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Assessing prevalence and determinants of PPD Pakistani population

Assessing prevalence and determinants of PPD Pakistani population. Presenter: Dr. Rozina Farhad Mistry Aga Khan Health Service Pakistan. PAKISTAN-SHARE OF THE WORLD 2005. POPULATION: 153 MILLION ( 2.37%) WOMEN IN RH GROUP: >33 million CHILDREN IN <5: >22 million.

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Assessing prevalence and determinants of PPD Pakistani population

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  1. Assessing prevalence and determinants of PPD Pakistani population Presenter: Dr. Rozina Farhad Mistry Aga Khan Health Service Pakistan WHO study on PPD for urban and rural population

  2. PAKISTAN-SHARE OF THE WORLD 2005 POPULATION: 153 MILLION ( 2.37%) WOMEN IN RH GROUP: >33 million CHILDREN IN <5: >22 million WHO study on PPD for urban and rural population

  3. COUNTRIES ACCORDING TO THE HUMAN DEVELOPMENT INDEX 2004 WHO study on PPD for urban and rural population

  4. 2005 - OTHER HARD FACTS - MILLIONS • POPULATION LIVING BELOW POVERTY LINE = 35.5 • POPULATION WITH NO ACCESS TO SAFE • WATER FOR DRINKING = 56.9 • POPULATION WITH ONE ROOM HOUSE = 57.9 • POPULATION WITH NO SANITATION = 78.2 • ADULT LITERATCY RATE = 57.4%. WHO study on PPD for urban and rural population

  5. WHO study on PPD for urban and rural population

  6. WHO study on PPD for urban and rural population

  7. Research Questions Primary • To assess prevalence of postpartum depression (PPD) among postpartum mothers in urban area (Karachi) and in the rural (Northern Areas) of Pakistan using the screening tool of Edinburgh Postpartum Depression Scale (EPDS). Secondary • To assess any differences in health and growth outcomes of children of the mothers diagnosed as having PPD versus the mothers without it. WHO study on PPD for urban and rural population

  8. Definition of Post Partum Depression • DSM IV defines Postpartum depression as a form of severe depression after delivery that requires treatment. • Studies state that postnatal depression is a psychological disorder which occurs within six weeks after childbirth WHO study on PPD for urban and rural population

  9. After delivery: • 50%-75% of the new mothers experience "baby blues" • 10% of these women develop a longer-lasting depression • one in 1,000 women develop the more serious condition called postpartum psychosis WHO study on PPD for urban and rural population

  10. ICD 10 diagnostic criteria for PPD i) At least two of the following features must be present for at least two weeks: • A depressed mood for most of the day • Loss of interest or pleasure in activities that are normally pleasurable, such as playing with the baby • Tiredness, decreased energy, and fatigue WHO study on PPD for urban and rural population

  11. ii) Any four of the following should be present: • Loss of confidence and self esteem • Feelings of guilt and blaming oneself • Recurrent thoughts of suicide or death, including that of the child • Difficulty in concentration • Agitation or lethargy • Sleep disturbance • Appetite disturbance WHO study on PPD for urban and rural population

  12. PPD-WHY SHOULD WE BECONCERNED PPD is a serious condition, it can be effectively treated with antidepressant medications and counseling Mother suffering from PPD is unable to do things she needs to do every day Only 20% seek Rx. The remaining individuals remain either undiagnosed, misdiagnosed, or seek no medical assistance . PPD has consequences for the physical and psycho-social development of children. WHY??? Infants show growth retardation at several time points in the first year of life In the absence of Rx, PPD can get worse and last for as long as a year. WHO study on PPD for urban and rural population

  13. Rationale for the study • Widely different PPD rates have been documented for developing countries • Scarce country specific data • Advocacy for incorporating early diagnosis and management of PPD mother and her baby • To develop culturally appropriate interventions to create awareness about impact of PPD on mothers and children WHO study on PPD for urban and rural population

  14. CONCEPTUAL FRAMEWORK Socio environmental factors Obstetric related factors Biological factors Post Partum Depression Child related factors Impact On maternal Health Impact on Growth outcome of Children WHO study on PPD for urban and rural population

  15. STUDY DETAILS • Cross sectional study with simple random sampling • Study Sites: a) Karachi (urban setting) Three women and children hospital of Aga Khan Health Service, Pakistan b) Gilgit and Ghizer district in the Northern Areas (rural setting). WHO study on PPD for urban and rural population

  16. Actual sample surveyed Total: 1256 Urban: 720 Rural : 536 • Response rate Urban: 97.5% • Rural : 95.7% WHO study on PPD for urban and rural population

  17. Data collection instrument • The instrument used in the study had two sections: • General information section • Developed on the basis of log of factors identified from various studies • Edinburgh post partum depression scale WHO study on PPD for urban and rural population

