Hashima E Nasreen

Intimate partner violence and its association with maternal depressive symptoms 6-8 months after childbirth in rural Bangladesh

Background The prevalence of intimate partner violence (IPV), a gross violation of human rights, ranges widely across the world with higher prevalence reported in low- and middle-income countries. Evidence related mainly to physical health shows that IPV has both direct and indirect impacts on womens health. Little is known about the impact of IPV on the mental health of women, particularly after childbirth. Objective To describe the prevalence of IPV experienced by women 6–8 months after childbirth in rural Bangladesh and the factors associated with physical IPV. The study also aims to investigate the association between IPV and maternal depressive symptoms after childbirth. Design The study used cross-sectional data at 6–8 months postpartum. The sample included 660 mothers of newborn children. IPV was assessed by physical, emotional, and sexual violence. The Edinburgh Postnatal Depression Scale assessed maternal depressive symptoms. Results Prevalence of physical IPV was 52%, sexual 65%, and emotional 84%. The husbands education (OR: 0.41, CI: 0.23–0.73), a poor relationship with the husband (OR: 2.64, CI: 1.07–6.54), and emotional violence by spouse (OR: 1.58, CI: 1.35–1.83) were significantly associated with physical IPV experienced by women. The perception of a fussy and difficult child (OR: 1.05, CI: 1.02–1.08), a poor relationship with the husband (OR: 4.95, CI: 2.55–9.62), and the experience of physical IPV (OR: 2.83, CI: 1.72–4.64) were found to be significant predictors of maternal depressive symptoms among women 6–8 months after childbirth. Neither forced sex nor emotional violence by an intimate partner was found to be significantly associated with maternal depressive symptoms 6–8 months postpartum. Conclusions It is important to screen for both IPV and depressive symptoms during pregnancy and postpartum. Since IPV and spousal relationships are the most important predictors of maternal depressive symptoms in this study, couple-focused interventions at the community level are suggested.Background The prevalence of intimate partner violence (IPV), a gross violation of human rights, ranges widely across the world with higher prevalence reported in low- and middle-income countries. Evidence related mainly to physical health shows that IPV has both direct and indirect impacts on womens health. Little is known about the impact of IPV on the mental health of women, particularly after childbirth. Objective To describe the prevalence of IPV experienced by women 6-8 months after childbirth in rural Bangladesh and the factors associated with physical IPV. The study also aims to investigate the association between IPV and maternal depressive symptoms after childbirth. Design The study used cross-sectional data at 6-8 months postpartum. The sample included 660 mothers of newborn children. IPV was assessed by physical, emotional, and sexual violence. The Edinburgh Postnatal Depression Scale assessed maternal depressive symptoms. Results Prevalence of physical IPV was 52%, sexual 65%, and emotional 84%. The husbands education (OR: 0.41, CI: 0.23-0.73), a poor relationship with the husband (OR: 2.64, CI: 1.07-6.54), and emotional violence by spouse (OR: 1.58, CI: 1.35-1.83) were significantly associated with physical IPV experienced by women. The perception of a fussy and difficult child (OR: 1.05, CI: 1.02-1.08), a poor relationship with the husband (OR: 4.95, CI: 2.55-9.62), and the experience of physical IPV (OR: 2.83, CI: 1.72-4.64) were found to be significant predictors of maternal depressive symptoms among women 6-8 months after childbirth. Neither forced sex nor emotional violence by an intimate partner was found to be significantly associated with maternal depressive symptoms 6-8 months postpartum. Conclusions It is important to screen for both IPV and depressive symptoms during pregnancy and postpartum. Since IPV and spousal relationships are the most important predictors of maternal depressive symptoms in this study, couple-focused interventions at the community level are suggested.

“I can't stop worrying about everything”—Experiences of rural Bangladeshi women during the first postpartum months

Over recent years, researchers have found evidence which indicates that the prevalence of postpartum depressive symptoms crosses cultural boundaries and is reported to be at least as high in non-Western countries as in Western countries. However, qualitative studies about new mothers’ experiences from non-Western countries, such as Bangladesh, are rare, particularly in rural areas. This study aims to describe the experiences and concerns of rural Bangladeshi mothers with postpartum depressive symptoms. Open narrative interviews were conducted with 21 mothers with depressive symptoms 2–3 months postpartum, consecutively selected from a longitudinal study about prevalence and risk factors of perinatal depressive symptoms. Inductive content analysis was used to analyse data and three themes emerged: family dynamics, living at the limits of survival, and role of the cultural context after childbirth. These themes were based on six categories and 15 subcategories. The findings show that troublesome family relationships, including intimate partner violence and violence in the family, influenced the mothers’ mental well-being. They and their families lived at the limit of survival and the mothers expressed fear and worries about their insecure situation regarding economic difficulties and health problems. They felt sorry for being unable to give their infants a good start in life and sad because they could not always follow the traditional norms related to childbirth. Thus, it is important to focus on the depressive symptoms among new mothers and offer counselling to those showing depressive symptoms, as the cultural traditions do not always alleviate these symptoms in the changing Bangladeshi society today.

