Predictors of Postnatal Depression in the Slums Nairobi, Kenya: A Cross-Sectional Study

studies on PND from low-income PND prophylactic and therapeutic strategies. More is to determine the role of cultural factors in PND development.

Although PND is a public health problem, African countries (32), including Kenya, have neglected it. Therefore, more research is needed due to the scarcity of published work in this area (22). Moreover, it is crucial to investigate and understand PND risk factors to devise targeted prevention and treatment strategies (33). This study aimed to investigate PND predictors in early postpartum period (6-10 weeks) in two low-resourced urban communities.

Participants and Procedures
This paper is a cross-sectional design and is a part of a longitudinal study (34) and investigated hypothesized risk factors for PND. Data was collected from Lang'ata and Riruta Health Centres-MCH clinics. Both are situated in Nairobi county and serve low-resource communities.
Mothers were recruited as they brought their infants for the rst MCH clinic visit through continuous purposive sampling until the required sample was achieved(567 participants). The sampling method is published elsewhere (34). Informed consenting mothers lled up a self-administered Social-Demographic Questionnaire (SDQ) and an English version of the original (1961) Becks Depression Inventory (BDI).
We obtained ethical approval from Kenyatta National Hospital Ethical Committee, O ce of the President through the Ministry of Higher Education Science and Technology and Medical O cer of Health (MOH), Nairobi County.

Data collection instruments
Sociodemographic questionnaire A sociodemographic questionnaire to collect personal information and hypothesized PND risk factors that include: -mothers' age in years; educational level; marital status; monthly household income; suffering from chronic illness; satisfaction with body image; con ict with any close relatives; have a stressful life event; pregnancy planned; happy with infants' health; not able to work (fatigue) and age of the infant and gestational age.  (35)(36)(37)(38). BDI is a self-administered report which takes approximately 10 minutes to complete.

Data analysis
Item means, standard deviations, frequencies and percentages were calculated for the sociodemographic, psychosocial related variables. The association between each independent variable and the dependent variable was assessed in bivariate analyses. Those independent variables with P-value <0.25 were entered into a multivariate logistic regression to control the cofounders and identify PND predictors using the enter method. P-value of <0.05 was used as the criterion for statistical signi cance, and an OR with a 95% con dence interval was used to indicate the strength of association. All analysis was conducted with IBM SPPS v 23.

Results
Of the total 591 eligible mothers, 575 participated in the study, which made a response rate of 97.3%.
Sociodemographics and other characteristics of the participants Table 1 reports the characteristics of the participants in our sample. The mean age was 25.9 years and ranged from 18-40. The majority of the participants (45.1%) were aged between 18-24 years; 37.6% were aged between 25-30 years; 17.3% were aged between 30-40 years. A majority (89.8%) were married, more than half (53.4%) had a secondary level of education, nearly 36.5% had a primary education level, the rest, 10.1%, had a tertiary level of education. A majority (67.7%) of the participants were earning income below 20,000(196$) per month. 5.1% of the women had been suffering from chronic illness, 86.9% were satis ed with their body, 11.6% had a con ict with their relatives, 28.4% had a stressful life event, 67.4% had planned their pregnancy, 66.7% were happy with baby's health, and 23.8% had work-related problems (fatigue). A majority (70.5%) had infants aged 7-10 weeks, while the rest had infants aged 6 weeks. About 9.3% had babies born before 37 weeks (Pre-term births).  and Extreme depression (40+); (n = 6, 1.1%). Therefore, the PND prevance is 27.0%. The mean BDI scores was 7.7, SD = 8.9 and ranged from 0-54.  This study con rms that unplanned pregnancy is a risk factor for PND (42). Probably the unwanted pregnancy stressed the mothers due to the circumstances surrounding the pregnancy. For example, unplanned pregnancy has negative consequences that include; stigma, perceived loss of opportunities (43), poor health (44) and unhappiness (45).
Unemployed women had higher PND symptoms than the employed in this study, as other studies show(46), (47). A possible explanation is that unemployment could have exposed women to nancial stress. A di cult nancial situation may contribute to PND development(48). Besides, unemployed women are at risk of domestic abuse (49), which in turn may cause PND development (50).
Women who felt fatigued and unable to perform the usual household chores after giving birth were more depressed than those who did not. In a study correlating with our ndings, Giallo et al. found that mothers in the high-risk depressive symptoms group were most likely to complain of fatigue (51). However, postnatal fatigue should be best understood as separate psychological constructs or experiences (52).

Limitations
The study participants resided in urban slums and therefore did not represent the rest of the city population. This study was a cross-sectional design and could not determine cause and effect. Prevalence of depression