Suhi Hanif: Department of Epidemiology and Population Health, Stanford University, CA, USA.
Jannat-E-Tajreen Momo: Environmental Health and WASH, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),Dhaka-1212, Bangladesh.
Farjana Jahan: Environmental Health and WASH, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),Dhaka-1212, Bangladesh.
Liza Goldberg: Department of Earth System Science, Stanford, CA, USA.
Natalie Herbert: Department of Earth System Science, Stanford, CA, USA.
Afsana Yeamin: Environmental Health and WASH, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),Dhaka-1212, Bangladesh.
Abul Kasham Shoab: Environmental Health and WASH, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),Dhaka-1212, Bangladesh.
Reza Mostary Akhter: Maternal and Child Nutrition, International Centre for Diarrhoeal Disease Research, Bangladesh.
Sajal Kumar Roy: Bangladesh Water Development Board.
Gabriella Barratt Heitmann: Department of Epidemiology and Population Health, Stanford University, CA, USA.
Ayse Ercumen: College of Natural Resources, North Carolina State University, Raleigh, NC, USA.
Mahbub Rahman: Environmental Health and WASH, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),Dhaka-1212, Bangladesh.
Fahmida Tofail: Maternal and Child Nutrition, International Centre for Diarrhoeal Disease Research, Bangladesh.
Gabrielle Wong-Parodi: Department of Earth System Science, Stanford, CA, USA.
Jade Benjamin-Chung: Department of Epidemiology and Population Health, Stanford University, CA, USA. ORCID
Background: Prenatal depression can have lasting adverse impacts on child health. Little is known about the impact of floods on prenatal depression in low- and middle-income countries. Methods: We conducted a cross-sectional survey of 881 pregnant women from September 24, 2023 to July 19, 2024 in riverine communities in rural Bangladesh. We recorded participant-reported flooding in the past 6 months, administered the Edinburgh Postnatal Depression Scale (EPDS), and obtained water level data and remote sensing data on distance to surface water. We fit generalized linear and log-linear models adjusting for month, wealth, education, age, and gestational age. We conducted 2 focus group discussions with 20 adult women. Findings: 3.6% of compounds were flooded in the past 6 months. Compound flooding was associated with elevated depression (adjusted prevalence ratio (aPR) = 2.08, 95% CI 1.14, 3.51) and thoughts of self-harm (aPR=8.40, 95% CI 4.19, 16.10). Latrine flooding was associated with higher depression (aPR=3.58, 95% CI 1.49, 7.29)). Higher water levels and shorter distance to permanent surface water were significantly associated with mean EPDS scores. Focus groups revealed that domestic violence, inadequate sanitation, gendered vulnerabilities in accessing latrines, childcare difficulties, and food insecurity were key drivers of depression due to floods. Flood preparedness strategies included relocation, storing food, and home modifications. Interpretation: Flooding, higher water levels, and proximity to water bodies were associated with prenatal depression in a rural, low-income setting. Inadequate sanitation and hygiene infrastructure were particularly strong drivers of depression. Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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