title: Postnatal depression by HIV status among women in Zimbabwe.
abstract: BACKGROUND
  Postnatal depression (PND) is a serious public health problem in resource-limited countries. Research is limited on PND affecting HIV-infected women in sub-Saharan Africa. Zimbabwe has one of the highest antenatal HIV infection rates in the world. We determined the prevalence and risk factors of PND among women attending urban primary care clinics in Zimbabwe.
  
  
  METHODS
  Using trained peer counselors, a simple random sample of postpartum women (n = 210) attending the 6-week postnatal visit at two urban primary care clinics were screened for PND using the Shona version of the Edinburgh Postnatal Depression Scale (EPDS). All women were subsequently subjected to mental status examination using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for major depression by two psychiatrists who had no knowledge of the EPDS test results.
  
  
  RESULTS
  Of the 210 mothers (31 HIV positive, 148 HIV negative, 31 unknown status) enrolled during the postpartum period, 64 (33%) met DSM-IV criteria for depression. The HIV prevalence was 14.8%. Of the 31 HIV-infected mothers, 17(54%) met DSM-IV criteria for depression. Univariate analysis showed that multiparity (prevalent odds ratio [OR] 2.22, 95% confidence intervals [CI] 1.15-4.31), both parents deceased (OR 2.35, 95% CI 1.01-5.45), and having experienced a recent adverse life event (OR 8.34, CI 3.77-19.07) were significantly associated with PND. Multivariate analysis showed that PND was significantly associated with adverse life event (OR 7.04, 95% CI 3.15-15.76), being unemployed (OR 3.12, 95% CI 1.23-7.88), and multiparity (OR 2.50, 95% CI 1.00-6.24).
  
  
  CONCLUSIONS
  Our data indicate a high burden of PND among women in Zimbabwe. It is feasible to screen for PND in primary care clinics using peer counselors. Screening for PND and access to mental health interventions should be part of routine antenatal care for all women in Zimbabwe.
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
authors.forename: Dixon
authors.initials: D
authors.lastname: Chibanda
authors.forename: Walter
authors.initials: W
authors.lastname: Mangezi
authors.forename: Mufuta
authors.initials: M
authors.lastname: Tshimanga
authors.forename: Godfrey
authors.initials: G
authors.lastname: Woelk
authors.forename: Simbarashe
authors.initials: S
authors.lastname: Rusakaniko
authors.forename: Lynda
authors.initials: L
authors.lastname: Stranix-Chibanda
authors.forename: Stanley
authors.initials: S
authors.lastname: Midzi
authors.forename: Avinash K
authors.initials: AK
authors.lastname: Shetty
mesh_terms: D000293:Adolescent; D000328:Adult; D019052:Depression, Postpartum / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D015999:Multivariate Analysis; D010298:Parity; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D015030:Zimbabwe / Q000453:epidemiology