CHAPTER ONE

INTRODUCTION

1.1. Background

Postpartum depression (PPD) is a serious, but treatable medical illness involving feelings of extreme sadness, indifference and/or anxiety, as well as changes in energy, sleep, and appetite(1). Up to 1 in 7 women have post partum depression(2–4). Postpartum depression often occurs within a few months to a year after birth, with depressive symptoms lasting more than 6 months among 25-50% of those affected(5). It is noted in a meta-analysis that post partum depression prevalence varied substantially among countries and regions, from 6.48% to 60.93%(6). Results from this same meta-analysis show that post partum depression was found in 17.22% of women worldwide (6).

The literature review by Atuhaire et al. in 2020 concluded that the magnitude of post partum depression in Africa ranges from 6.9% to 50.3% (7).They had a prevalence of post partum depression in Uganda at 43%, 31.7-39.6% in South Africa, 33% in Zimbabwe, 10.7-22.9% in Nigeria, 19.9% in Ethiopia, 13-18.7% in Kenya, , 6.9-14% in Morocco,  12% in Tanzania, and 9.2% in Sudan(12).

In Cameroon, Adama et al. had a prevalence of post partum depression at 23.4% in Yaoundé(8), Nwana  et al. in the Tubah Health District had a prevalence at 31.8%  (9), Ayamba et al. in Buea had a prevalence at 53.3% (10), Ghogomu et al. in Limbe had a prevalence at 61.8% (11), in the years 2015, 2022, 2021, and 2016 respectively.

Depressive disorders are known to be a cause of disability worldwide (12). The occurrence of depressive illness following childbirth can have negative impacts on the mother, her marital relationship, her baby, and can also have long term effects if left untreated (13). Maternal post partum depression has been linked to infant malnutrition and increased prevalence of other pediatric diseases, such as respiratory and diarrheal illnesses(14), poor infant physical growth, poor weight gain and cognitive development, and can contribute to later emotional, behavioural, cognitive, and interpersonal problems(15). Untreated maternal depression disrupts the early mother-infant relationship thus, bringing a lack of responsiveness to the baby and inappropriate parenting behaviours (16).

Stress, acute pain during labor, which are  a fundamental features of overall birth experience, vary widely and has a link with increased risk of post partum depression (17). Psychosocial risk factors that are associated with post partum depression include: lack of satisfaction in the marital relationship(8), recent conflicts with the partner or father of the child(8,11), recent stressful life events(11), lack of social support(11), and gender based violence (9,18). Obstetric risk factors include: prenatal anxiety, prenatal depression (19,20), unplanned pregnancy(11) and unwanted pregnancy(21). Risk factors in the past history include baby blues(8,22), history of mental illness, history of depression(9), alcohol consumption, smoking and family history of mental illness(7,9). There are also factors related to the baby such as difficulties in feeding the baby(8), problems with the baby’s sleeping (8,10), having a male baby(9), and socioeconomic factors like recent financial problems(8,9,11), and unemployment (10,11).

For various reasons, including the reproductive cycle (23), post partum depression is caused, at least in part, by the rapid change in the reproductive hormones estradiol and progesterone before and immediately after delivery(19). Post partum depression is characterized by symptoms such as tearfulness, a feeling of guilt, emotional lability, sleep problems and loss of appetite(24). Mothers are unaware of the symptoms of the illness and those that are aware that they have a problem tend to keep quiet about it for fear of being stigmatized or considered weak(24).

Early detection and intervention of post partum depression are important to prevent negative consequences for both infants and mothers (25,26). Psycho education entails putting in place strategies on how to adapt and deal with stress, acquiring knowledge on wellbeing and mental health, and creating social support groups(27). Women are also encouraged to exercise, engage in acupuncture and massages, obtain adequate exposure to morning light, and seek support from friends and family members as an adjunct to treatment for postpartum depression(21).

Psychotherapy such as interpersonal therapy (IPT) and cognitive behavioural therapy (CBT) have been successful in prevention and treatment of post partum depression. Pharmacotherapy with the use of antidepressants is also effective(21).

It will be important for health care providers to ensure a thorough clinical history is obtained, which specifically asks about previous episodes or feelings of depression (15).

1.2. Problem Statement

The ongoing sociopolitical crisis in the English speaking part of Cameroon has increased the stressors that may increase the prevalence of post partum depression. Signs and symptoms of post partum depression are often not recognized and undertreated(12) in lower and middle income countries. In Cameroon, studies have highlighted the burden of post partum depression in rural and urban areas(8–11). However, we do not find data about this condition in the Bamenda Regional Hospital. 

1.3. Rationale

Studies in Cameroon show high prevalence of post partum depression. Despite this finding, we do not find data on the clinical presentation of post partum depression in Cameroon to the best of our search. The current research will provide baseline data in the BRH, which will contribute in reducing the misdiagnosis and under recognition of this condition in order to improve maternal mental health in our setting through screening and making early diagnosis and treatment interventions.

1.4. Research Question

1) What is the prevalence of post partum depression among mothers in the Bamenda Regional Hospital.?

2) What are the risk factors of post partum depression among women in the Bamenda Regional Hospital.?

3) What is the clinical presentation of post partum depression among mothers in the Bamenda Regional Hospital.?

1.5. Research Objectives

1.5.1. General Objective

To determine the prevalence, risk factors associated with post partum depression and the clinical presentation of post partum depression amongst mothers in Bamenda Regional Hospital.

1.5.2. Specific Objectives

1. To determine the prevalence of post partum depression among mothers in the Bamenda Regional Hospital..
2. To identify the factors associated with post partum depression in the Bamenda Regional Hospital.

• To compare the clinical presentation between depressed and non-depressed postpartum women.