A Comparison of Antenatal Depressive Disorders in Urban and Rural Pregnant Women in Nigeria

Background: The prevalence of antenatal depression (AND) is consistently higher in urban areas in developed counties while the reverse is the case in developing counties developing countries. This highlights that socioeconomic gaps and health disparities between different settings could have important implications on perinatal mental health. Nigeria, the most populous nation in Africa, is home to multiple ethnic and cultural groups and about half of the population is rural. But then a majority of Nigerian studies on and were conducted in the urban and semi-urban southern regions. Few, if any, such studies were ever conducted in the urban or rural settings of northern Nigeria. The study aimed to determine and compare the prevalence and factors associated with AND among pregnant women in urban and rural northern Nigeria settings. A descriptive comparative cross-sectional study was conducted among antenatal clinic attendees of an urban and a rural health facility in Kano State, northern Nigeria. Data were collected from pregnant mothers. A socio-demographic and clinical characteristics questionnaire was used to obtain the relevant data. Edinburgh Postnatal Depression Scale (EPDS), Hamilton Depression Rating Scale (HDRS) and the major depression module of the Mini International Neuropsychiatric Interview (MINI-7) were used to screen, rate and diagnose depression among the respondents respectively.

Results: The urban pregnant women were older (28.3±5.7 versus 26.0±5.6 years, p=0.001), better educated (12.8±2.8 versus 8.9±4.3 years of schooling, p<0.001), earning higher average monthly income (36.0 USD vs 13.0 USD, p<0.001), in the second trimester of the pregnancy (22% versus 9.7%, p=0.004). While the rural women were more likely to have planned to get pregnant (84.1% versus 69.3%, p=0.003) and used psychoactive substances while pregnant (20.7% versus 8.7%, p=0.003). The prevalence of AND was significantly higher among the rural respondents as compared to the urban respondents (33.1% versus 14.7% p<0.001). Anaemia in pregnancy (AIP), a history of a background medical problem (BMP) was significantly associated with AND in the urban setting (p= 0.032 and p= 0.001 respectively). While in the rural setting, AIP and a history of BMP were significantly associated with AND (p=0.0063 and p=0.008 respectively). Furthermore, among the multigravid urban and rural respondents, previous pregnancy complication was found to be significantly associated with AND (p=0.030). Among the urban women, the predictor for AND was a history of BMP (OR=5.049, 95%CI=1.451-17.570). The significant predictors for AND in the rural setting were AIP (OR=3.337, 95%CI=1.468-7.798) and history of BMP (OR=3.298, 95%CI=1.267-8.885).

Conclusion: Rural prevalence of AND was significantly much higher than the urban rate. Certain factors, such as BMP and AIP, were associated with AND in both urban and rural settings.