Perinatal death triples the prevalence of postpartum depression among women in Northern Uganda: A community-based cross-sectional study.

INTRODUCTION: Deaths during the perinatal period remain a big challenge in Africa, with 38 deaths per 1000 pregnancies in Uganda. The consequences of these deaths can be detrimental to the women; some ending up with postpartum depression. We examined the association between perinatal death and postpartum depression among women in Lira district, Northern Uganda. METHODS: We conducted a community-based cross-sectional study of 1,789 women. Trained research assistants screened women for postpartum depressive symptoms on day 50 postpartum using the Edinburgh postpartum depression scale (EPDS). Socio-demographic, economic, birth and survival status of the neonate were collected during pregnancy and within one week postpartum. We used generalized estimating equation for the Poisson family with a log link using Stata to estimate the prevalence ratio of the association between postpartum depressive symptoms (EPDS scores ≥14) and perinatal death. Mothers who lost their babies between 7-49 days postpartum were excluded. RESULTS: Of the 1,789 participants symptomatically screened for postpartum depression, 377 (21.1%) [95% confidence interval (95%CI): 17.2%, 23.0%] had probable depressive symptoms. The prevalence of postpartum depressive symptoms among the 77 women who had experienced perinatal death (37 stillbirths and 40 early neonatal deaths (≤7 days of life)) was 62.3% [95% CI: 50.8%, 72.6%] compared to 19.2% [95% CI: 17.4%, 21.2%], among 1,712 with live infants at day 50 postpartum. Women who had experienced a perinatal death were three times as likely to have postpartum depressive symptoms as those who had a live birth [adjusted prevalence ratio 3.45 (95% CI: 2.67, 4.48)]. CONCLUSIONS: The prevalence of postpartum depressive symptoms, assessed by EPDS, was high among women who had had a perinatal death in Northern Uganda. Women experiencing a perinatal death need to be screened for postpartum depressive symptoms in order to intervene and reduce associated morbidity.

The Effect of Health Worker Training on Early Initiation of Breastfeeding in South Sudan: A Hospital-based before and after Study.

Globally, suboptimal breastfeeding contributes to more than 800,000 child deaths annually. In South Sudan, few women breastfeed early. We assessed the effect of a Baby-Friendly Hospital Initiative training on early initiation of breastfeeding at Juba Teaching Hospital in South Sudan. We carried out the training for health workers after a baseline survey. We recruited 806 mothers both before and four to six months after training. We used a modified Poisson model to assess the effect of training. The prevalence of early initiation of breastfeeding increased from 48% (388/806) before to 91% (732/806) after training. Similarly, early initiation of breastfeeding increased from 3% (3/97) before to 60% (12/20) after training among women who delivered by caesarean section. About 8% (67/806) of mothers discarded colostrum before compared to 3% (24/806) after training. Further, 17% (134/806) of mothers used pre-lacteal feeds before compared to only 2% (15/806) after training. Regardless of the mode of birth, the intervention was effective in increasing early initiation of breastfeeding [adjusted prevalence ratio (APR) 1.69, 95% confidence interval CI (1.57-1.82)]. These findings suggest an urgent need to roll out the training to other hospitals in South Sudan. This will result in improved breastfeeding practices, maternal, and infant health.

Determinants of Health Facility Utilization at Birth in South Sudan.

South Sudan has a high maternal mortality ratio estimated at 800 deaths per 100,000 live births. Birth in health facilities with skilled attendants can lower this mortality. In this cross-sectional study, we determined the level and determinants of health facility utilization and skilled birth attendance in Jubek State, South Sudan. Mothers of children aged less than two years were interviewed in their homes. Multivariable regression analysis was performed to determine factors associated with health facility births. Only a quarter of the mothers had given birth at health facilities, 209/810 (25.8%; 95% CI 18.2-35.3) and 207/810 had a skilled birth attendant (defined as either nurse, midwife, clinical officer, or doctor). Factors positively associated with health facility births were four or more antenatal visits (adjusted odds ratio (AOR) 19; 95% CI 6.2, 61), secondary or higher education (AOR 7.9; 95% CI 3, 21), high socio-economic status (AOR 4.5; 95% CI 2.2, 9.4), and being primipara (AOR 2.9; 95% CI 1.5, 5.4). These findings highlight the need for efforts to increase health facility births in South Sudan.

