PPD affects 15-25% of women in Africa, with a higher prevalence in North Central Nigeria. However, data on PPD prevalence in African countries is limited, with rates varying widely from 6.9% in Morocco to 43% in Uganda. In Nigeria, PPD prevalence ranges from 14.6% to 23.0%, with a study in Jos, North Central Nigeria, reported 21.8%. PPD is a significant public health concern in Africa and is three times higher compared to developed countries.

Biological factors such as hormonal theory, genetic predisposition, and neurochemical imbalances contribute to PPD, with hormonal changes after childbirth and a history of depression triggering symptoms, highlighting the importance of understanding these factors.

Psychological factors, such as the transition to motherhood, negative birth experiences, and inadequate social support, can significantly impact the experiences and symptoms of PPD, highlighting the need for comprehensive support.

Socio-cultural factors, including cultural attitudes, social expectations of new mothers, and socioeconomic status, can significantly impact the prevalence of Postpartum Depression (PPD). These factors, combined with the stigma associated with seeking mental health services, can exacerbate the issue.

1. History of psychiatric disorder
2. Lack of emotional and social support
3. Lack of confiding relationship
4. Recent adverse life events
5. Low socioeconomic status,
6. Low level of education,
7. Unemployment
8. Obstetric factors: unplanned pregnancy, complications in pregnancy, and a history of abortion, Lack of antenatal care, and
9. Infant care factors: an unhealthy baby, the death of an infant, parity,

The most stable predictors reported over time include a prior history of depression.

African cultures in Nigeria, influenced by sociocultural factors, offer significant support for women who have delivered. The communal-living lifestyle in rural areas provides comfort and relief from pregnancy and delivery challenges. Traditional naming ceremonies, celebrated on the baby's eighth day, help maintain high spirits. The cultural practices of a woman's mother or mother-in-law also aid in successful adjustment to life after birth.

It can Minor or major (mild, moderate & severe). The onset at 6 weeks, spontaneous recovery within 3-4 months. Severe depression is less common than mild depression (which does not require drug treatment).  Some of the manifestations include:

1. Poor appetite
2. Diurnal mood variation
3. Loss of interest/enjoyment/concentration
4. Feeling of guilt/failure
5. Reduced concentration
6. Psychomotor agitation
7. Anxiety
8. Suicide/infanticide

1. Damaged social attachments to infants
2. Disrupted emotional/social/cognitive development of the infant
3. Marital breakdown
4. Infant health may be impacted by postpartum depression as a result of poor parenting. PPD mothers are less able to recognize and react to newborn cues appropriately.
5. Impact on birth results like low birth weight or preterm delivery.
6. The woman’s quality of life, social functioning, and economic productivity.
7. There may be issues with the care of the newborn due to the mother's quality of life being affected, and in the extreme, the patient may endanger the child by physically injuring it.
8. There are verified and well reported instances of women killing their newborn children, in the context of postpartum mental illnesses

Management involves a multi-disciplinary approach, as follows:

1. Admit the mother and baby to a special ward in the psychiatric unit (mother-baby unit), with adequate supervision. This is to ensure continue bonding between the mother and the child, which is essential in recovery.
2. Psychotherapy e.g. Interpersonal therapy and supportive therapy in mild to moderate cases.
3. Drug treatment for severe depression include the use of:
   1. TCA e.g. amitriptyline, imipiramine.
   2. SSRIs e.g. paroxetine, fluoxetine. SSRI (sertraline) is the most preferred in breast feeding mothers due to low side effects in breastfed infants
   3. MAOI

1. Continue treatment beyond puerperium.
2. Electroconvulsive therapy can also be used in the management in severe cases.
3. Ensure adequate rest/sleep.
4. Regular aerobic exercise
5. Massaging-mother’s partner massaging her for 20 minutes twice weekly, likewise mother massaging the baby has been found to reduce PPD symptoms.
6. Support/reassure the relations

PPD is a common but largely preventable disorder in Nigeria and Sub-Saharan Africa. It is generally also agreed that while this illness can progress into major depression and carries a great risk of ill health and death, it is an underdiagnosed and underrated illness in many countries.

1. Personal & family history of psychiatric illness are important at booking
2. Close collaboration is recommended between obstetrician & psychiatrist for pregnant women with mental illness or those at risk
3. Appropriate counselling to women with previous history of mental illness.
4. Screened of all pregnant women for depression at least twice in the early third trimester and postpartum period.
5. Psychoactive drugs in pregnancy and breastfeeding should be prescribed with care.