Prevalence and Factors Associated with Post-Partum Depression Among Women in Rural Tanzania: A Mixed Method Study

Background: Post-partum depression (PPD) is a mental health disorder occurring following childbirth, affecting about 15% of women globally and between 7% and 52% in low and middle-income countries (LMICs). Despite the higher burden in LMICs settings, there is limited information on its magnitude and drivers.

Methods: We conducted a cross-sectional mixed-methods study to assess the prevalence, risk factors, and perceptions of PPD in the Kilombero district. Edinburgh Postnatal Depression Scale (EPDS) was used to assess the prevalence of PPD. We used a structured questionnaire to evaluate factors associated with PPD, in-depth interviews (IDIs) were used to explore mothers' experiences with signs of PPD, and focus group discussions were used to explore awareness, perceptions, and experiences of dealing with PPD among community members and health workers.

Results: Among 601 mothers enrolled, 53(8.8%) had an EPDS score of 13, suggesting PPD. Factors associated with increased risk of PPD were thoughts of abortion (aOR 4.88 (2.33 – 10.16); p <0.001), hospitalization (aOR 4.83 (1.80 – 12.90) p=0.002) and experiences of sexual violence (aOR 3.15 (1.13 – 8.71) p= 0.03). Availability of social support was associated with reduced risk of PPD (aOR 0.24(0.12 – 0.50) p< 0.001). Common themes from IDIs included lack of social support, difficult livelihoods, abuse, unplanned pregnancies, forced marriage, and young age. Community members expressed limited knowledge of PPD during the FGDs despite having examples of women who fit the description of PPD in their communities. Health workers were aware of PPD, but they do not routinely screen for it.

Conclusion: PPD is prevalent but primarily neglected in rural communities. Sensitization of PPD presentation and associated risk factors among both community members and health workers is necessary. Screening for PPD should also be incorporated in the post-natal care package to improve maternally and child health outcomes.