Date of Award

11-27-2021

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr. Narjis Rizvi

Second Advisor

Prof. Haleema Yasmeen

Third Advisor

Miss Farina Abrejo

Department

Community Health Sciences

Abstract

Background: Childbirth is a crucial event in a woman’s life which brings significant challenges in terms of the introduction of a new role, a change in personal identity as well as family structure, and a new organization of daily life activities. Neuroendocrine adaptations and physiological hormonal surges superimposed by psychosocial stressors can make a woman vulnerable to distress. Depression and anxiety are the common antenatal mental disorders (CAMD) that may complicate the overall happy experience of a pregnancy. The current World Health Organization (WHO) recommendations for antenatal care have not extensively incorporated a protocol for assessment of mental wellbeing during pregnancy. This study aimed to determine the frequency of CAMD among women receiving antenatal care at a tertiary care hospital in Karachi and assess the health facility’s readiness and response to address CAMD.
Methods: A mixed-methods study was conducted in one of the largest public tertiary care hospitals of Karachi from 15th October till 5th November 2021. The study was approved from the Ethical Review Committee of The Aga Khan University, Karachi. PMHP Screening Tool for Mental Distress during Pregnancy was used to screen women for CAMD and identify their risk factors. Key-informant interviews were conducted to assess the readiness and response of the facility towards CAMD. Quantitative data was analyzed using IBM SPSS v.23.0. Thematic analysis was done for the qualitative data.
Results: Of the 200 women screened for CAMD, 47 (23.5%) were positive. Statistically significant risk factors for CAMD were being divorced/widowed/separated women (p=0.000), having a history of miscarriage/neonatal/infant loss (p=0.019), having a desire for a male child (p=0.009), birth spacing mess than one year, having a past history of depression or anxiety before this pregnancy (p=0.033), and having a significant life event in the past year (p=0.020). The facility’s readiness to respond to the medical needs of these women was in terms of suboptimal leadership, restrained financial support, and lack of trained and sensitized workforce. However, the providers were responsiveness towards CAMD.
Conclusion and recommendations: One and every four pregnant women is suffering from undiagnosed anxiety or depression in one of the largest tertiary care hospitals in Karachi. The facility’s readiness to the burden is inadequate. Suboptimal leadership, restrained financial support, and lack of trained and sensitized workforce are the most common challenges hindering the readiness towards CAMD. Despite this, the HCPs understood this gap in the healthcare system and were responding to CAMD within their limited resources and constricted time to provide services at individual and informal level.

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