Perinatal maternal Mental Health in Ethiopia
This study seeks to find out the mechanism through which mental health affects infant health, for example through earlier cessation of breastfeeding, poorer maternal help-seeking behaviour on behalf of their infant (e.g. vaccination and treatment for illnesses) and difficulties maintaining an hygienic home environment.
The study is being carried out in ten sub-districts of Butajira, a predominantly rural area 130km south of Addis Ababa, the capital of Ethiopia.
It is using networks established by the Butajira Demographic Surveillance Site (DSS) www.butajira.org to collect information about the living circumstances, physical and mental health of mothers, before and after the birth of their children, and the health of their babies.
The Butajira DSS is a member of the INDEPTH Network www.indepth-network.org, an international network of field sites in 17 countries that collectively monitor 1,800,000 people at a household level. The sites are located in Africa and Asia and each one monitors a geographically defined population, and produces data on all births, deaths, causes of death and migration. This monitoring system provides a platform for the design and evaluation of a wide range of health care innovations as well as research studies, helping developing countries set health priorities and policies.
Infant under-nutrition and mortality are major public health issues in rural Ethiopia. Around one in ten children die before they reach their first birthday and 50% of children under the age of five years of age are chronically under-nourished. Mental disorder in the mother has recently been shown to be strongly associated with infant under-nutrition and impaired development in South Asia, but has not been investigated in settings where infant survival is more precarious, such as in Ethiopia.
The results of the study will guide rational resource allocation in settings where resources are scarce. If maternal mental health is found to be important, the results can be used to improve awareness of mental health issues and lobby for mental health interventions to be included as part of national health strategies.
1,066 women were recruited during the third trimester of their pregnancy and interviewed about their physical and mental health and household circumstances. As far as possible, standard measures have been used, adapted for the local conditions and translated into Amharic, the official language of Ethiopia. Most women do not access formal healthcare facilities for the birth and so the research team also undertook collection of birth weights in the field. The mothers and their infants are subsequently being followed up with more interviews and further baby measurements.
The Department of Psychiatry and Community Health in the Faculty of Medicine at the University of Addis Ababa and the Section of Epidemiology in the Health Service and Population Research Department at the IoP are research collaborators. The principal investigator at the IoP is Professor Martin Prince; the principal investigator in Addis Ababa is Dr Atalay Alem. The co-investigators, Girmay Medhin and Dr Charlotte Hanlon.
A succesful funding application was made to extend the project until the children are three years old, making the study the first to look at the longer term effects of perinatal maternal mental disorder upon child health, growth, development and survival in a low-income setting.