The Effect of Maternal Depressive Symptoms on Infant Feeding Practices in Rural Ethiopia: Community Based Birth Cohort Study
Authors: Woldetensay Yitbarek Kidane , Belachew Tefera , Ghosh Shibani , Kantelhardt Eva Johanna , Biesalski Hans Konrad , Scherbaum Veronika 
Published: December 2019

Abstract
Background: Infant feeding is a multidimensional and multi-risk factor practice with a vital role in ensuring optimal child health, growth and development. Maternal depressive symptoms have been shown to have adverse consequences on feeding practices. However, most of these findings were based on single infant feeding practice (IFP) dimension; e.g. early initiation of breastfeeding, exclusive breastfeeding or introduction of complementary foods. This study aims to explore the longitudinal relationship between maternal depressive symptoms and IFPs in rural Ethiopia using summary IFP index. Methods: This study uses existing data from the ENGINE birth cohort study. The study had an open cohort design, with rolling recruitment and follow up of pregnant women for a period of two years. It was conducted from March 2014 to March 2016 in three districts (Woliso, Tiro-Afeta and Gomma) in the southwest of Ethiopia. The sample size was 4680 with pregnant women recruited between 12 and 32 weeks of gestation. Data were collected once during pregnancy for all women (twice for those in the first trimester), at birth, and then every three months until the child was 12 months old. Data collection was conducted by trained nurses electronically using Open Data Kit (ODK) software. A composite measure of IFP index was computed using 14 WHO recommended infant and young child feeding (IYCF) practice indicators. Maternal depressive symptoms (prenatal and postnatal) were assessed using the patient health questionnaire (PHQ-9). Linear multilevel mixed effects model was fitted to assess longitudinal relationship of IFPs and maternal depression. Results: Early postnatal depressive symptoms were inversely and significantly associated with IFPs (ß= -1.031, P=0.001). However, prenatal maternal depression was not significantly associated with IFPs (ß= -0.024, P=0.953). Similarly, intimate partner violence (ß= -0.208, P=0.001) was negatively associated with IFPs. On the other hand, maternal social support (ß= 0.107, P=0.002) and maternal social participation (ß= 0.552, P<0.001) were positively associated with IFPs. Maternal education and gestational age at birth were other important factors positively associated with IFPs. Moreover, contrary to expected, moderate household food insecurity (ß= 0.836, P=0.003), severe household food insecurity (ß= 1.034, P=0.01) and infant morbidity episodes (ß= 0.625, P=0.013) were positively associated with IFPs. Conclusion: Early postnatal depressive symptoms and intimate partner violence were negative predictors of IFPs. On the other hand, maternal education, gestational age at birth, maternal social support and social participation are positive predictors of IFPs. Overall, we conclude that a multitude of factors are related to IFPs and hence coordinated, multi-sectoral and multi-stakeholder interventions including maternal depressive symptoms screening and management are needed to improve IFPs.Key words: Infant feeding practices, prenatal depression, postnatal depression, household food insecurity, intimate partner violence, social support, Ethiopia