Feasibility of a Birth-cohort In Pakistan: Evidence For Better Lives Study

Abstract

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.

Patterns of adverse childhood experiences and associations with prenatal substance use and poor infant outcomes in a multi-country cohort of mothers: A Latent Class Analysis

“…It is possible that, with the EBLS cohort, structural factors such as cultural norms work as a protective factor. For instance, normative gender roles, religious practices, and social taboos are cultural norms that may preclude women from smoking, consuming alcoholic beverages, and using illicit substances (Anwer et al, 2021;Morrow et al, 2002;Owusu-Dabo et al, 2009). Prenatal illicit drug use was present in 6% of the study sample which is comparable to other ACE studies involving a cohort of pregnant women residing in HIC (3.1%) (see Racine et al, 2018).…”

“…It is possible that, with the EBLS cohort, structural factors such as cultural norms work as a protective factor. For instance, normative gender roles, religious practices, and social taboos are cultural norms that may preclude women from smoking, consuming alcoholic beverages, and using illicit substances (Anwer et al, 2021;Morrow et al, 2002;Owusu-Dabo et al, 2009). .…”

Perceived stress during the prenatal period: assessing measurement invariance of the Perceived Stress Scale (PSS-10) across cultures and birth parity

“…Thirty percent of women were nulliparous, with higher rates in Romania (64.9%) and lowest rates in Ghana (15.7%). Education levels ranged from 0 to 20 years completed, with an average of 7.77 years in Pakistan (Anwer et al 2022) and 12.83 years completed in Romania. For this analysis, data of women expecting twins were retained.…”