Abstract

Background: Postnatal Depression (PND) is a serious mood disorder that steals motherhood after delivery and affects the health and development of a newborn. While its impact on motherhood and newborn in developed countries is well described its epidemiology and consequences on infant health in Middle and Low Income countries is not well known and it is for this reason that we intended to conduct this review.

Methods:  We searched for observational studies written in English language and conducted in middle and low income countries through December 1^st, 2007 to December 31^st, 2017. CINHAL, MEDLINE, Emcare, PubMed, Psych Info and Scopus Data bases were searched for the following search terms: Postnatal depression, acute respiratory infection, pneumonia, diarrhea, exclusive breast feeding, common infant illnesses, and malnutrition. We excluded studies in which the main outcomes were not measured following a standardized approach. We have meta-analyzed the estimates from primary studies by correcting the pooled estimates for possible publication bias and heterogeneity following Egger’s and Higgins test, respectively. All analysis were conducted in STATA 14. The study protocol was registered in PROSPERO with protocol number CRD42017082624.

Result: Fifty-eight studies on PND prevalence (among 63,293 women) and 17 studies (among 32,454 infants) on infant health outcomes were included. PND prevalence was higher in the low income countries (Pooled prevalence (PP) = 25.8%; 95%CI: 17.9% – 33.8%) than in the middle income countries (PP= 20.8%; 95%CI: 18.4% – 23.1%) and reached pick in five to ten weeks after birth. Bad obstetric history, poor social support, low economic and educational status of the mother, and exposure to any form of violence were associated with an increased risk of PND. The risk of having adverse infant health outcomes was 31% higher among depressed postnatal mothers (Pooled relative risk (PRR) = 1.31; 95%CI: 1.17-1.48).  Malnutrition (1.39; 1.21 – 1.61), non-exclusive breast feeding (1.55; 1.39 – 1.74), and common infant illnesses (2.55; 1.41 – 4.61) were the main types of adverse infant health outcomes observed in infants of depressed postnatal mothers relative to postnatal mothers without depression.

Interpretation:  One in four and one in five postnatal mothers were depressed in low and middle income countries, respectively and its cause could be explained by different social, maternal and psychological constructs. High risk of adverse infant health outcomes are associated with PND. Timely screening of new mothers for PND and evidence based interventions is a pressing need for postnatal mothers of low and middle income countries.

Key words: Postnatal depression, adverse infant health outcomes, systematic review, Meta-analysis, Low and Middle-income countries.