Risk factors and experiences of prepartum depression among pregnant women in urban- low income in Nairobi Kenya: a mixed-method study

Background: Prepartum depression is common among pregnant women and has not been studied much in low and middle-income countries. Evidence shows that mental illnesses are more prevalent in urban than in rural areas. The study objective was to determine the magnitude of prepartum depression, risk factors, and real-life experiences of depression among pregnant women. Method: A mixed-method cross-sectional study was conducted. It included 262 pregnant women attending antenatal clinics in two public health facilities in the urban low-income settlement of Nairobi, Kenya. Edinburgh Postnatal Depression Scale (EPDS) with cut-off >13 was used to classify clinical depressive illness. Further, a focus group discussion was conducted with 20 women identified with the depression. Bivariate analysis with Odd's Ratio was used to test associations. Variables with a p<0.05 in multivariate were considered significant. Result: Out of the 262 women, 33.6% were found to have prepartum depression as indicated by an EPDS score of >13. Women's gestational age in the second trimester (87.5%) was statistically significantly associated with prepartum depression (p<0.001). Income levels <10,000 KES (58%) were statistically significantly associated with prepartum depression (p<0.001). Further, thematic analysis of qualitative data indicated that poverty, lack of social support, domestic violence, and unfriendly health care were major contributors to prepartum depression. Conclusion: Significant numbers of pregnant women were found to experience depression. This prevalence rate indicates a high disease burden of women who live with depression, which is not diagnosed because screening of depression is not done in primary health care centers. This study calls for a need and consideration for screening for perinatal depression in primary health care facilities, mainly in resource-poor areas. Interventions targeting means of resolving conflicts in families are highly needed. Such steps would help achieve key sustainable development goals where maternal and child health remains a key priority.