| Issue/Objective |
The birth of a small and/or sick newborn increases the risk of postpartum
depression, and these infants often require specialized care that caregivers may be inadequately prepared to provide. In 2022, Partners In Health/ Inshuti Mu Buzima (PIH/IMB) implemented a nurturing care intervention integrating nurturing care framework principles into an existing peer counselor-delivered breastfeeding support model in neonatal care units at three rural district hospitals in Rwanda. This study aimed to determine the prevalence of maternal depression and parenting confidence and to assess their association with exposure to the intervention among mothers of infants born preterm, with low birthweight, or with other neonatal conditions at six months of age. |
| Methodology/Approach |
We conducted a cross-sectional study including mothers to all children who were admitted in Neonatal Care Units (NCUs) at Kirehe, Rwinkwavu and Butaro District Hospitals (DH) in Rwanda between September 09, 2022 and February 24, 2023. Kirehe DH served as the intervention site, while Rwinkwavu and Butaro DHs served as control sites. Maternal depression and parenting confidence were measured using the Edinburgh Postnatal Depression Scale (EPDS) and Assessment of Parenting Tool (APT) respectively, on admission and at 6 months. We reported the proportion of mothers who had depression, defined as EPDS score≥12. We also reported median and IQR for total scores on the APT task-specific and APT - domain-general subscales. We used logistic regression and linear regression models to assess whether the nurturing care intervention was associated with outcomes, while controlling for possible confounding factors. |
| Results |
This study included 533 women [Intervention: 250 (46.9%) vs. 283 (53.1%) in control].
At 6 months, maternal depression was highly associated with the maternal depression score at NCU admission (p<0.001). The APT task-specific score of parenting confidence at 6 months was 49 [IQR 49-49] in the intervention and 74 [IQR 53-94] in the control (p<0.001) whereas the APT general domain-subscale median score was 51 [IQR 48-58] and 46 [IQR 43-48] in the intervention and control groups, respectively (p<0.001). Occupation, social economic status, receiving the PDC follow-up intervention, neonatal sepsis, LBW, multiple conditions, depression and parenting confidence scores at NCU admission were associated with parenting confidence at 6 months. The intervention was significantly associated with a lower APT task-specific score in both the crude (Coef: -30.77: 95% CI: -34.73, -26.81) and adjusted (Coef: -25.15, -15.79) models; and a higher score on the APT domain-general subscale in both the crude (Coef: 6.71; 95% CI: 5.92, 7.50) and adjusted (Coef: 4.93, 95% CI: 3.93, 5.93) models.
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| Discussion/Conclusion |
The nurturing care intervention is associated with increased parenting confidence. However, it was found not to be associated with maternal depression. Given that maternal depression at follow-up was highly influenced by depression score on admission and socioeconomic status, we recommend interventions to reduce maternal depression and poverty at NCU admission. |
| Presenters and Affiliations |
Yvette NKURUNZIZA York University |
