Estelle Sidze’s research while affiliated with African Population and Health Research Center and other places

Background Despite a growing body of evidence on maternal mental health in Africa, significant gaps remain in understanding its overall landscape, risk factors/determinants, immediate and long-term effects, accessibility to healthcare and services, and availability of practicable/effective interventions. This paper provides a thorough review of both peer-reviewed and grey literature and makes key recommendations and directions for future research and development. Methods We systematically reviewed extant evidence using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Peer-reviewed studies published in English between 2010, and June 2024 were included based on a priori criteria. The National Institutes of Health (NIH) and Critical Appraisal Skill Program (CASP) quality assessment tools were used to critically appraise the reliability, validity and overall quality of included articles. A qualitative narrative synthesis was perfomed to summarize the findings effectively. Results A total of 206 full-text articles evaluated for eligibility and inclusion in the systematic review, predominantly observational studies with a minority employing randomized controlled trial (RCT) designs, were included, with 70%, 22%, and 8% of the articles rated as good, fair, and poor quality, respectively. Women in Africa experience a wide range of common perinatal mental disorders, including major depressive disorders and psychosis, either discretely or comorbid. Socioeconomic disadvantages and other intertwined poverty-related factors at the individual, family, social, and environmental levels are implicated in maternal mental health disorders. Currently, there is insufficient evidence regarding the short- and long-term health, development, and social impacts of maternal mental health. Addtionally, there is limited knowledge about the availability and accessibility of mental healthcare, evidence-based context-specific interventions, and healthcare-seeking behaviors of women in Africa, as well as their access to and utilization of mental health services. Conclusion The evidence base on maternal mental health in Africa suffers from considerable variability, inconsistency, and equivocal findings resulting from heterogeneity across the studies. This restricts generalizability and the ability to draw valid conclusions. Published studies also likely underestimate the scale and health impacts of perinatal mental disorders. Evidence from these studies are rarely used to inform policies and programs. The maternal mental health ecosystem in Africa needs to be better understood. More rigorous study designs should be implemented to focus on evidence generation and the evaluation of interventions, alongside robust integration of mental health services within health systems. Policy initiatives aimed at reducing socioeconomic disparities in maternal, newborn, and child health, particularly concerning maternal mental health, must be supported by these studies. Article Highlights • Women across Africa suffer from various mental health problems, including major depressive disorders, anxiety, and psychosis, occurring separately or in combination. • The evidence base on maternal mental health in Africa displays significant variability, inconsistency, and ambiguous findings, largely attributed to study heterogeneity. • Factors at the individual, familial, societal, and environmental levels contribute to poverty-related issues that can lead to or worsen maternal mental health disorders. • Current evidence has not been synthesized to improve our understanding of the short- and long-term health impacts, developmental consequences, and social implications of maternal mental health conditions, as well as the healthcare-seeking behaviors and access to mental health services. • Insufficient policy prioritization and funding for maternal mental health in Africa hinder the development, evaluation, and sustainability of interventions. • There is an urgent need to integrate mental health services into primary healthcare, particularly in resource-limited settings across Africa. This integration should be guided by evidence from rigorous research that uses longitudinal designs. It is also essential to emphasize the importance of investing in digital and community-based approaches to improve the accessibility to mental health services.

Acute malnutrition, defined as a weight-for-height Z-score below -2 standard deviations of the WHO growth standards, is prevalent among children in low- and middle-income countries. Our study aimed to identify immediate, underlying, and basic determinants of acute malnutrition among children in Turkana and Samburu, two arid and semi-arid regions in Kenya. Data are from a longitudinal study that recruited children under 3 years of age, with follow-up every 4 months over six waves. Generalized estimating equations were used to assess risk factors of acute malnutrition in this population. Among immediate factors, children who recently experienced diarrhea had 19% and 23% higher odds of acute malnutrition and those who consumed animal-source foods had 12% and 22% lower odds of acute malnutrition in Turkana and Samburu, respectively. Among underlying factors, children in Turkana whose caregivers used alcohol had 32% higher odds of acute malnutrition. Among basic factors, children in Turkana whose caregivers had 3-5 or 6 or more children had 39% and 70% higher odds, whereas those in female-headed households had 34% and 81% higher odds of acute malnutrition in Turkana and Samburu, respectively. Children in Turkana fisherfolk communities had 36% higher odds of acute malnutrition compared with those in urban or peri-urban areas. Key risk factors for acute malnutrition included child diarrhea, caregivers use of alcohol (in Turkana), caregivers number of children, female-headed households, and fisherfolk livelihood (in Turkana), while consuming animal-source foods was associated with lower risk. Interventions should target these intersecting factors to reduce acute malnutrition in these counties.

