Date of Award

10-2025

Degree Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Advisor

Dr. Steve Mutiso

Second Advisor

Prof. Lukoye Atwoli

Third Advisor

Dr. Felix Oindi

Department

Obstetrics and Gynaecology (East Africa)

Abstract

Introduction: One in seven women experience peripartum depression, a common disorder that can occur during pregnancy or in the postpartum phase. Women are particularly vulnerable to depressive symptoms during pregnancy and the immediate postpartum period due to physiological changes during pregnancy as well as other sociocultural stressors. Peripartum depression is associated with significant maternal and perinatal adverse outcomes, including self-neglect, substance use, preterm birth, low birth weight and poor neurocognitive development, in offspring. There is a need to understand the prevalence and factors associated with depressive symptoms during pregnancy to improve maternal and neonatal outcomes. To our knowledge, this is the first study in this setting to explore the prevalence and factors associated with a screen-positive depression scale among pregnant women attending antenatal clinics.

Objective: To determine the prevalence and risk factors for screen-positive depression among pregnant women attending the Antenatal Clinic at The Aga Khan University Hospital.

Methods: This study was a cross-sectional descriptive study conducted among 412 pregnant women attending antenatal clinics at Aga Khan University Hospital. A researcher-designed sociodemographic tool and the Edinburgh Postnatal Depression Scale (EPDS) questionnaire were used for data collection. The data were analyzed via the Statistical Package for Social Sciences (SPSS) version 28.0. A score cutoff of =/>13 was used to determine positive depression. Descriptive analysis, frequencies and percentages were used for categorical variables. Cross-tabulation was used to compare sociodemographic variables between those who screened positive and those who did not. The chi-square test was used to determine if the difference in categorical variables between the two groups was significant. Univariate and multivariable logistic regression was used to determine factors that predict the presence of a screen-positive depression test.

Results: The mean age of the participants was 31.7 years, with 94.2% having attained tertiary education. Among the participants, 83.7% were married, and approximately two-thirds (69.4%) had a household income above 100,000. The majority of the population had more than one pregnancy, and only 7 participants reported a background mental illness, whereas 10% reported experiencing intimate partner violence. The median gestational age was 24 weeks (IQR 16--34). The prevalence of screen-positive depression was 22.9%. On multivariate analysis, single women had 3.29 times greater odds of screening positive for depression than married women did (AOR= vi 3.29, 95% CI 1.64--6.58, P=0.001), whereas a unit increase in parity was associated with 34% greater odds of screening positive for depression (AOR= 1.34, 95% CI 1.07--1.69, p=0.012) when adjustments were made for other factors.

Conclusion and Recommendation: There is a high prevalence of screen-positive antepartum depression among pregnant women, which is in line with studies in other settings in Kenya; hence, there is a need to institute antepartum depression screening among all women attending antenatal clinics in the country. Being single and having higher parity are key factors predicting antepartum depression among women seeking antenatal care at The Aga Khan University Hospital and should be taken into consideration when screening tools for peripartum depression are adopted, and this should be performed in subsequent pregnancies even if a woman has screened negative in her previous pregnancy.

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1

Last Page

56

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