Authors : Liliane Mukwiye; Valens Muhayimpundu; Vedaste Baziga; Alice Muhayimana

Volume/Issue : Volume 11 - 2026, Issue 10 - October

Google Scholar : https://tinyurl.com/3dmeytt4

DOI : https://doi.org/10.38124/ijisrt/26Oct038

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Abstract : Background: Mothers of preterm and critically ill newborns admitted to neonatal intensive care units may experience anxiety, depression, and psychological distress. Nurses and midwives are well positioned to recognize maternal mental health difficulties and facilitate support and referral. However, evidence on their preparedness to provide maternal mental health support in Rwanda remains limited. This study assessed knowledge, attitudes, and practices regarding maternal mental health and factors associated with practice in selected Rwandan referral hospitals.  Methods: A multicenter analytical cross-sectional study was conducted among 123 nurses and midwives working in neonatal intensive care units of four Rwandan referral hospitals. A census approach was used, with 123 of 125 eligible participants providing analyzable data. Data were collected using a 54-item questionnaire. Knowledge was classified using an 80 percent threshold, while attitude and practice were classified using a 70 percent threshold. Internal consistency was assessed using appropriate reliability coefficients. Bivariate analyses were conducted using SPSS version 25, and multivariable logistic regression using R version 4.6.1. Firth penalized logistic regression was used for knowledge and practice models because of sparse data.  Results: Among 123 participants, 109 were female, 56 were aged 30 to 39 years, and 67 had more than five years of neonatal intensive care experience. Only 21 participants had received maternal mental health training, and 32 reported availability of maternal mental health guidelines. Overall, 101 participants demonstrated good knowledge and 97 had positive attitudes, whereas only 29 demonstrated good practice. In the adjusted practice model, workplace and mentorship were independently associated with good practice. Knowledge and attitude were not significantly associated with practice in bivariate analysis.  Conclusions: Nurses and midwives demonstrated good knowledge and positive attitudes toward maternal mental health, but these were not consistently reflected in practice. Strengthening maternal mental health care in Rwandan neonatal intensive care units may require structured mentorship, accessible guidelines, and supportive supervision.

Keywords : Attitudes; Knowledge; Maternal Mental Health; Midwives; Neonatal Intensive Care Unit; Nurses; Practice; Rwanda.

References :

