Date of Award

9-15-2017

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Alfred Murage

Second Supervisor/Advisor

Dr. Mukaindo Mwaniki

Department

Obstetrics and Gynaecology (East Africa)

Abstract

Introduction: Miscarriages are a common pregnancy complication affecting about 10-15% of pregnancies. Miscarriages may be associated with a myriad psychiatric morbidity at various timelines after the event. Depression has been shown to affect about 10-20% of all women following a miscarriage. However, no data exists in the local setting informing on the prevalence of post-miscarriage depression.

Objective: To determine the prevalence of positive depression screen among post-miscarriage women at the Aga Khan University hospital, Nairobi.

Methods: The study was cross-sectional in design. Patients who had a miscarriage were recruited at the post-miscarriage clinic review at the gynecology clinics at Aga Khan University Hospital, Nairobi. The Edinburgh postnatal depression scale was used to screen for depression in the patients. Prevalence was calculated from the percentage of patients achieving the cut –off score of 13 over the total number of patients. Secondary analysis was done using Univariate and multivariate analysis to compare clinical variables between the screen - positive and screen - negative women in order to delineate the potential pattern of association between the two among the study subjects.

Results: A total of 182 patients were recruited for the study. The prevalence of positive depression screen was 34.1% since 62 of the 182 patients had a positive depression screen. Univariate analysis revealed that education level (p=0.039) and mode of conception (p=0.005) impacted on the outcome of the depression screen. In multivariate analysis, multiple factors impacted on the depression screen and these included: age (p=0.009), education level (p=0.001), gestation at miscarriage (p=0.04), marital status (p=0.043), prior miscarriage (p=0.011) and mode of conception (p=0.03). Moreover, of the patients who had a positive depression screen, 21(33.1%) had thoughts of self-harm.

Conclusion: A positive depression screen is present in 34.1% of women in our population 2 weeks after a miscarriage. More so, factors that seem to impact on the positive depression screen include a younger age, a lower education level, an older gestational age at miscarriage, being single, an assisted mode of conception and a prior miscarriage. Thoughts of self-harm are present in about a third of these women (33.1%) hence pointing out the importance of screening these women using the EPDS after a miscarriage.

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