Common Perinatal Mental Disorders in Rwanda: A Challenge for Nursing Education and Practice

Umuziga, Providence M.

Purpose: Common perinatal mental disorders (CPMDs) in women (depression and anxiety) are recognized as a significant public health concern globally but often undiagnosed and thus untreated (WHO, 2008; Rahaman, Fisher, Bower & et al. 2013). Because of elevated risk factors, in African countries CPMDs may be more prevalent and occur in over 20% of new mothers (Sawyer, Ayers & Smith, 2010). However, Clarke, King and Prost (2013) demonstrated that CPMDs can be reduced in mothers in low and middle income countries (LMICs) through the simple provision of health promotion interventions. Our study was aimed at determining the occurrence and factors of CPMDs in a selected district hospital of Eastern Province/Rwanda. Therefore, the presentation will be describing the occurrence and factors of CPMDs in Rwanda, the implications or challenges that may pose to nursing research, education and practice.

Methods: A descriptive quantitative cross-sectional survey was conducted with a systematically selected sample of 165 mothers, all in the perinatal period (in the 2^nd trimester of pregnancy up to first year postnatally). Demographic data and factors associated with CPMDs were determined using a structured questionnaire. Screening tools included the Zungu Self-rating anxiety scale (SAS) and the Edinburgh Postnatal Depression Scale (EPDS). The Cronbach alpha values were 0.87 and 0.89 for SAS and EPDS respectively.

Results: More than a third of respondents (38.2%) were aged 25-29 years and almost half were married (44.8%). Most were unemployed (77%) and had only primary education (60.6%). Approximately 37% of the respondents had perinatal anxiety (PNA; SAS > 45) while 50.3% had possible perinatal depression (PND; EPDS ≥ 10). In logistic regression, a poor relationship with husband/partner was the only predictor of PNA (Odd Ratio= 0.44, C.I. = 0.211-0.905). A logistic regression of determinants of PND found a young age (Odds Ratio: 131.97, C.I. = .003-.261), having four or more children (Odds Ratio = .028, C.I. = .003-.261), and a poor relationship with one’s partner predicted PND (Odds Ratio: .089, C.I. = .030-.266).

Conclusion: The study found that CPMDs are prevalent and predicted by social factors. A poor relationship with husband and young age were found to be the strongest determinants of CPMDs suggesting that social and health promotion interventions may be the most successful strategy to prevent the onset of CPMDs.

This study further points to a number of challenges that will need to be addressed in the areas of research, education and practice. With the study, questions can be asked if these pose further challenges to nurses, and if so what are the challenges? Are nurses aware of this issue? Is there any attention put to the assessment of CPMD in the undergraduate curriculum? Are the nurses prepared to handle this problem in their practice?