Use of Counseling to Mitigate Psychological Morbidity After Stillbirth Among Women in Kitui And Machakos Counties, Kenya
Kanini, Caroline Mumbe
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Stillbirth is a baby born without any signs of life weighing at least 1000grams or with at least 28 weeks gestation. There is no burden affecting families is big and yet invisible in society and global arena as stillbirth. Stillbirth is a traumatizing experience for most women and a risk factor to development of psychological morbidity. The kind of care women receive during this critical period influences exhibition of psychological morbidity such as depression, anxiety and post traumatic stress disorder which can be mitigated by counseling. Supporting psychological consequences of women enable them to take care of the present and subsequent children. The main aim of this study was to determine the use of counseling in mitigating psychological morbidity after stillbirth among women in Kitui and Machakos Counties. Specifically the study aimed to determine care offered to women after stillbirth, to evaluate psychological morbidity exhibited by women after stillbirth, to determine the effect of counseling on psychological morbidity after stillbirth, determine factors that influence psychological morbidity exhibited by women who deliver stillbirth after counseling and to determine the coping strategies employed by women after stillbirth. This was a quasi experimental study (non randomized controlled trial) with an interventional (Machakos County) and control group (Kitui County). Edinburgh Postnatal Depression Scale 1, Hopkins Symptom Checklist 25 (first 10 for assessing anxiety) and Impact of Events Scale-revised measured Depression, anxiety and post traumatic stress disorder respectively. Women in the interventional group were counseled while those in the control group received routine care offered by midwives in the ward. Descriptive and inferential statistics were used to analyze the data. Fishers exact test with significant p <0.05 was used to determine factors influencing psychological morbidity exhibited by women who delivered stillbirth after counseling. Student t test for unpaired and paired data determined the effect of the intervention between and within the study groups respectively. Significant variables were further subjected to multi-variable logistic analysis to measure the strength of the association and control for confounding factors. The study findings revealed that women received minimal psychological support on grief reaction, memories creation and need to ascertain the cause of death. Women who delivered stillbirth experienced depression, anxiety and post traumatic stress disorder. Counseling was found to mitigate the selected psychological morbidity in this study (all P values < 0.01). Various factors influenced psychological morbidity after stillbirth (p values: age = 0.05, education < 0.01, occupation = 0.04, years of marriage = 0.019, partners‘ education = 0.017, viewing the baby = 0.04, timing of death = 0.039, informed on the cause of death < 0.0108 and myths < 0.01). Key informants expressed need for professional and psychological support since they are also affected by the stillbirth experience to avoid compromising care offered to the women. The study concluded that counseling can mitigate psychological morbidity after stillbirth and women need holistic care from health care providers, families and communities where they live. The study recommends that the county governments need to integrate counseling into care of women after stillbirth, engage stakeholders to discuss stillbirth as a public health concern to address misconceptions and offer support to health care providers to offer proper care to women to mitigate the psychological morbidity.