Factors of Rapid Repeat Pregnancy and Its Consequences on Depression among Adolescents in the Greater Accra Region, Ghana.
Date
2018-07
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
University Of Ghana
Abstract
Rapid repeat pregnancy (RRP) is defined as pregnancy onset within 24 months of the
previous pregnancy outcome. RRP has been identified to result from different situations
and as such might create different risks to the individual. Several studies have shown an
association between RRP and mental health issues such as anxiety, emotional stress,
depression, aggression and poorer education attainment. There is a pint-size consensus as
to which risk factors are the very key predictors of RRP and whether the outcome (RRP)
may lead to depression. This study seeks to identify the main risk factors that could lead to
RRP and its consequences on depression among adolescents.
METHODS: A mixed method approach (quantitative and qualitative) was used for this
study which was conducted in 12 public health facilities in the Greater Accra Region. An
unmatched case-control study design was used for the study. The cases were adolescent
girls aged between 15 and 19 years who have had more than one pregnancy within two
years. Controls were adolescent girls aged between 15 and 19 years who have had one
pregnancy which either ended an abortion or delivery with more than twenty-four months
spacing. The sample size for the quantitative method was n= 417 with 209 controls and
208 cases. Both the qualitative and quantitative components were hospital-based. Six
FGDs were conducted among the control group in six of the selected hospitals and
involved a total of forty-six adolescents. Eleven In-depth Interviews (IDI) were also held
with every eligible adolescent who had experienced RRP (case) in six of the twelve health
facilities selected for the research. STATA 15 MP (StataCorp, College Station, TX, USA)
was used to analyze the quantitative aspect of the work. Univariate, bivariate and multivariate
logistic regression analyses were conducted with p-value of <0.05 considered as significant.
Composite score analysis was used in estimating the level of depression among the
participants using Beck’s Depression Inventory scale. The qualitative data were audio recorded, translated into English and transcribed verbatim. Thematic content analysis was
adopted for the analysis. Data triangulation was done to support the quantitative data using
the qualitative data.
RESULTS: There were two outcome variables in the study. The first one was the risk
factors for RRP and the second was the effect of RRP on depression.
Risk factors for RRP: The median ages at menarche between cases and controls were 12
and 13 years respectively and it was observed that most of the girls who experienced
menarche at age 12 years and below were involved in early sexual activity (age at first
sexual intercourse) than those who did not. It was also revealed in the study that the
number of times a pregnant adolescent visits the hospital for ANC had some form of
influence on the risk of RRP. The peers of the adolescents were the main source of
information on issues of sex among the cases as compared with the control group.
Transactional sex was more common among the cases than the controls. In a univariate
analysis variables that showed significance as risk factors for RRP were planning of last
pregnancy, history of miscarriage, married or living with partner, parental care, and at
least 4 ANC visits. All these variables were significantly associated with odds of RRP.
There was an evidence that the odds of RRP for the adolescents who have ever had a
miscarriage was about eight times more than that among those who have never had a
miscarriage (aOR=7.92; 95%CL: 3.18-19.71; p<0.0001).
Effect of RRP on depression: The risk of being depressed among cases were 19% higher
than the control group (crude RR=1.19; 95%Cl=0.99 to 1.43; p=0.070). After adjusting for
the confounding variables, this increased significantly to 36% higher risk of being
depressed (adjusted RR=1.36; 95%Cl=1.11 to 1.67; p=0.003) suggesting an evidence of
association between RRP and depression.
CONCLUSION: This research has identified the main risk factors of RRP to be, age at
menarche, marital status, parental care and support, number of times of ANC visits, sex
education and transactional sex. Again the study has investigated the extent to which
having subsequent birth in less than 24 months (Rapid Repeat Pregnancy) could adversely
affect psychological state of an adolescent mother. The results from this study could
provide an insight into designing targeted interventions by policy makers and other
stakeholders.
Key words: Rapid Repeat Pregnancy, depression, unmatched case-control, mixed method,
Antenatal visits transactional sex, menarche, cases, controls.
Description
PhD.
Keywords
Rapid Repeat Pregnancy (RRP), Depression, Adolescents, Greater Accra Region