Perinatal Depression and Breastfeeding: A Mixed Methods Study Among South Sudanese Refugees in the West Nile Region in Uganda

Abstract Objectives The specific study objectives were: 1) to identify perceived common stressors among parents in refugee settlements, 2) to analyze the associations of perinatal depression and early initiation of breastfeeding and 3) to analyze the associations between perinatal depression and exclusive breastfeeding. Methods Qualitative study participants were mothers (n = 66) and fathers (n = 49) who compromised eight focus group discussions (FGDs): four mothers FGDs, two fathers FGDs, two mothers and fathers FGDs. Two FGDs with Village Health Team and six individual interviews with key informants also were conducted. Thematic analysis was used in NVivo, v. 12. Quantitative study participants (n = 390) were pregnant mothers who were enrolled in a community-based randomized control study. Perinatal depression was measured using Patient Health Questionnaire-9 during 3rd trimester and postpartum. Early initiation and exclusive breastfeeding were assessed using WHO guidelines. SAS, v. 9.4, was used to conduct logistic regressions to analyze perinatal depression and breastfeeding and models were adjusted for confounders. Results Five themes related to common stressors among refugees included: marital conflict and violence, other violence and conflict, lack of basic needs, inadequate health care, issues involving childbirth, and issues involving children. Over two-thirds (66.3%) of mothers breastfed within one hour after birth and 55.5% exclusively breastfed. Antenatal depression occurred in 19.9% of participants and 23.5% had postpartum depression. Antenatal depression was not significantly associated with early initiation of breastfeeding or exclusive breastfeeding. Postpartum depression was associated with significantly lower odds of breastfeeding within an hour after birth [AOR 0.35 (0.21- 0.61), p-value < 0.001] and of exclusive breastfeeding [AOR 0.44 (0.26–0.74), p-value < 0.01]. Conclusions Screening and treatment for perinatal depression during antenatal and postnatal care is important for refugee mothers. Interventions aiming to improve breastfeeding among refugees may also consider addressing postpartum depression. Funding Sources Supported by a grant from the Nestlé Foundation for the study of problems of nutrition in the world, Lausanne, Switzerland and Oklahoma State University Foundation Marilynn Thoma Chair and Humphreys Grant.