95% CI; 15.96–27.78). The pooled prevalence of AND was highest in the third trimester of pregnancy at 32.10% and it was 19.13% in the first trimester and 18.86% in the second trimester of pregnancy. In addition, the pooled prevalence of AND was 26.48% and 18.28% as measured by BDI and the EPDS, respectively. The pooled prevalence of AND was 15.50% for the studies conducted in the community setting and it was 25.78% for the studies conducted in the institution-based setting.

 

Source:

http://doi.org/10.1371/journal.pone.0211764

 

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