Association of Maternal Morbidities with Health-Related Quality of Life, Functional Status and Posttraumatic Stress Disorder Among Postpartum Women in South Gondar Zone, Northwest Ethiopia

: Marelign, Tilahun

dc.contributor.author	: Marelign, Tilahun
dc.date.accessioned	2023-02-20T12:33:28Z
dc.date.available	2023-02-20T12:33:28Z
dc.date.issued	2022-07-19
dc.identifier.uri	http://ir.bdu.edu.et/handle/123456789/15049
dc.description.abstract	Background: Maternal health care outcomes usually focus on mortality and morbidity, with a traditional pathology focused aim of preventing, detecting and managing maternal health problems. While these are still very relevant today, efforts need to go beyond survival, with a view to consider health-related quality of life, functional status and posttraumatic stress disorder as an additional outcome that can maximize the health and well- being of women throughout their lives. However, most of the existing studies of maternal health focus on mortality and morbidity, and there is limited research that aims to assess women's healthrelated quality of life, functional status and posttraumatic stress disorder as a primary outcome and to the best of the authors’ knowledge there is no study conducted in this regard in Ethiopia. Objective: The objective of this study was to investigate the association of maternal morbidities with maternal health-related quality of life, functional status and posttraumatic stress disorder along with other predictors in South Gondar zone, Northwest Ethiopia. Methods: The study had two components. The first was a quantitative study which was conducted in South Gondar zone, Northwest Ethiopia from October 2020 to March 2021 and used a health facility-linked community-based follow-up study. A sample of 775 delivering women were recruited after child birth and before discharge using the criteria published by the WHO Maternal Morbidity Working Group. Functional status was measured by the Amharic version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) instrument. Health-related quality of life was measured by the Amharic version of the World Health Organization Quality of Life (WHOQOL-BREF) instrument. The short version of depression, anxiety and stress scale 21 (DASS-21) questionnaire was used to measure depression, anxiety and stress. We have also used the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) to measure posttraumatic stress disorder symptoms. The Stata Traj package was used to determine trajectories of health-related quality of life, functional status and posttraumatic stress disorder using a group-based trajectory modeling. The multinomial logistic regression model was also used to identify predictors of trajectory group membership. Mediation analysis using the Karlson, Holm, Breen (KHB) method was also carried out to determine the mediation percentage of mediator variables on the trajectory group membership of posttraumatic stress disorder symptoms. In addition, a cross-lagged autoregressive path analysis was used to determine the longitudinal direction of association between depression, anxiety and posttraumatic stress disorder. The second component was a qualitative study which consisted of nine in-depth interviews. The purpose of this part of the study was to substantiate and complement the main quantitative study. The selection of participants was facilitated by the health extension workers of the respective kebeles under consideration. Three towns of the study area, Estie, Addis Zemen and Debre Tabor were identified for the conduct of the nine in-depth interviews. Purposive sampling technique was used to select the study participants and thematic analysis was used for this part of the study. Results: Four distinct trajectories for physical and psychological and five trajectories for the social relationships and environmental health-related quality of life were identified. Direct maternal morbidities [AOR & (95%CI) = 6.66 (1.01, 43.98)], indirect maternal morbidities [AOR & (95%CI) = 5.76 (1.79, 18.51)], poor social support [AOR & (95%CI) = 2.63 (1.21, 5.69)], vaginal delivery [AOR & (95%CI) = 2.16 (1.10, 4.23)] and anxiety [AOR & (95%CI) = 1.54 (1.02, 2.32)] were found to be predictors of lower health-related quality of life trajectory group membership. With regard to functional status, three distinct functional status trajectory groups with different longitudinal patterns were identified across the six domains of WHODAS 2.0. Direct maternal morbidities [AOR & (95%CI) = 6.98 (1.41, 34.52)], indirect maternal morbidities [AOR & (95%CI) = 10.15 (3.04, 33.87)], poor social support [AOR & (95%CI) = 7.76 (3.90, 15.43)], vaginal delivery [AOR & (95%CI) = 2.57 (1.06, 6.23)] and fear of childbirth [AOR & (95%CI) = 6.07 (2.74, 13.46)] were found to be predictors of poor functioning trajectories. Majority of postpartum women who participated in the qualitative study were in favor of the negative impact of maternal morbidities on their health-related quality of life and functional status. For the posttraumatic stress disorder symptom, four distinct trajectories were also identified. Perceived traumatic childbirth [AOR & (95%CI) = 14.07 (4.48, 44.16)], fear of childbirth [AOR & (95%CI) = 1.02 (1.004, 1.04)], depression [AOR & (95%CI) = 1.44 (1.22, 1.68)], anxiety [AOR & (95%CI) = 1.38 (1.17, 1.63)] and psychological violence [AOR & (95%CI) = 7.56 (1.14, 50.08)] were found to be predictors of chronic PTSD trajectory group membership. Depression and anxiety not only were strongly related to trajectories of PTSD symptoms directly but also mediated much of the effect of the other factors on trajectories of PTSD symptoms. Moreover, the result of a cross-lagged autoregressive path analysis indicated that anxiety and depression are a causal risk factors for posttraumatic stress disorder and anxiety was also found to be a causal risk factor for depression. Conclusion and recommendation: Both the quantitative and qualitative components of the study showed that maternal morbidities (direct or indirect) negatively impacted the healthrelated quality of life, functional status and mental health of postpartum women. Early diagnosis and treatment of maternal morbidities and mental health problems, developing encouraging strategies for social support and providing health education or counseling for women with less or no education are essential to improve health-related quality of life and functional status trajectories of postpartum women. Postnatal screening and treatment of depression and anxiety may contribute to decrease PTSD symptoms of women in the postpartum period. Providing adequate information about birth procedures and response to mothers’ needs during childbirth and training of health care providers to be mindful of factors that contribute to negative appraisals of childbirth are essential to reduce fear of childbirth and traumatic childbirth so as to prevent PTSD symptoms in the	en_US
dc.language.iso	en	en_US
dc.subject	Public Health	en_US
dc.title	Association of Maternal Morbidities with Health-Related Quality of Life, Functional Status and Posttraumatic Stress Disorder Among Postpartum Women in South Gondar Zone, Northwest Ethiopia	en_US
dc.type	Thesis	en_US