Peer-reviewed article
A retrospective mixed methods analysis of maternal psychosocial health during the COVID-19 pandemic in Ghana: lessons for future public health crises
Ruthfirst E. A. Ayande, Gloria Ethel Otoo, Jessica Pearlman, Sarah Gonzalez-Nahm, Elena T. Carbone ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study looked at how COVID-19 related stress affected the mental health of Ghanaian women who were pregnant during the pandemic. An online survey of 221 mothers of children aged 0–15 months was combined with in-depth interviews with 11 women. Mothers recalled their anxiety and worry during pregnancy. Higher health literacy was linked to lower coronavirus anxiety, and job or wage loss was linked to higher anxiety. The authors suggest that future pandemic responses should include maternal mental health screening through telehealth and mHealth and community health literacy resources.
Key points
- 11% of mothers had probable dysfunctional coronavirus-related anxiety and 33% had probable dysfunctional thinking about COVID-19.
- Higher health literacy scores were linked to lower anxiety scores (β=-0.43, 95% CI [-0.80, -0.05] per point on the AAHLS).
- Loss of jobs and wages predicted higher anxiety scores when adjusted for health literacy (β = 1.30, 95% CI [0.07, 2.53]).
- Mothers who reported exercising during COVID had higher obsession scores (β = 1.08, 95% CI [-0.01, 2.16], p = 0.05).
- Interview themes fell into three domains: COVID-19 Pandemic Impacts, COVID-19 Adaptations, and Social Support Networks.
Limitations
Mothers were conveniently sampled, completed an online survey, and recalled their anxiety retrospectively, so results may be biased and may not represent all Ghanaian mothers. The associations are not proof of cause, only 11 women were interviewed, and the study focuses on maternal mental health rather than directly measuring child outcomes.
Abstract
Observed impacts of the COVID-19 pandemic in countries in the global north include increasing rates of maternal anxiety and depression. However, little research has been done in sub-Saharan Africa assessing the impact of the pandemic on maternal psychosocial stress. This study aimed to examine the association between COVID-related stressors and psychosocial health among Ghanaian women who were pregnant during the pandemic. This was a sequential explanatory mixed-methods study. An online survey was administered to conveniently sampled Ghanaian mothers with children 0–15 months old from June 2021 to January 2022. Demographic and health information, health literacy (HL) information measured by the All Aspects of Health Literacy scale (AAHL), and COVID-19 health and well-being were collected. Using the Coronavirus Anxiety Scale (CAS) and the Obsession with Coronavirus Scale (OCS), mothers were asked to recall their levels of anxiety and worry while they were pregnant during the pandemic. Generalized linear models were used to assess the association between COVID-related stressors and maternal CAS and OCS scores. In-depth interviews were conducted to gather information from participants about their experiences of pregnancy and childbirth during the COVID-19 pandemic, and thematic analyses were performed using the social support networks in health framework. A total of 221 mother-child dyads were analyzed. Eleven women participated in the in-depth interviews. We observed a rate of 11% for probable dysfunctional coronavirus-related anxiety and 33% for probable dysfunctional thinking about COVID-19. In adjusted models for baseline characteristics, we observed that higher HL scores corresponded with reduced CAS scores (β=-0.43, 95% CI [-0.80, -0.05] for every point increase in AAHLS scores). For COVID-related health and well-being, loss of jobs and wages predicted higher CAS scores when adjusted for HL as a main covariate (β = 1.30, 95% CI [0.07, 2.53]). Participants who reported exercising during COVID had higher OCS scores compared to those who reported not exercising, when adjusting for HL (β = 1.08, 95% CI [-0.01, 2.16], p = 0.05). Themes emerging were categorized into three domains: COVID-19 Pandemic Impacts, COVID-19 Adaptations, and Social Support Networks. This study assessing the association between COVID-19 pandemic stressors and maternal health and well-being provides valuable insights into the pandemic’s short- and medium-term effects. Given the complexity of the pandemic’s stress response, including potential intersections between psychosocial health, social support, and health literacy, public health policies must incorporate these needs into future pandemic responses. This includes leveraging telehealth and mHealth platforms for maternal mental health screening as well as providing community-based health literacy resources. Further studies examining the longer-term effects of the pandemic are also warranted.