Psychological distress among mothers of young children in rural Ghana and Uganda and its association with child health and nutritional status

Abstract

Depression and anxiety, the most common mental disorders (CMD), are highly prevalent among women of childbearing age, but are even higher among mothers in low- and middle-income countries (LMIC), possibly due to mothers' disproportionate exposure to multiple risk factors, such as poverty, gender disparities and violence, and a high prevalence of medical illness. The extra burden imposed by maternal CMD in LMIC can be nothing short of catastrophic, affecting infant and child growth and leading to preventable illness and death among children. One possible mechanism, by which maternal CMD lead to compromised child development, is through negatively affecting mothers' health-promoting behaviors (e.g., contraceptive use, participation in antenatal care) and child-care practices (e.g., vaccination uptake, cessation of breastfeeding, sanitation practices). The aim of this study was three-fold. First, to assess psychological distress among mothers of young children (aged 0-5 years) as measured by the Kessler 6 (K6), a brief screening instrument for nonspecific psychological distress in Ghana and Uganda. Second, to identify sociodemographic, socioeconomic, obstetric, and psychosocial correlates of maternal psychological distress in Ghana and Uganda. Third, to explore the relationship between maternal psychological distress, child health-promoting practices, and child health outcomes and nutritional status. The study utilized cross-sectional baseline data from the Millennium Villages Project. One hundred mothers in Ghana and 100 in Uganda who had at least one child up to 5 years at the time of baseline collection participated in the study. Results provided evidence for the adequate reliability and validity of the K6 in our study. Several correlates of maternal distress were identified in the study, some of which were common for both sites, while others where site-specific. Maternal distress was associated with maternal sanitation practices in Uganda. An exploratory analysis revealed a significant relationship between maternal distress and risk for child undernutrition. These findings offer partial support for the relationship between maternal psychological distress and poor child health outcomes. Discussion of the study findings focuses on the social roots of maternal distress in SSA. The clinical implications of the study and recommendations for future research are discussed