Key Decision Makers and Actors in Selected Newborn Care Practices: A Community-Based Survey in Northern Uganda.

Knowledge of key decision makers and actors in newborn care is necessary to ensure that health interventions are targeted at the right people. This was a cross-sectional study carried out in Lira district, Northern Uganda. Multivariable logistic regression was used to determine factors associated with mothers being the key decision maker regarding where to give birth from and when to initiate breastfeeding. Fathers were the key decision makers on the place of birth (54.3%, n = 505) and on whether to seek care for a sick newborn child (47.7%, n = 92). Grandmothers most commonly bathed the baby immediately after birth (55.5%, n = 516), whereas mothers and health workers were common decision makers regarding breastfeeding initiation. Predictors for a mother being the key decision maker on the place of birth included: Mother having a secondary education (AOR 1.9: 95% C.I (1.0-3.6)) and mother being formally employed (AOR 2.0: 95% (1.5-2.9)). Mothers, fathers, grandmothers, health-workers, and traditional birth attendants were the most influential in the selected newborn care practices. Programs that aim to promote newborn care need to involve husbands, grandmothers, and health workers in addition to mothers.

Prevalence and determinants of pre-lacteal feeding in South Sudan: a community-based survey.

BACKGROUND: Pre-lacteal feeding (PLF) is a barrier to optimal breastfeeding and increases the risk of diarrhoea and acute respiratory tract infections in infants.The prevalence and predictors of PLF are not well studied in South Sudan. Understanding the predictors of PLF is crucial in designing interventions to increase exclusive breastfeeding (EBF) rates. OBJECTIVE: To assess the prevalence and factors associated with PLF in Jubek State, South Sudan. METHOD: This was a community based cross-sectional study of 810 mothers of children under two years of age in Jubek State, South Sudan. Mothers were interviewed in their homes using a semi-structured questionnaire to collect data on PLF, socio-demographic and birth characteristics. Multivariable analysis was used to identify factors independently associated with PLF. RESULTS: A total of 426/810 (53 %), 95% confidence interval (CI) [48 %, 59 %] mothers had given pre-lacteal feeds to their infants. The commonest pre-lacteal feeds included glucose solution (54%), water (26%), and infant formula (14%). Having received antenatal breastfeeding counselling decreased the odds of PLF [adjusted odds ratio (AOR) 0.60; 95% CI (0.43, 0.82)]; while discarding of colostrum increased the use of pre-lacteal feeds [AOR 1.57; 95% CI (1.17, 2.11)]. CONCLUSION: The prevalence of PLF in South Sudan is high. Predictors of PLF included lack of breastfeeding counselling and discarding of colostrum. Infant feeding counselling should be given to all pregnant women in the health facilities and communities. The counselling should emphasize the health benefits of colostrum and discourage the practice of discarding it.

Factors associated with delayed initiation of breastfeeding: a survey in Northern Uganda.

BACKGROUND: Initiation of breastfeeding later than 1 hour after birth is associated with increased neonatal morbidity and mortality. OBJECTIVE: To determine the prevalence and factors associated with delayed initiation of breastfeeding. METHODS: We conducted a survey in 2016 of 930 children under the age of 2 years in Lira district, northern Uganda. Mothers of the children were interviewed and data was collected on mobile phones using Open Data Kit software ( https://opendatakit.org ). Multivariable logistic regression was used to determine factors associated with delayed initiation of breastfeeding. RESULTS: Almost half [48.2%, 95% confidence interval (CI) (44.3-52.1)] of the mothers delayed initiation of breastfeeding. Factors significantly associated with delayed initiation of breastfeeding in multivariable analysis included caesarean delivery [Adjusted Odds Ratio (AOR) 11.10 95% CI (3.73-33.04)], discarding initial breast milk [AOR 2.02 95% CI (1.41-2.88)], home delivery [AOR 1.43 95% CI (1.04-1.97)] and mother being responsible for initiating breastfeeding as compared to a health worker or relative [AOR 1.73 95% CI (1.33-2.26)]. Mothers having a secondary education were less likely [AOR 0.54 95% CI (0.30-0.96)] to delay initiation of breastfeeding as compared to those with no education. CONCLUSION: About half the mothers delayed initiation of breastfeeding until after 1 hour after birth. Programs to promote, protect and support breastfeeding in this post conflict region are urgently needed.