Browsing by Subject "Trajectory"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Open Access
    Perinatal depressive symptoms among low-income South African women at risk of depression: trajectories and predictors
    (2019-06-14) Garman, Emily C; Schneider, Marguerite; Lund, Crick
    Abstract Background The aim of the study was to identify trajectories of perinatal depressive symptoms and their predictors among women living in a low-resource setting in South Africa, and who present with a risk of depression during pregnancy. Methods This is a secondary analysis of a randomised controlled trial among 384 women living in Khayelitsha, a low income setting in South Africa, recruited at their first antenatal visit if they scored 13 or above on the Edinburgh Postnatal Depression Scale, were at least 18 years of age, less than 29 weeks pregnant and spoke isiXhosa. Participants were followed up at 8 months gestation, 3 and 12 months postpartum. Latent trajectories of depressive symptoms were identified using growth mixture modelling, based on the Hamilton Depression Rating Scale (HDRS). There were no differences in HDRS scores between the control and intervention arms, so all participants were assessed together. Health, social and economic predictors of trajectories were investigated to identify high-risk groups with greater or more chronic depressive symptoms, using univariate logistic regression. Results Two trajectories were identified: antenatal only (91.4%), with moderate to severe symptoms at baseline which later subside; and antenatal and postnatal (8.6%), with severe depressive symptoms during pregnancy and later in the postpartum period, which subside temporarily to moderate levels at 3 months postpartum. Predictors for the antenatal and postnatal trajectory include severe food insecurity, intimate partner violence, lower social support, greater functional impairment, problematic drinking and suicide risk. Conclusions A small proportion of women who are at risk for depression antenatally remain at risk throughout the perinatal period, and can be differentiated from those who show a natural remission. Identification and referral strategies should be developed with these findings in mind, especially given the limited mental health resources in low-income settings.
  • Thumbnail Image
    Item
    Open Access
    Tropical Cyclone Eline and Its Unusual Penetration and Impacts over the Southern African Mainland
    (2004) Reason, C J C; Keibel, A
    February-March 2000 saw devastating floods in Mozambique, Zimbabwe, and South Africa. Due to the huge damage and loss of life, global media attention was extensive. Less well known is that one of the weather systems that contributed to these floods (ex-Tropical Cyclone Eline) tracked almost 2000 km across southern Africa toward the cool southeast Atlantic and led to substantial rainfall over arid to semiarid southern Namibia (over two standard deviations above average for these two months and the wettest summer since 1976). Less than 5% of southwest Indian Ocean tropical cyclones actually make landfall on the east coast of southern Africa and even fewer significantly penetrate into the interior, because of the relatively dry 1-1.5-km-high interior plateau that covers most of the region. It is argued that the precursor synoptic conditions together with large-scale circulation and SST anomalies over the Indian Ocean associated with a strengthening La Niña were highly favorable for this unusual evolution and track of Eline. A summary of the accuracy of La Réunion and Met Office forecasts of Tropical Cyclone Eline over the Indian Ocean is given. Over the mainland, almost all countries do not have any NWP capacity, and the challenges and potential solutions for improved forecasting for the region are discussed. It is argued that by keeping informed of current rainfall, vegetation, and soil moisture conditions over southern Africa, as well as evolving climate signals in the tropical oceans, local forecasters could at least be in a state of heightened alert in advance, since these factors significantly influence extreme weather event characteristics in the region.