BackgroundEvidence for Better Lives Study (EBLS) is an endeavour to establish a global birth cohort with participants from resource poor settings across the globe. It aims to investigate mediators and moderators of child development and wellbeing; it envisages informing policy and practice change to promote child health and wellbeing globally. Pakistan is one of the resource poor settings taking part in this global birth cohort; we report the feasibility of establishing such a birth cohort in Pakistan.MethodFrom March 2019 to July 2019, 153 third trimester pregnant women were identified, using community health worker registers, and approached for baseline demographics and a number of maternal wellbeing, mental health, support related information and stress related biomarkers in a peri-urban area of Islamabad Capital Territory. From October 2019 to December 2019, we re-contacted and followed 121 between 8-24 weeks postnatal period. All interviews were done after consent and data was collected electronically. Results150 (98%) third trimester pregnant women consented and were interviewed, 111 (74%) provided bio-samples and 121 (80.6%) were followed up postnatally. Their mean age and years of schooling was 27.29 (5.18) and 7.77 (4.79) respectively. Majority (82.3%) of the participants were housewives. Nearly a tenth were first time mothers while 63% of women reported current pregnancy to have been unplanned. Overall wellbeing and mental health were reported to be poor (WHO-5 mean scores 49.41 (32.20) & PHQ-9 mean scores 8.23 (7.0)). About 22% of women reported four or more adverse childhood experiences; 12.2% reported intimate partner violence during their current pregnancy. During the postnatal follow up visits, 58% of the women reported breastfeeding their infants. ConclusionThe study demonstrated Pakistan site could identify, approach, interview and follow up women and children postnatally, with a high response rates for both the follow up visits and bio-samples. Thus, a larger scale pregnancy birth cohort study in Pakistan is feasible to conduct.

Background Evidence for Better Lives Study Foundational Research (EBLS-FR) is a preliminary endeavor to establish the feasibility of a global birth cohort, and within this feasibility study, piloting the research instrument, with participants from eight lower middle-income countries across the globe. It aims to investigate mediators and moderators of child development and wellbeing; it envisages informing policy and practice change to promote child health and wellbeing globally. Pakistan is one of the resource poor lower middle-income country (LMIC) taking part in this global birth cohort; we report the feasibility of establishing such a birth cohort in Pakistan. Method From March 2019 to July 2019, 153 third trimester pregnant women were identified, using community health worker registers, and approached for baseline demographics and a number of maternal wellbeing, mental health, support-related information, and stress-related biomarkers from bio-samples in a peri-urban area of Islamabad Capital Territory. One hundred fifty of these women gave consent and participated in the study. From October 2019 to December 2019, we re-contacted and were able to follow 121 of these women in the 8–24 weeks postnatal period. All interviews were done after obtaining informed consent and data were collected electronically. Results One hundred fifty (98.0%) third trimester pregnant women consented and were successfully interviewed, 111 (74.0%) provided bio-samples and 121 (80.6%) were followed up postnatally. Their mean age and years of schooling was 27.29 (SD = 5.18) and 7.77 (SD = 4.79) respectively. A majority (82.3%) of the participants were housewives. Nearly a tenth were first time mothers. Ninety-two (61.3%) of the women reported current pregnancy to have been unplanned. Overall wellbeing and mental health were reported to be poor (WHO-5 mean scores 49.41 (SD = 32.20) and PHQ-9 mean scores 8.23 (SD = 7.0)). Thirty-eight (21.8%) of the women reported four or more adverse childhood experiences; 46 (31.3%) reported intimate partner violence during their current pregnancy. During the postnatal follow up visits, 72 (58.0%) of the women reported breastfeeding their infants. Conclusion The foundational research demonstrated that Pakistan site could identify, approach, interview, and follow up women and children postnatally, with a high response rates for both the follow up visits and bio-samples. Therefore, a future larger-scale pregnancy birth cohort study in Pakistan is feasible.

Understanding the impact of neighborhood characteristics is crucial given its multigenerational impact. However, there is low availability of validated instruments measuring neighborhood dimensions, particularly in pregnant women, and a lack of cross-country validation of neighborhood-related scales. In this study, we used data from the [masked] study to assess the conceptual and measurement equivalence of the community domains of neighborhood cohesion, intergenerational closure, and neighborhood and social disorder, testing for measurement invariance across eight low- and middle-income countries (LMICs). Following this, we examined patterns of associations with prenatal maternal stress, well-being, and depressive symptoms through the use of nomological networks. We found that the conceptual and measurement equivalence of the neighborhood domains were good across the eight LMICs, although some adjustments had to be made to improve the model fit in two of the sites. Moreover, our results suggest that, in general, higher levels of neighborhood and social disorder, and lower levels of cohesion and intergenerational closure in the community were similarly associated with adverse maternal outcomes across the included sites. The results of this study emphasize the importance of exploring the community context when assessing maternal well-being and supports the need to advocate for community-based interventions that promote safer physical and social environments within maternal programs.