Association between the continuum of care and postpartum depression among Angolan mothers.

Background: This study investigated the association between maternal and child health service utilization patterns and postpartum depression (PPD).

Methods: This study analyzed a dataset of women who participated in a randomized controlled trial to examine the effectiveness of the Maternal and Child Health Handbook in Angola. We defined probable PPD as an Edinburgh Postpartum Depression Scale (EPDS) score ≥ 10. The EPDS was administered at approximately 6 months postpartum. Service utilization patterns were defined using numbers of antenatal care (ANC), facility delivery, and vaccination visits by 6 months postpartum. The association between service utilization patterns and PPD was examined using logistic regression analyses adjusting for socioeconomic factors and parity. The continuum of care (CoC) complete pattern (four ANC/facility delivery/four vaccination) was used as a reference.

Results: The data of 7087 participants whose children were alive and aged 6 months or older at the endline survey were analyzed. Prevalence of PPD was 17.9 % in urban and 43.2 % in rural municipalities. In urban municipalities, dropouts from the CoC at delivery and after delivery had significantly higher odds of PPD (AOR = 1.45, 95 % CI = 1.00-2.10; AOR = 1.57, 95 % CI = 1.24-1.99). In rural municipalities, dropouts from the CoC after delivery (AOR = 1.60, 95 % CI = 1.12-2.28) had significantly higher odds of PPD.

Limitations: The onset of depressive symptoms was not assessed. The EPDS was validated in some Portuguese speaking countries but not in Angola.

Conclusion: PPD was associated with irregular service utilization patterns such as dropouts from the CoC. Therefore, CoC and mental health must be promoted simultaneously.