A comparative study of postnatal depression and associated factors in Gauteng and Free State provinces, South Africa

Background: The factors contributing to probable postnatal depression (PND), a type of clinical depression that can affect woman after childbirth, are socially derived. Therefore, variations among groups of women necessitate studies in different communities. Aim: This study compared the prevalence of PND and associated factors among women attending postnatal services facilities. Setting: The study setting included Tshwane Municipal district in Gauteng province (GP) and Fezile Dabi District (FS) in Free State province (FSP), South Africa. Methods: A total of 477 mothers within 12 weeks of giving birth were recruited by convenient sampling in health facilities. A self-developed questionnaire was used to obtain information on socio-demographics, obstetric history, and children’s characteristics. The Edinburgh Postnatal Depression Scale (EPDS) was used to collect data on depression symptoms, with a score of ≥ 13 used as a cut-off for probable PND. Data were analysed using STATA 14. Multivariate logistic regression was used to determine association between probable PND and various covariates. Results: The overall mean age of women was 28 ± 6 years. The overall prevalence rate of PND was 22%, slightly higher in FS (23%) than in GP (21%). Most participants living in GP were married, had tertiary education, were employed and from the households with income of more than R8000.00. A chi-square test showed that planned pregnancy was significantly higher in GP compared with FS (p ≤ 0.001). Multivariate logistic regression showed that support from a partner or husband decreased the odds of a probable PND in GP (adjusted odd ratio [AOR] 0.37; 95% confidence interval [CI] [95%CI: 0.14–0.96; p = 0.041] and in the FS [AOR = 0.14, 95%CI: 0.05–0.40; p ≤ 0.001]). Significant associations of probable PND with several factors – planned pregnancy, baby age, support in difficult times, partner or husband drinking alcohol and stressful events – were more common in the FSP than in the GP. Conclusion: The prevalence of probable PND and its associated risk factors in the GP and the FS indicates the need for routine screening and targeted interventions in both urban and rural settings. Contribution: The results confirm that the prevalence of PND is similar in both rural and urban areas, and that pregnancy planning remains a challenge in the FS, which calls for increased efforts to revive family planning programmes in primary health care facilities.