Publications (17)124.23 Total impact
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Article: The impact of prior preeclampsia on the risk of superimposed preeclampsia and other adverse pregnancy outcomes in patients with chronic hypertension.
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ABSTRACT: We sought to compare the rates of superimposed preeclampsia and adverse outcomes in women with chronic hypertension with or without prior preeclampsia. We conducted secondary analysis of 369 women with chronic hypertension (104 with prior preeclampsia) enrolled at 12-19 weeks as part of a multisite trial of antioxidants to prevent preeclampsia (no reduction was found). Outcome measures were rates of superimposed preeclampsia and other adverse perinatal outcomes. Prepregnancy body mass index, blood pressure, and smoking status at enrollment were similar between groups. The rates of superimposed preeclampsia (17.3% vs 17.7%), abruptio placentae (1.0% vs 3.1%), perinatal death (6.7% vs 8.7%), and small for gestational age (18.4% vs 14.3%) were similar between groups, but preterm delivery <37 weeks was higher in the prior preeclampsia group (36.9% vs 27.1%; adjusted risk ratio, 1.46; 95% confidence interval, 1.05-2.03; P = .032). In women with chronic hypertension, a history of preeclampsia does not increase the rate of superimposed preeclampsia, but is associated with an increased rate of delivery at <37 weeks.American journal of obstetrics and gynecology 02/2011; 204(4):345.e1-6. · 3.28 Impact Factor -
Article: Domestic violence prior to and during pregnancy among Pakistani women
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ABSTRACT: Objective. Abuse of women has been associated with adverse pregnancy outcomes. Data about abuse from developing countries are scarce, especially from Muslim societies. Our objective was to investigate domestic violence before and during pregnancy among women in an urban area of Pakistan. Design. Population-based cohort study. Setting. An urban community in Hyderabad, Pakistan. Population. Thousand three hundred and twenty-four pregnant women at 20–26 weeks gestation. Methods. Socio-demographic and reproductive history data were obtained through structured interviews. We used a modified World Health Organization screening instrument to assess women's experience of domestic violence. Measures. Physical, sexual, and verbal abuse and demographic characteristics. Results. The majority of women had received some schooling and in most households the husbands were employed; by Pakistani standards, they were middle class. Young maternal age, having an unemployed husband and one with other wives/partners, and having had a prior pregnancy were significant predictors of abuse. In the six months prior to and/or during pregnancy, 51% reported experiencing verbal, physical or sexual abuse. Twenty percent reported physical or sexual abuse alone. Sixteen percent of women considered suicide as a response to the abuse. Conclusions. Domestic violence is common among urban Pakistani women of reproductive age, suggesting a need for universal screening during antenatal care, and for support and referral. Further research is needed to determine factors that place women at greatest risk, and to assess the impact of domestic violence on pregnancy outcomes.Acta Obstetricia Et Gynecologica Scandinavica 12/2010; 87(11):1194 - 1201. · 1.77 Impact Factor -
Article: Tobacco use and secondhand smoke exposure during pregnancy in two African countries: Zambia and the Democratic Republic of the Congo.
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ABSTRACT: To study pregnant women's knowledge, attitudes and behaviors towards tobacco use and secondhand smoke (SHS) exposure, and exposure to advertising for and against tobacco products in Zambia and the Democratic Republic of the Congo (DRC). Prospective cross-sectional survey between November 2004 and September 2005. Antenatal care clinics in Lusaka, Zambia, and Kinshasa, DRC. Pregnant women in Zambia (909) and the DRC (847). Research staff administered a structured questionnaire to pregnant women attending antenatal care clinics. Pregnant women's use of tobacco, exposure to SHS, knowledge of the harms of tobacco and exposure to advertising for and against tobacco products. Only about 10% of pregnant women reported ever having tried cigarettes (6.6% Zambia; 14.1% DRC). However, in the DRC, 41.8% of pregnant women had tried other forms of tobacco, primarily snuff. About 10% of pregnant women and young children were frequently or always exposed to SHS. Pregnant women's knowledge of the hazards of smoking and SHS exposure was extremely limited. About 13% of pregnant women had seen or heard advertising for tobacco products in the last 30 days. Tobacco use and SHS exposure pose serious threats to the health of women, infants and children. In many African countries, maternal and infant health outcomes are often poor and will likely worsen if maternal tobacco use increases. Our findings suggest that a 'window of opportunity' exists to prevent increased tobacco use and SHS exposure of pregnant women in Zambia and the DRC.Acta Obstetricia Et Gynecologica Scandinavica 03/2010; 89(4):531-9. · 1.77 Impact Factor -
Article: Prevalence of anxiety, depression and associated factors among pregnant women of Hyderabad, Pakistan.