Pesticide Exposure and Cardiovascular Hemodynamic Parameters Among Male Workers Involved in Mosquito Control in East Coast of Malaysia

BACKGROUND Research findings have linked exposure to pesticides to an increased risk of cardiovascular (CVS) diseases. Therefore, this study aimed to assess the impact of chronic mix-pesticides exposure on CVS hemodynamic parameters. METHODS A total of 198 male Malay pesticide-exposed and 195 male Malay nonexposed workers were examined. Data were collected through exposure-matrix assessment, questionnaire, blood analyses, and CVS assessment. Explanatory variables comprised of lipid profiles, paraoxonase 1 (PON1), and oxidized low-density lipoprotein (ox-LDL). Outcome measures comprised of brachial and aortic diastolic blood pressure (DBP) and systolic BP (SBP), heart rate, and pulse wave velocity (PWV). Linear regressions identified the B coefficient showing how many units of CVS parameters are associated with each unit of covariates. RESULTS Diazoxonase was significantly lower and ox-LDL was higher among pesticide-exposed workers than the comparison group. The final multivariate linear regression model revealed that age, body mass index (BMI), smoking, and pesticide exposure were independent predictors of brachial and aortic DBP and SBP. Pesticide exposure was also associated with heart rate, but not with PWV. Lipid profiles, PON1 enzymes, and ox-LDL showed no association with any of the CVS parameters. CONCLUSIONS Chronic mix-pesticide exposure among workers involved in mosquito control has possible association with depression of diazoxonase and the increase in ox-LDL, brachial and aortic DBP and SBP, and heart rate. This study raises concerns that those using pesticides may be exposed to hitherto unrecognized CVS risks among others. If this is confirmed by further studies, greater efforts will be needed to protect these workers.

Prevalence and determinants of antepartum depressive and anxiety symptoms in expectant mothers and fathers: results from a perinatal psychiatric morbidity cohort study in the east and west coasts of Malaysia

BackgroundResearch on antepartum psychiatric morbidities investigating depressive and anxiety symptoms in expectant mothers and fathers is lacking in low- and middle-income countries. This study aimed to estimate the prevalence of antepartum depressive, anxiety and co-occurring significant symptoms and explore the associated factors in a cross-section of Malaysian expectant mothers and fathers.MethodsWe used cross-sectional data from a prospective cohort study of 911 expectant mothers and 587 expectant fathers during their third trimester of pregnancy, from health clinics of two states in the east and west coasts of Malaysia. The validated Malay version of Edinburgh Postnatal Depression Scale and the anxiety sub-scale of Depression, Anxiety and Stress Scale were used to measure the depressive and anxiety symptoms. Multiple logistic regression analyses identified the determinants of antepartum depressive and anxiety symptoms (ADS and AAS).ResultsPrevalence of ADS was 12.2% in expectant mothers and 8.4% in expectant fathers, while AAS was 28.8% in expectant mothers and 13.3% in expectant fathers, and co-occurring significant symptoms was 8.0% in expectant mothers and 4.0% in expectant fathers. Expectant mothers and fathers having perceived social/family support were less likely to suffer from ADS. Intimate partner violence, poor relationship with husbands, depression in earlier pregnancy and husband’s depression in current pregnancy in expectant mothers, and living in rented house, sex preference for the unborn child, stressful life events and wife’s depression in current pregnancy in expectant fathers were associated with a greater likelihood of ADS. The determinants for AAS were living in rented house and with parents/in-laws, poor relationship with husbands, restrictions during pregnancy and stressful life events for expectant mothers, and stressful life events and being unsupportive towards wives in household chores for expectant fathers.ConclusionBoth ADS and AAS are prevalent in expectant mothers and fathers, and largely an undetected problem in Malaysia. Administration of couple-based screening and referral program during antenatal check-up should be universal practices to identify and treat the psychiatric morbidities.