Prevalence of depression among women with obstetric fistula in low-income African countries: a systematic review and meta-analysis

Abstract

Depression is one of mental health consequences that present in women with obstetric fistula. It is estimated that over 264 million people of all ages suffer from depression globally. The objective of this systematic review and meta-analysis was to synthesize the epidemiologic evidence from previous studies on the prevalence of depression among women with obstetric fistula in low-income African countries. We followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines to conduct this meta-analysis. The common databases (PubMed, SCOPUS, EMBASE, Psych INFO, Google Scholar, African Index Medicus, and African Journals Online (AJOL)) were searched for the relevant literature. We used a random-effect meta-analysis model to estimate the overall prevalence of depression and the Q -and I² -statistics were used to assess the heterogeneity between the studies included in the meta-analysis. Egger's test and visual inspection of the symmetry in funnel plots were used to check for the presence of publication bias. The pooled estimated prevalence of depression among women with obstetric fistula in low-income African countries was 56.2% (95% CI 43.1-68.4). The prevalence of depression among women with obstetric fistula was 74.4% in Ethiopia, 72.9% in Kenya, 46.0% in Malawi, 41.0% in Sudan, 34.8% in Nigeria, and 27.7% in Tanzania. Furthermore, the prevalence of depression was higher (97.0%) when it was measured by using Beck's Depression Inventory (BDI) when compared with Patient Health Questionnaire (PHQ9) (62.7%), General Health Questionnaire (GHQ-28) (36.7%), Hamilton Depression Rating Scale (HDRS) (41.0%), and Center for Epidemiologic Studies Depression Scale (CES-D) (27.7%). Moreover, the pooled estimated prevalence of depression among women with obstetric fistula was ranged from 48.1 to 57.7% in a leave-one-out sensitivity analysis. The prevalence of depression among women with obstetric fistula in low-income African countries was high. Screening and appropriate management of depression among women with obstetric fistula are warranted.

Keywords: Africa; Depression; Low-income; Meta-analysis; Obstetric fistula; Prevalence; Systematic review.