Prevalence and factors associated with the multiple morbidity of postpartum depression, diabetes mellitus and hypertension among mothers in Mbarara district, south western Uganda: A parallel convergent mixed methods study.

Background: The occurrence of multiple morbidities of postpartum depression (PPD), hypertension and diabetes mellitus (DM) among postpartum mothers poses a health care challenge because it not only affects the mother but also the life of the new born baby and that of close family members. Therefore, this study aimed at examining the prevalence and factors associated with these comorbidities among mothers in public health facilities in Mbarara, south western Uganda. Methods: We conducted a facility based cross sectional study using parallel convergent mixed methods to collect information from 309 postpartum mothers from 6 weeks to 6 months after childbirth. Using consecutive sampling, mothers were enrolled from postnatal clinics of two health facilities: Mbarara Regional Referral Hospital and Bwizibwera Health Center IV in urban and rural southwestern Uganda respectively. A psychiatric classification based on the Mini-International Neuropsychiatric Interview (MINI 7.0.2) for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) was used. DM was diagnosed by measuring Hemoglobin A1c (HbA1c). Hypertension was diagnosed when a person's systolic blood pressure (SBP) was ≥140 mm Hg and/or their diastolic blood pressure (DBP) was ≥90 mm Hg following repeated examination. The primary outcome was multiple morbidity defined as co-occurrence of PPD, hypertension and DM. Logistic regression was used to determine the factors associated with multiple morbidity. In the qualitative phase, 20 key informant interviews each lasting 30-45 min were conducted purposively. The interviews were audio recorded, transcribed verbatim and translated from the local dialect of Runyankore to English and analyzed thematically. Results: The prevalence of multiple morbidity was 13.6% (95% CI: 10.2-19.3%). The prevalence of multi - morbidity did not vary significantly across age categories, p = 0.056. Having high cortisol levels between 6 weeks and 6 months postpartum was the only factor significantly associated with multi-morbidity among mothers with postpartum depression in both bivariate analysis and multivariate analysis adjusted OR = 6.9, (95% CI: 3.29-14.47), p < 0.001. In addition, this study revealed that psychological and socioeconomic factors, intimate partner violence and life style changes were likely to predispose the mothers to the multiple morbidity of PPD, Hypertension and DM. Conclusion: Both quantitative and qualitative data offered complementary insights. The quantitative analysis highlighted high cortisol levels and diabetes mellitus as key biological factors associated with the multiple morbidity of PPD, hypertension and DM and qualitative findings enriched this understanding by illustrating the psychological, socioeconomic hardships, IPV and lifestyle changes context of these biological changes as they were frequently reported, offering a more holistic view of the factors influencing multiple morbidity among postpartum mothers.