Validation of chichewa version of the city birth trauma scale at postnatal clinics in Lilongwe, Malawi.

backgroundPostpartum Post-Traumatic Stress Disorder (PTSD) is a significant mental health concern for postpartum women. In Malawi, there were no data showing the prevalence of Postpartum Post-Traumatic Stress Disorder and no validated Chichewa tool for assessing Postpartum PTSD. City Birth Trauma Scale (CityBiTS) is a tool that is used to assess Postpartum PTSD. CityBiTS is the best choice because it was developed specifically to measure trauma related to childbirth, tailors to the unique psychological, physical and emotional experiences of postpartum women. The tool also adheres to DSM-5 Criteria and has been validated across cultures which has shown high reliability and credibility to be used in clinical practice and research. The study aimed at assessing the diagnostic accuracy of the Chichewa Version City Birth Trauma Scale at Postnatal clinics in Lilongwe District, Malawi. The study's objectives were; to determine the prevalence of postpartum PTSD and establish the psychometric properties of Chichewa Version of the City Birth Trauma Scale in Malawi.

methodsIt was a cross-sectional study conducted at two hospital facilities and these were Bwaila Hospital and Area 25 Health Centre postnatal clinics in Lilongwe District, Malawi. English City Birth Trauma Scale was translated into Chichewa version and adapted. A total of 384 postnatal mothers were selected by systematic random sampling technique. Data was analysed by SPSS version 23 and Sensitivity Analysis was done to examine the psychometric properties.

resultsThe prevalence of Postpartum PTSD was 22.6% [95% CI 18.8% - 27.1%] on Structured Clinical Interview for Diagnostic Statistical for Mental Disorders Version 5 and 10.9% [95% CI 7.9% - 14.5% on City Birth Trauma Scale. The following psychometrics were established: Cronbach's alpha 0.780, ROC 0.872, sensitivity 81.6% [95% CI 71.8%-89.1%], specificity 78.9% [95% CI 73.8%-83.4%], Positive Predictive Value 53.0% [95% CI 47%-58.9%], Negative Predictive Value 93.6%, [95% CI 90.4%-95.8%] optimum cut-off score > 23, Youden Index 0.605, Exploratory Factor Analysis for variance 65.6%.Factor 1 which are birth-related symptoms and factor 2 which are general symptoms emerged and all items loaded except items 10 and 17 and Convergent Validity at 0.65. The prevalence rate of Postpartum PTSD and Psychometric properties were consistent with other studies affirming its utility.

conclusionThe study determined the information on prevalence of Postpartum PTSD. It further demonstrated that Chichewa Version City Birth Trauma Scale is a reliable, accurate and valid tool for screening Postpartum PTSD with good psychometric properties for clinical practice and research.