Background In low- and middle-income countries (LMICs), maternal mental health (MMH) during and after pregnancy is often neglected despite ongoing global efforts to reduce maternal mortality and morbidity. The complex nature of MMH problems and their stigmatization require a thorough understanding from the perspective of the different parties involved. Hence, we assessed the drivers of MMH problems, challenges in seeking help, and perceptions towards emotional and psychological support for pregnant women among four stakeholder groups in Western Kenya. Methodology A qualitative approach was taken to examine the perspectives towards MMH among mothers, fathers, nurses and community health workers (CHWs). Focus Group Discussions (FGDs) were organized among the four groups. Participants were drawn from three hospitals in Kisumu County, Western Kenya. The socio-ecological model for health behavior structured the analyses, with an initial deductive approach. The identification of specific themes within each level was conducted inductively. Additionally, suggestions for locally acceptable MMH care were collected. Results In total, ten FGDs were held with 73 participants. We found a large level of consensus among stakeholders regarding common causes, consequences and coping strategies for MMH challenges, such as poverty, stigma, intimate partner violence and a lack of social support. In contrast to mothers, fathers also highlighted domestic disputes stemming from disagreements over (resuming) sexual activity. Nurses predominantly mentioned medical consequences of MMH challenges, while CHWs had a more holistic perspective. Participants expressed a need and made recommendations for contextualized MMH care, particularly for a group-based intervention led by CHWs with partner involvement. Conclusions The findings show that there is a need for MMH support in rural, low-resource settings. Mothers and CHWs showed a high level of convergence illustrating the importance of the liaison function of the CHWs between the nurses and mothers. Group-based MMH care was perceived as suitable by all stakeholders. The results of this study guided the design of an MMH intervention that was tested for feasibility and acceptability in the same setting.

Background: The progressive increase in maternal health (MH) coverage observed in Cameroon over the past decades has not been accompanied by a satisfactory reduction in maternal mortality. In this study, we analysed inequalities in service contact, intervention care and quality-adjusted coverage of maternal healthcare continuum in order to assess the capacity of the health system to provide comprehensive and equitable care. Methods: We combined data from the 2018 Cameroon Demographic and Health Survey and the 2015 Emergency Obstetric and Neonatal Care Evaluation Survey of Health Facilities to estimate the quality-adjusted coverage of antenatal care and intra- and postpartum care. Inequalities were assessed using absolute and relative inequality measures. Results: Contact coverage for antenatal care services was 86.3% (95% CI: 85.4-87.1), but only 14.4% (95% CI: 13.7-15.1) of women had the opportunity to receive comprehensive antenatal care of optimal quality. Similarly, contact coverage for intra- and postpartum care was 68.5% (95% CI: 67.3-69.6), but only 31.4% (95% CI: 19.6-26.4) of women had the opportunity to receive optimal quality intra- and postpartum care. The missed opportunity for health benefits was greater for intra- and postpartum care than for antenatal care (20.0% vs. 10.9%). There are large inequalities in the quality-adjusted coverage of the continuum of maternal healthcare by region, place of residence, religion, level of education and wealth quintile index. Relative inequalities are accentuated when the quality of MH services is taken into account. Although all categories of women are affected by the loss of opportunities for health benefits, it is the most advantaged socioeconomic groups who are most affected. Conclusion: Our results highlight the importance of using effective coverage indicators specific to maternal health care, and of combining measures of relative and absolute inequalities to establish priorities and propose recommendations to policy-makers adapted to the context of low- and middle-income countries.

Introduction Background: Maternal mental health is increasingly becoming a public health concern in developing countries because of predominant health and socio-economic inequalities. Mental well-being is essential for a woman to cope with daily life stresses and contribute positively to her community. Initiatives that empower women can enhance their well-being and improve the health of their families. However, limited evidence shows how women’s empowerment affects maternal well-being in a rural setting. Objectives This paper explores the perspective of women’s economic empowerment in a rural Kenyan community and its effect on women’s mental well-being. Methods We purposively sampled women and men from the rural community who met the eligibility criteria (women who were pregnant and or with a child less than two years old and married men and residents in the community. We conducted two focus group discussions with the men and women separately, 11 key informant interviews with community stakeholders, and a four-month participant observation of 20 women participants who were pregnant and or with a child less than one year old. Results The study found that economically empowered women had greater decision-making power and self-efficacy. However, cultural expectations and barriers that dictated the role of women prevented them from accessing and controlling resources and participating in important decisions such as land and property ownership. Women faced domestic violence (physical, verbal, and denial of basic needs) and inadequate support (emotional, physical, and financial) from spouses and other family members. These challenges and barriers increased their mental stress. To cope, women engaged in economic activities individually or in groups to meet the basic needs of their families. Conclusions Women’s economic empowerment can positively and negatively affect their overall well-being. Positively, women gain greater access to resources, improved decision-making, and the ability to plan and achieve their goals. Negatively, empowerment can lead to reduced spousal and kin support and an increased risk of domestic violence. Furthermore, these negative consequences can also affect women’s mental well-being. To ensure the well-being of mothers, it is crucial to engage men in empowerment programs and raise awareness in communities to address socio-cultural norms that impede women’s economic empowerment and negatively affect the well-being of women. Additionally, mental health support should be incorporated into these empowerment programs to mitigate the negative effects of women’s empowerment and improve resilience. Disclosure of Interest None Declared

