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Perinatal mental distress and infant morbidity in Ethiopia: a cohort study
  1. Joanna Ross1,
  2. Charlotte Hanlon2,3,
  3. Girmay Medhin4,
  4. Atalay Alem3,
  5. Fikru Tesfaye5,
  6. Bogale Worku6,
  7. Michael Dewey2,
  8. Vikram Patel1,7,
  9. Martin Prince2
  1. 1London School of Hygiene and Tropical Medicine, London, UK
  2. 2King's College London, Institute of Psychiatry, Health Service and Population Research Department, London, UK
  3. 3Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
  4. 4Aklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
  5. 5School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
  6. 6Department of Paediatrics and Child Health, Addis Ababa University, Faculty of Medicine, Addis Ababa, Ethiopia
  7. 7Sangath Centre, Mapusa, Goa, India
  1. Correspondence to Dr Charlotte Hanlon, Faculty of Medicine, Department of Psychiatry, PO Box 9086, Addis Ababa University, Addis Ababa, Ethiopia; charlotte.hanlon{at}


Objectives (1) To investigate the impact of perinatal common mental disorders (CMD) in Ethiopia on the risk of key illnesses of early infancy: diarrhoea, fever and acute respiratory illnesses (ARI) and (2) to explore the potential mediating role of maternal health behaviours.

Design Population-based cohort study.

Setting Demographic surveillance site in a predominantly rural area of Ethiopia.

Participants 1065 women (86.3% of eligible) in the third trimester of pregnancy were recruited and 954 (98.6%) of surviving, singleton mother–infant pairs were followed up until 2 months after birth.

Main exposure measure High levels of CMD symptoms, as measured by the locally validated Self-Reporting Questionnaire (SRQ-20 ≥6), in pregnancy only, postnatally only and at both time-points (‘persistent’).

Main outcome measures Maternal report of infant illness episodes in first 2 months of life.

Results The percentages of infants reported to have experienced diarrhoea, ARI and fever were 26.0%, 25.0% and 35.1%, respectively. Persistent perinatal CMD symptoms were associated with 2.15 times (95% CI 1.39 to 3.34) increased risk of infant diarrhoea in a fully adjusted model. The strength of association was not affected by including potential mediators: breast feeding practices, hygiene, the infant's vaccination status or impaired maternal functioning. Persistent perinatal CMD was not associated with infant ARI or fever after adjusting for confounders.

Conclusions Persistent perinatal CMD was associated with infant diarrhoea in this low-income country setting. The observed relationship was independent of maternal health-promoting practices. Future research should further explore the mechanisms underlying the observed association to inform intervention strategies.

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  • Funding The Wellcome Trust provided funding for this study (GR07164A).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Ethiopian Science and Technology Agency (National Research Ethics Committee) and King's College London Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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