  18. RESULTS

  19. WHO study on PPD for urban and rural population

  20. WHO study on PPD for urban and rural population

  21. WHO study on PPD for urban and rural population

  22. WHO study on PPD for urban and rural population

  23. ANALYTICAL FINDINGS WHO study on PPD for urban and rural population

  24. Statistical analysis • SA was done using SPSS-10.0 • Frequencies and percentages of the variables was calculated • Logistic regression analysis was performed to assess the significance of the variables by taking PPD either present or absent as a binary variable • P value of <0.05 was considered significant WHO study on PPD for urban and rural population

  25. Prevalence of depressive symptoms WHO study on PPD for urban and rural population

  26. OR=2.66 P<0.001 WHO study on PPD for urban and rural population

  27. OBSTETRIC RELATED CONTRIBUTORY FACTORS OF PPD WHO study on PPD for urban and rural population

  28. SOCIO-ENVIRONMENTAL CONTRIBUTORY FACTORS OF PPD WHO study on PPD for urban and rural population

  29. 47 % <0.001 26 % WHO study on PPD for urban and rural population

  30. 0.746 0.560 0.891 WHO study on PPD for urban and rural population

  31. Factors that were not found to be contributory in the urban and the rural population • Age of the mother (less than 20 years) • Parity • History of child death • Family structure: nuclear/extended • Education of parents • Planned or unplanned delivery • Married more than once WHO study on PPD for urban and rural population

  32. CONCLUSION • Our study has highlighted that the prevalence of PPD is: • almost similar (10.4%) to that found in the developed and many developing country setting • PPD is more prevalent in rural then in urban population • While there are many common determinants of PPD, there are also determinants which vary in urban and rural setting of Pakistan WHO study on PPD for urban and rural population

  33. CONCLUSION • A very strong association of PPD exists with the biological factor (family history of mental illness), obstetric and child growth related parameters • Our study confirms that babies born to mothers vulnerable to PPD exhibit signs of lagging on the growth parameters as early as in 4-6 weeks of baby’s age. WHO study on PPD for urban and rural population

  34. RECOMMENDATION WHO study on PPD for urban and rural population

  35. CREATE SUPPORTIVE ENVIRONMENT • More awareness programs are needed to reduce stigma attached to diagnosis of mental illness • The roles of father and mother need to be redefined from their traditional boundaries into creating a more supportive environment. • More awareness need to be created amongst the family member for extending additional social support to the new mothers. WHO study on PPD for urban and rural population

  36. DEVELOP PERSONAL SKILLS • Women and young girls need to learn to prepare themselves for different stages of life, to diagnose the condition and seek help at the right time. • Birth preparedness should be an integral component of the reproductive health strategy WHO study on PPD for urban and rural population

  37. REORIENT HEALTH SERVICES • Midwifery, Nursing, and medical education should develop capacity in skilled birth providers about diagnoses, management and counseling skills on PPD • Health care providers need to be trained to act as an enabler, mediator and advocate for implementation of policies and strategies that will support a mother suffering from PPD WHO study on PPD for urban and rural population

  38. REORIENT HEALTH SERVICES • Screening of mother for PPD should be instituted at 4-6 weeks of post natal period • Unskilled birth attendants (TBAs) should be trained in early diagnosis and referral at the right time for PPD. WHO study on PPD for urban and rural population

  39. STRENGTHEN COMMUNITY ACTION • Support groups and networks need to be established for PPD mothers from where she and her husband should be able to get the support required to deal with this condition. WHO study on PPD for urban and rural population

  40. HEALTH PUBLIC POLICY • Promote Multisectoral interventions for destigmatizing mental illness in Pakistani society • Media should be encouraged to bring about social change through challenging the traditional role of husbands in child rearing WHO study on PPD for urban and rural population

  41. FUTURE STUDIES • Assessment of prevalence of Ante-natal depression • Prospective study of babies born to PPD mother upto two years of age • Qualitative studies to understand the underlying norms of the societies related to gender preferences • Further analysis of differential impact of socio-economic status on the occurrence of PPD WHO study on PPD for urban and rural population

  42. STRENGTHS OF THE STUDY • Estimated PPD prevalence both in rural and urban areas. • Also assessed the impact of PPD on child growth parameters as early as 4 -6 weeks of age; • Wide representation of the population from various socio-economic class WHO study on PPD for urban and rural population

  43. Limitation of our study • The cases identified at risk of PPD with >12 score or equal to 12 score were not clinically evaluated to confirm the diagnosis. • It was not possible to undertake advanced statistical analysis such as multivariate analysis • Findings cannot be generalized to the entire rural population of Pakistan because of the ethnically different population living in different rural areas of Pakistan. WHO study on PPD for urban and rural population

  44. Acknowledgment • Ms. Laila Khalfan • Dr. Abid Hoosein • Mr. Rasool Bux • Mr. Intisar Siddiqui • Mr. Shamsu Rehman • Field teams and staff of AKHS, P • Board of AKHS, P WHO study on PPD for urban and rural population

  45. Thanks and Questions Please ! WHO study on PPD for urban and rural population

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