评估卢旺达农村地区 24-47 个月出生的小而患病儿童的母亲中与产妇心理健康不良相关的因素。
Assessing factors associated with poor maternal mental health among mothers of children born small and sick at 24-47 months in rural Rwanda.
机构信息
Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
Division of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
出版信息
BMC Pregnancy Childbirth. 2020 Oct 21;20(1):643. doi: 10.1186/s12884-020-03301-3.
BACKGROUND
Global investments in neonatal survival have resulted in a growing number of children with morbidities surviving and requiring ongoing care. Little is known about the caregivers of these children in low- and middle-income countries, including maternal mental health which can further negatively impact child health and development outcomes. We aimed to assess the prevalence and factors associated with poor maternal mental health in mothers of children born preterm, low birthweight (LBW), and with hypoxic ischemic encephalopathy (HIE) at 24-47 months of age in rural Rwanda.
METHODS
Cross-sectional study of children 24-47 months born preterm, LBW, or with HIE, and their mothers discharged from the Neonatal Care Unit (NCU) at Kirehe Hospital between May 2015-April 2016 or discharged and enrolled in a NCU follow-up program from May 2016-November 2017. Households were interviewed between October 2018 and June 2019. Mothers reported on their mental health and their child's development; children's anthropometrics were measured directly. Backwards stepwise procedures were used to assess factors associated with poor maternal mental health using logistic regression.
RESULTS
Of 287 total children, 189 (65.9%) were born preterm/LBW and 34.1% had HIE and 213 (74.2%) screened positive for potential caregiver-reported disability. Half (n = 148, 51.6%) of mothers reported poor mental health. In the final model, poor maternal mental health was significantly associated with use of violent discipline (Odds Ratio [OR] 2.29, 95% Confidence Interval [CI] 1.17,4.45) and having a child with caregiver-reported disability (OR 2.96, 95% CI 1.55, 5.67). Greater household food security (OR 0.80, 95% CI 0.70-0.92) and being married (OR = 0.12, 95% CI 0.04-0.36) or living together as if married (OR = 0.13, 95% CI 0.05, 0.37) reduced the odds of poor mental health.
CONCLUSIONS
Half of mothers of children born preterm, LBW and with HIE had poor mental health indicating a need for interventions to identify and address maternal mental health in this population. Mother's poor mental health was also associated with negative parenting practices. Specific interventions targeting mothers of children with disabilities, single mothers, and food insecure households could be additionally beneficial given their strong association with poor maternal mental health.
背景
全球对新生儿生存的投资使得越来越多患有疾病的儿童存活下来，并需要持续护理。在中低收入国家，人们对这些儿童的照顾者知之甚少，包括母亲的心理健康，这可能会进一步对儿童的健康和发展结果产生负面影响。我们旨在评估卢旺达农村地区 24-47 个月大的早产儿、低出生体重儿（LBW）和患有缺氧缺血性脑病（HIE）儿童的母亲的心理健康不良的发生率和相关因素。
方法
2015 年 5 月至 2016 年 4 月期间，在基里希医院新生儿护理病房（NCU）出院的早产儿、LBW 或 HIE 儿童及其母亲的横断面研究，以及 2016 年 5 月至 2017 年 11 月期间出院并参加 NCU 随访计划的儿童。2018 年 10 月至 2019 年 6 月期间对家庭进行了访谈。母亲报告了自己的心理健康状况和孩子的发育情况；直接测量儿童的人体测量指标。使用逻辑回归对不良母亲心理健康的相关因素进行了逐步回归分析。
结果
在 287 名儿童中，189 名（65.9%）为早产儿/LBW，34.1%患有 HIE，213 名（74.2%）筛查出有潜在照顾者报告的残疾。一半（n=148，51.6%）的母亲报告心理健康状况不佳。在最终模型中，不良的母亲心理健康状况与使用暴力纪律（优势比[OR]2.29，95%置信区间[CI]1.17，4.45）和有照顾者报告残疾的儿童（OR 2.96，95% CI 1.55，5.67）显著相关。家庭食物保障程度较高（OR 0.80，95% CI 0.70-0.92）、已婚（OR=0.12，95% CI 0.04-0.36）或未婚同居（OR=0.13，95% CI 0.05，0.37）可降低心理健康不良的几率。
结论
一半的早产儿、LBW 和 HIE 儿童的母亲心理健康状况不佳，这表明需要干预措施来识别和解决这一人群的母亲心理健康问题。母亲的心理健康状况不佳也与不良的育儿行为有关。鉴于残疾儿童的母亲、单身母亲和食物不安全家庭与不良母亲心理健康状况的强烈关联，针对这些群体的特定干预措施可能会额外有益。
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