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Epidemiology of Antenatal Depression in Africa

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Epidemiology of Antenatal Depression in Africa Dadi et al. BMC Pregnancy and Childbirth (2020) 20:251 https://doi.org/10.1186/s12884-020-02929-5 RESEARCH ARTICLE Open Access Epidemiology of antenatal depression in Africa: a systematic review and meta- analysis Abel Fekadu Dadi1,2, Haileab Fekadu Wolde1*, Adhanom Gebreegziabher Baraki1 and Temesgen Yihunie Akalu1 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. Keywords: Antenatal depression, Associated factors, Systematic review, Meta-analysis, Africa * Correspondence: [email protected] 1University of Gondar, College of Medicine and Health Sciences, Institute of Public Health, Department of Epidemiology and Biostatistics, Gondar, Ethiopia Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Dadi et al. BMC Pregnancy and Childbirth (2020) 20:251 Page 2 of 13 Background conflicts [18], history of obstetric complications, history Depression is one of the types of mood disorders charac- of depression [15, 29, 30], unplanned pregnancy, lack of terized by markedly decreased interest or pleasure in al- social support [27, 31], and low economic status [30]. most all activities, significant weight loss or gain, Despite variations in the magnitude and associated fac- disturbed sleep, feeling of fatigue, loss of appetite, feeling tors of antenatal depression across different countries of of hopelessness, reduced self-esteem and confidence, di- Africa, pooling the available evidence and reporting the minished ability to think or concentrate, and recurrent extent of the problem in a more precise way might help thoughts of death [1, 2]. According to the World Health policymakers to prioritize the problem more than ever. Organization (WHO) 2017 estimate, 322 million people Therefore, the objective of the current review is to assess are living with depression, and29.9 million (9%) of these the epidemiology of antenatal depression in Africa. are living in Africa. Depressive disorders are ranked among the top five contributors to the global disease Method burden [3]. The prevalence of depression increased by Search strategy and selection criteria 18.4% between 2005 and 2015 worldwide [4]. The study conforms to the Preferred Reporting Items Antenatal depression is a non-psychotic depressive epi- for Systematic Reviews and Meta-Analysis (PRISMA) sode ranging from mild to severe symptoms that occur guidelines [32]. The reviewed articles were sourced from while the woman is pregnant [5, 6]. Women are known to the following databases: MEDLINE (via Ovid), Psy- be at higher risk of mental disorders like depression than cINFO, CINAHL (EBSCO), Psychiatry Online, Emcare, males [7]. The mental health of women of reproductive PubMed, Scopus. Besides, google scholar, snowballing, age is becoming a significant public health problem both and retrieving references from a list of eligible studies in developing and developed countries, and depression is were employed. A search strategy was developed for the most prevalent mental disorder during pregnancy [8, each database by using a combination of free texts and 9]. A systematic review and meta-analysis conducted in controlled vocabularies (i.e., Mesh terms). developed countries showed the prevalence of depression Example of the search strategy for PubMed: to be 7.4, 12.8, and 12% at the first, second, and third tri- mesters of pregnancy, respectively [10]. Another meta- ((Prenatal depression) OR antenatal depression) OR analysis conducted worldwide also reported the preva- "depression during pregnancy" Filters: Observational lence of antenatal depression that ranges from 0.5 to 51% Study; Publication date from 2007/01/01 to 2018/ [11]. Moreover, a similar study from low-and middle- 08/02; Humans; English; Africa income countries also showed a mean weighted preva- lence of common mental disorders during pregnancy to We included all observational (cross-sectional, case- be 15.6% [12]. The magnitude of antenatal depression var- control, prospective, and retrospective cohort) studies ies across different countries in Africa, and studies showed conducted in Africa, which conducted from 2007 up to the prevalence to be between 8.3 and 78.2% [8, 13–18]. 2018 and included antenatal depression and associated Depressive disorders during pregnancy may have dev- factors as a primary outcome. Additionally, studies in- astating consequences not only for the mother but also cluded must have used a validated tool to screen depres- for the child and family [19]. Antenatal depression is sion, and they must be available in the English language. identified to be a risk factor for adverse obstetric and Studies that were reviewed, studies with a poor quality birth outcomes like fetal growth retardation, low Apgar based on NOS [33],and studies that were conducted on score, preterm birth, low birth weight, and stillbirth [13, high-risk population groups were excluded from the 20–23]. Antenatal depression is also associated with in- review. creased smoking, alcohol consumption, and unhealthy Articles were independently screened in two stages: behaviors [24]. These factors, together with depression, firstly, the titles and abstracts were screened, and sec- may predispose the mothers to obstetric complications ondly, the full-text articles that met the eligibility criteria [19] such as preterm labor [25], preeclampsia, abruption mentioned above were retrieved and screened further placenta [26, 27]. Furthermore, depression during preg- for possible inclusion by two reviewers (AFD and HFW). nancy is also associated with postnatal depression [28], Where there was disagreement between the two re- which negatively affects child development, mother- viewers, further discussion was made until a consensus infant interaction, and the family at large [9]. reached. Compared with women in developed countries, women in developing countries are more exposed to the Data extraction risk factors for the development of antenatal depression, The data extraction sheet was prepared to collect infor- such as; younger age of mothers [18], low level of educa- mation on the name of the author, year of publication, tion, exposure to domestic violence [8] or relationship country, study setting(i.e., population-based versus Dadi et al. BMC Pregnancy and Childbirth (2020)
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