Measurement of maternal functioning during pregnancy and postpartum: findings from the cross-sectional WHO pilot study in Jamaica, Kenya, and Malawi

Abstract

Background The World Health Organization’s definition of maternal morbidity refers to “a negative impact on the woman’s wellbeing and/or functioning”. Many studies have documented the, mostly negative, effects of maternal ill-health on functioning. Although conceptually important, measurement of functioning remains underdeveloped, and the best way to measure functioning in pregnant and postpartum populations is unknown. Methods A cross-sectional study among women presenting for antenatal (N = 750) and postpartum (N = 740) care in Jamaica, Kenya and Malawi took place in 2015–2016. Functioning was measured through the World Health Organization Disability Assessment Schedule (WHODAS-12). Data on health conditions and socio-demographic characteristics were collected through structured interview, medical record review, and clinical examination. This paper presents descriptive data on the distribution of functioning status among pregnant and postpartum women and examines the relationship between functioning and health conditions. Results Women attending antenatal care had a lower level of functioning than those attending postpartum care. Women with a health condition or associated demographic risk factor were more likely to have a lower level of functioning than those with no health condition. However, the absolute difference in functioning scores typically remained modest. Conclusions Functioning is an important concept which integrates a woman-centered approach to examining how a health condition affects her life, and ultimately her return to functioning after delivery. However, the WHODAS-12 may not be the optimal tool for use in this population and additional components to capture pregnancy-specific issues may be needed. Challenges remain in how to integrate functioning outcomes into routine maternal healthcare at-scale and across diverse settings.

Longitudinal functional status trajectories and its predictors among postpartum women with and without maternal morbidities in Northwest Ethiopia: a group based multi-trajectory modelling

“…Our finding is consistent with previous studies showing women with a clinically diagnosed direct and indirect maternal morbidity were generally more likely to have a lower level of functioning compared with those with no condition. 11 18 Another study from Malaysia also showed that women who experienced severe morbidity had lower overall functional ability at 1 month postpartum compared with women without severe morbidity and that the difference between the two groups had disappeared by 6 months postpartum, although most women had not achieved full functional status by this time. 13 …”

“…Calculation of the sample size was done by comparing two proportions using Epi-Info software V.7. Accordingly, a minimum sample size of 753 (251 exposed and 502 non-exposed) was calculated by taking 0.05 α, power of 90%, 1.96 OR, 15.4% of mothers with indirect maternal morbidity having least well-functioning quintile (20% of women in the fifth quantile against the first four quantiles of WHODAS total score) as defined by a previous article, 11 1:2 ratio of exposed to non-exposed and by adding 10% non-response rate. 11 Based on the number of delivering mothers who visited each hospital during the previous 1 year (annual report of each hospital), proportional allocation of the total sample size was carried out to attain the required sample size in each hospital.…”

“… 4 In addition, most study designs on the association of maternal morbidity with functional status were cross-sectional, providing limited insights into functional status trajectories during postpartum period. 11 13 18 23 24 Therefore, the aim of this study was to identify the distinct trajectories and predictors of functional status from 6 th week to 18 th week of postpartum period among women in Northwest Ethiopia by using a group based multi-trajectory modelling.…”

Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda

“…One comparable study included women from Malawi, Kenya, and Jamaica and reported 18% of women had poor function at six weeks postpartum [22]. It is important to note that that study used different tools to measure functionality and focused on di culties in performing activities, while our study considered functional status as a multifaceted measure of mobility, level of energy, selfcare, performance of usual activities, and overall health.…”

The Comparative Impact of Cash Transfers and a Psychotherapy Program on Psychological and Economic Well-Being

“…The GHQ-12 has been used extensively to assess psychiatric morbidity in low-and middle-income countries, including Kenya, where it has been validated and used in previous randomized controlled trials, including that by Bryant et al on PM+ (Abubakar and Fischer 2012;Getanda, Papadopoulos, and Evans 2015;Bryant et al 2017). The PSS and WVS items have also been previously validated and used in Kenya (Haushofer and Shapiro 2016;Haushofer et al 2020), and the same is true for the WHODAS (Bryant et al 2017;Cresswell et al 2020). The scales had good properties in our sample, with Cronbach's alpha values of 0.88 for GHQ-12, 0.60 for PSS, and 0.78 for WHODAS.…”