Abstract:
Background: Postnatal depression (PND) is associated with adverse infant neurodevelopmental outcomes. Evidence is
limited on how PND influences neonatal (<28 days old) outcomes in low- and middle-income countries, such as Kenya,
which bear the global burden of neonatal morbidity and mortality.
Objectives: To explore how PND influences neonatal feeding and care practices among women in the early postnatal
period in rural Western Kenya.
Design: A cross-sectional study.
Methods: Semi-structured interviews were conducted at 2-weeks postpartum among mothers of newborn infants
identified <72 h old from the postnatal wards and clinics across five health facilities in Kisumu County of Western Kenya.
They were all screened for features suggestive of postnatal depression using the Edinburgh Postnatal Depression Scale.
Results: Twenty-four mothers were interviewed, 13 of whom had features suggestive of PND. All mothers experienced
health or socio-economic adversities in the perinatal period, including traumatic deliveries, financial constraints, and
challenging relationships with partners/other family members. Feeding difficulties due to perceived insufficient breastmilk
were a particular challenge for mothers with features of PND, who were more likely to introduce complementary feeds.
Maternal health-seeking decisions were influenced by high financial cost, long waiting times and poor interactions with
health care providers that induced stress and fear among mothers. Maternal caregiving capacity was influenced by her
ability to juggle other household duties, which was difficult for mothers with features suggestive of PND. Support from
friends and relatives positively impacted maternal mood and caregiving ability.
Conclusion: Mothers experienced many stress-inducing events in the perinatal period which potentially exacerbated
features of PND in the immediate postnatal period. Women with features of PND were particularly vulnerable to
these stressors that influenced infant caregiving practices. Addressing the socio-economic challenges and health system
gaps that include scale up of compassionate and respectful care for women during pregnancy and childbirth, as well as
early screening and intervention of PND, through enhanced referral pathways between health facilities and community
support structures, could mitigate against the impact of PND on neonatal caregiving.