1. WHO. Perinatal mental health [Internet]. 2019 [cited 2026 Oct 1]. Available from: https://www.who.int/teams/mental-health-and-substance-use/promotion-prevention/perinatal-mental-health
2. Gerstein ED, Njoroge WFM, Paul RA, Smyser CD, Rogers CE. Maternal depression and stress in the neonatal intensive care unit: Associations with mother-child interactions at age 5 years. J Am Acad Child Adolesc Psychiatry. 2019;58(3):350–8. doi:10.1016/j.jaac.2018.08.016
3. O’Dea GA, Youssef GJ, Hagg LJ, Francis LM, Spry EA, Rossen L, et al. Associations between maternal psychological distress and mother-infant bonding: A systematic review and meta-analysis. Arch Womens Ment Health. 2023;26(4):441–52. doi:10.1007/s00737-023-01332-1
4. Holditch-Davis D, Santos H, Levy J, White-Traut R, O’Shea TM, Geraldo V, et al. Patterns of psychological distress in mothers of preterm infants. Infant Behav Dev. 2015;41:154–63. doi:10.1016/j.infbeh.2015.10.004
5. Segre LS, McCabe JE, Chuffo-Siewert R, O’Hara MW. Depression and anxiety symptoms in mothers of newborns hospitalized on the neonatal intensive care unit. Nurs Res. 2014;63(5):320–32. doi:10.1097/NNR.0000000000000039
6. Shetty AP, Halemani K, Issac A, Thimmappa L, Dhiraaj S, K. R, et al. Prevalence of anxiety, depression, and stress among parents of neonates admitted to neonatal intensive care unit: A systematic review and meta-analysis. Clin Exp Pediatr. 2024;67(2):104–15. doi:10.3345/cep.2023.00486
7. Nakidde G, Kumakech E, Mugisha JF. Maternal mental health screening and management by health workers in southwestern Uganda: a qualitative analysis of knowledge, practices, and challenges. BMC Pregnancy Childbirth. 2023;23:477. doi:10.1186/s12884-023-05763-7
8. Turner M, Chur-Hansen A, Winefield H. The neonatal nurses’ view of their role in emotional support of parents and its complexities. J Clin Nurs. 2014;23(21–22):3156–65. doi:10.1111/jocn.12558
9. Nortey MA, Asampong E. Nurse’s knowledge, attitudes, and practices toward perinatal depression: a study among nurses in southern Ghana. Nurs Midwifery Res J. 2024;20(4):245–59. doi:10.1177/0974150x241296600
10. Poreddi V, Gandhi S, Ramachandra, Ganjekar S, Desai G, Chandra PS. Evaluation of a manual-based training program in changing auxiliary nurse midwives (ANMs) knowledge, attitudes, and skills related to maternal mental health. Indian J Psychiatry. 2023;65(6):617–25. doi:10.4103/indianjpsychiatry.indianjpsychiatry_567_22
11. Zhu L, Pan X, Chen C, Chen J, Pan Y, Chen X, et al. Knowledge, attitudes, and support needs of obstetric and gynecological nurses and midwives toward perinatal mental health disorders screening in Central China: A multicenter cross-sectional survey. Front Public Health. 2024;12:1424075. doi:10.3389/fpubh.2024.1424075
12. Baron EC, Hanlon C, Mall S, Honikman S, Breuer E, Kathree T, et al. Maternal mental health in primary care in five low- and middle-income countries: A situational analysis. BMC Health Serv Res. 2016;16:206. doi:10.1186/s12913-016-1291-z
13. Prom MC, Denduluri A, Philpotts LL, Rondon MB, Borba CPC, Gelaye B, et al. A systematic review of interventions that integrate perinatal mental health care into routine maternal care in low- and middle-income countries. Front Psychiatry. 2022;13:859341. doi:10.3389/fpsyt.2022.859341
14. Brown S, Sprague C. Health care providers’ perceptions of barriers to perinatal mental healthcare in South Africa. BMC Public Health. 2021;21:1905. doi:10.1186/s12889-021-11954-8
15. Kigozi-Male NG, Heunis JC, Engelbrecht MC. Primary health care nurses’ mental health knowledge and attitudes towards patients and mental health care in a South African metropolitan municipality. BMC Nurs. 2023;22:25. doi:10.1186/s12912-023-01188-x
16. Umuziga MP, Gishoma D, Hynie M, Nyirazinyoye L. Antenatal depressive symptoms in Rwanda: Rates, risk factors, and social support. BMC Pregnancy Childbirth. 2022;22:193. doi:10.1186/s12884-022-04522-4
17. Umuziga MP, Adejumo O, Hynie M. A cross-sectional study of the prevalence and factors associated with symptoms of perinatal depression and anxiety in Rwanda. BMC Pregnancy Childbirth. 2020;20(1):68. doi:10.1186/s12884-020-2747-z
18. Abimana MC, Karangwa E, Hakizimana I, Kirk CM, Beck K, Miller AC, et al. Assessing factors associated with poor maternal mental health among mothers of children born small and sick at 24–47 months in rural Rwanda. BMC Pregnancy Childbirth. 2020;20:643. doi:10.1186/s12884-020-03301-3
19. Umuziga MP, Gishoma D, Hynie M, Nyirazinyoye L, Nyiringango G. How can I seek a consultation if I don’t have a high fever?: Barriers to mental healthcare access for women in the perinatal period in Rwanda. Rwanda J Med Health Sci. 2024;7(2):302–18. doi:10.4314/rjmhs.v7i2.17
20. Nsengiyumva A, Sezibera V, Cubaka V, Ahishakiye A, Nshimyiryo A, Mulindabigwi A, et al. Healthcare providers’ knowledge and practices of perinatal depression in rural Rwanda. Int J Innov Sci Res Technol. 2025;10(1):449. doi:10.5281/zenodo.14709716
21. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–9. doi:10.1016/j.jclinepi.2007.11.008
22. Van Wyk L, Majiza AP, Ely CSE, Singer LT. Psychological distress in the neonatal intensive care unit: a meta-review. Pediatr Res. 2024;96(6):1510–8. doi:10.1038/s41390-024-03599-1
23. WHO. A guide to developing knowledge, attitude, and practice surveys. Geneva: World Health Organization; 2008.
24. Republic of Rwanda. Law relating to the protection of personal data and privacy. Rwanda Off Gaz [Internet]. 2021 [cited 2026 Aug 1]. Available from: https://rwandalii.org/akn/rw/act/law/2021/58/eng@2021-10-15
25. Sofronas M, Feeley N, Zelkowitz P, Sabbagh M. Obstetric and neonatology nurses’ attitudes, beliefs, and practices related to the management of symptoms of maternal depression. Issues Ment Health Nurs. 2011;32(12):735–44. doi:10.3109/01612840.2011.609635
26. Adjorlolo S, Aziato L, Akorli VV. Promoting maternal mental health in Ghana: an examination of the involvement and professional development needs of nurses and midwives. Nurse Educ Pract. 2019;39:105–10. doi:10.1016/j.nepr.2019.08.008
27. Firth D. Bias reduction of maximum likelihood estimates. Biometrika. 1993;80(1):27–38. doi:10.1093/biomet/80.1.27
28. Heinze G, Schemper M. A solution to the problem of separation in logistic regression. Stat Med. 2002;21(16):2409–19. doi:10.1002/sim.1047
29. WHO. WHO guide for integration of perinatal mental health in maternal and child health services [Internet]. Geneva: World Health Organization; 2022. Available from: https://www.who.int/publications/i/item/9789240057142
30. WHO. WHO recommendations on maternal and newborn care for a positive postnatal experience [Internet]. Geneva: World Health Organization; 2022. Available from: https://www.who.int/publications/i/item/9789240044074