Acute malnutrition in children under 5 years is persistent in Eastern Africa’s arid and semi-arid lands. This study aimed to identify the drivers of acute malnutrition in Turkana and Samburu counties, Kenya. This was a population-based longitudinal mixed-methods observational study. Qualitative and quantitative data were collected at Wave 1 but only quantitative data were collected during follow-up. Participants were a representative sample of children and their primary caregivers from households with children under 3 years at Wave 1. Anthropometric measurements of all children under 5 years in the sampled households were taken at Wave 1 (May to July 2021), and one child under 3 years was randomly selected for follow-up about every 4 months over 2 years for six data collection waves. The study also collected data on socio-demographics; child feeding practices and morbidity, household water and food insecurity; shocks; coping strategies, social safety nets and economic safeguards; water, sanitation, and hygiene; women’s decision making; and food consumption. Qualitative data were collected through community dialogues, focus group discussions, in-depth interviews, photovoice and key informant interviews with mothers and fathers with children under 5 years, community leaders, county officials and staff of nongovernmental organizations. The data were coded and analyzed thematically. Data collection is complete, and analysis is ongoing. The analysis includes thematic analysis of qualitative data and descriptive and multivariable regression analysis of quantitative data.

Mid-upper arm circumference (MUAC) or weight-for-height/length Z-score (WHZ) are recommended in wasting diagnosis, but there are discrepancies between these indicators in identifying children as wasted. We compared the extent to which WHZ, MUAC, MUAC-for-age Z-score (MAZ) identify the same children as wasted and assessed the predictors of discordance and concordance in wasting diagnosis by these indicators using data from a longitudinal study of children younger than 3 years at recruitment in Turkana and Samburu counties. Wasting prevalence was consistently lower based on MUAC than WHZ and MAZ. Compared to WHZ, MAZ had higher sensitivity than MUAC, with the sensitivity of MAZ increasing and MUAC decreasing with age. Both indicators had high specificity. WHZ had a better agreement with MAZ than MUAC in wasting diagnosis. Older children were less likely to be classified as wasted by MUAC alone or by both MUAC and WHZ but were more likely to be classified as wasted by WHZ alone, MAZ alone or by both MAZ and WHZ. Compared to girls, boys were less likely to be classified as wasted by MUAC alone but more likely to be classified as wasted by WHZ alone. Stunted children were more likely to be classified as wasted by MUAC alone, MAZ alone, both MUAC and WHZ, and both MAZ and WHZ but not by WHZ alone. Classifications of wasting based on WHZ, MAZ, and MUAC are age, sex, and stunting status dependent. Compared to WHZ, MAZ is a more reliable and valid indicator than MUAC in these settings.

Introduction : Investigating elective and emergency caesarean section (CS) separately is important for a better understanding of birth delivery modes in the sub-Saharan Africa (SSA) region and identifying bottlenecks that prevent favourable childbirth outcomes in SSA. This study aimed at evaluating the prevalences of both CS types, determining their associated socioeconomic factors and their association with early neonatal mortality in SSA. Methods : SSA countries Demographic and Health Surveys data that had collected information on the CS’ timing were included in our study. A total of 21 countries were included in this study, with a total of 155 172 institutional live births. Prevalences of both CS types were estimated at the countries’ level using household sampling weights. Multilevel models were fitted to identify associated socioeconomic factors of both CS types and their associations with early neonatal mortality. Results : The emergency CS prevalence in SSA countries was estimated at 4.6% (95% CI 4.4–4.7) and was higher than the elective CS prevalence estimated at 3.4% (95% CI 3.3–3.6). Private health facilities’ elective CS prevalence was estimated at 10.2% (95% CI 9.3–11.2) which was higher than the emergency CS prevalence estimated at 7.7% (95% CI 7.0–8.5). Conversely, in public health facilities, the emergency CS prevalence was estimated at 4.0% (95% CI 3.8–4.2) was higher than the elective CS prevalence estimated at 2.7% (95% CI 2.6–2.8). The richest women were more likely to have birth delivery by both CS types than normal vaginal delivery. Emergency CS was positively associated with early neonatal mortality (adjusted OR=2.37, 95% CI 1.64–3.41), while no association was found with elective CS. Conclusions : Findings suggest shortcomings in pregnancy monitoring, delivery preparation and postnatal care. Beyond antenatal care (ANC) coverage, more attention should be put on quality of ANC, postnatal care, emergency obstetric and newborn care for favourable birth delivery outcomes in SSA.