Maternal Mental Health and Maternal and Child Nutrition in Eastern Democratic Republic ofCongo:A Mixed Methods Study

nutrition;mental health;DR Congo;Human Nutrition

Emerson, JillianStrobino, Donna ;

Johns Hopkins University

关键词: nutrition;    mental health;    DR Congo;    Human Nutrition;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/40829/EMERSON-DISSERTATION-2017.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Introduction:Maternal depression is associated with child underweight and stunting in low and middle-income countries, but evidence from sub-Saharan Africa is mixed and there are not studies in post-conflict, humanitarian settings where the population is at higher risk of post-traumatic stress disorder.There is little understanding of how maternal mental health is related to mothers’ own diet and nutritional status. This dissertation aims to understand how maternal mental health problems are associated with maternal and child diet and nutritional status and child feeding practices in Eastern DR Congo.Methods:The research was nested within a larger study evaluating Jenga Jamaa II, a United States Agency for International Development food assistance program.The larger study assessed household food security and child nutrition indicators for four Jenga Jamaa II interventions (Women’s Empowerment, Prevention of Malnutrition in Children under 2 Approach, Farmer Field Schools, and Farmer-to-Farmer) and a control group.Participants were eligible for the present study if they were enrolled in the parent study and had a child five years of age or younger also enrolled.There were 828 mothers and 812 children who participated.Mental health was measured using a questionnaire with items from the Hopkins Symptom Checklist- 25 (HSCL-25), measuring depression and anxiety symptoms, the Harvard Trauma Questionnaire (HTQ), measuring post-traumatic stress disorder (PTSD) symptoms, and 14 additional items measuring other locally-relevant symptoms.Average scale scores were calculated for HSCL-25 and HTQ subscales, and a variable for high psychological distress was created for participants with scores in the upper quartile of both measures.Regression analyses were used to evaluate the association between mental health measures and maternal dietary diversity, BMI, and underweight, adjusting for confounding variables.Maternal mental health symptoms were then evaluated in relation to child diet (dietary diversity, meal frequency, achieving minimum dietary diversity, and achieving minimum meal frequency) and child anthropometry (height-for-age z score, weight-for-age z score, weight-for-height z score, stunting, and underweight).A qualitative analysis was conducted using in-depth interviews and focus group discussions with a sub-sample of 35 mothers who scored in the upper and lower quartiles of the mental health questionnaire to understand how maternal mental health affects child care and feeding practices from the mothers’ perspectives.Key informant interviews were conducted among health workers.The qualitative analysis was conducted with methods adapted from Grounded Theory. Results:Higher levels of maternal mental health symptoms, indicating greater distress, were associated with higher maternal dietary diversity scores (HSCL-25: ß: 0.18, p=0.002, HTQ: ß: 0.13, p=0.017, High Distress: ß: 0.27, p=0.003), but not with BMI or underweight.In the analysis evaluating children’s diet and nutritional status, HSCL-25 (ß: 0.18, p=0.036) and HTQ (ß: 0.19, p=0.026) were associated with higher dietary diversity but not achievement of minimum dietary diversity (consuming 4 out of 7 food groups in the previous day).All maternal mental measures were associated with higher meal frequency (HSCL-25: ß: 0.13, p=0.001, HTQ:ß: 0.12, p=0.001, High Distress: ß: 0.15, p=0.014).Maternal mental health was associated with achieving minimum meal frequency when defined by consumption of only three meals/snacks per day for non-breastfed children (HSCL-25: OR: 2.06, HTQ: OR: 1.93, High Distress: OR: 2.68, p<0.001 for all) but there was no association if the threshold was moved to four meals/snacks.No child anthropometric measures were associated with maternal mental health. The qualitative research revealed that mothers perceived psychological distress to be related to loss of appetite and weight loss.Their distress, often combined with their weight loss, led to difficulties breastfeeding, mainly due to perceived milk insufficiency. Conclusions:The older age of the children and the lack of variation in outcome variables may have limited the study’s ability to find an association with child growth.The positive association between higher levels of maternal mental health problems and maternal and child diet indicators warrants further study. Qualitative research results indicate a need for responsible parenting interventions targeted at fathers and increased breastfeeding support for distressed mothers.