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ABSTRACT: Few studies have examined the relationship between antenatal depression, anxiety and domestic violence in pregnant women in developing countries, despite the World Health Organization's estimates that depressive disorders will be the second leading cause of the global disease burden by 2020. There is a paucity of research on mood disorders, their predictors and sequelae among pregnant women in Pakistan. To determine the prevalence of anxiety and depression and evaluate associated factors, including domestic violence, among pregnant women in an urban community in Pakistan. All pregnant women living in identified areas of Hyderabad, Pakistan were screened by government health workers for an observational study on maternal characteristics and pregnancy outcomes. Of these, 1,368 (76%) of eligible women were administered the validated Aga Khan University Anxiety Depression Scale at 20-26 weeks of gestation. Eighteen per cent of the women were anxious and/or depressed. Psychological distress was associated with husband unemployment (p = 0.032), lower household wealth (p = 0.027), having 10 or more years of formal education ( p = 0.002), a first (p = 0.002) and an unwanted pregnancy ( p < 0.001). The strongest factors associated with depression/anxiety were physical/sexual and verbal abuse; 42% of women who were physically and/or sexually abused and 23% of those with verbal abuse had depression/anxiety compared to 8% of those who were not abused. Anxiety and depression commonly occur during pregnancy in Pakistani women; rates are highest in women experiencing sexual/physical as well as verbal abuse, but they are also increased among women with unemployed spouses and those with lower household wealth. These results suggest that developing a screening and treatment programme for domestic violence and depression/anxiety during pregnancy may improve the mental health status of pregnant Pakistani women.International Journal of Social Psychiatry 07/2009; 55(5):414-24. · 1.15 Impact Factor -
Article: Antioxidant supplementation and premature rupture of the membranes: a planned secondary analysis.
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ABSTRACT: The purpose of this study was to determine if antioxidant supplementation during pregnancy reduces the incidence of premature rupture of the membranes (PROM). A placebo-controlled, double-blind trial was conducted. PROM and preterm PROM (PPROM) were planned secondary outcomes of the trial. Women between 12(0/7) and 19(6/7) weeks of gestation and diagnosed to have chronic hypertension or a prior history of preeclampsia were randomized to daily treatment with both vitamin C (1000 mg) and E (400 IU) or placebo. Outcome data for PROM were available for 697 of 739 patients. The rates of PROM (37/349 [10.6%] vs 19/348 [5.5%]; adjusted risk ratio [RR] 1.89 [95.42% CI, 1.11-3.23]; P = .015), and PPROM (16/349 [4.6%] vs 6/348 [1.7%]; RR 2.68 [1.07-6.71]; P = .025) were increased in the antioxidant group. Contrary to expectations, vitamins C and E supplementation in this dose combination may be associated with an increased risk of PROM and PPROM.American journal of obstetrics and gynecology 11/2008; 199(4):433.e1-8. · 3.28 Impact Factor -
Article: Variation in the postpartum hemorrhage rate in a clinical trial of oral misoprostol.
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ABSTRACT: The main objective of this study was to identify factors associated with variation in the rate of acute postpartum hemorrhage (PPH), defined as blood loss >or= 500 mL within 2 hours of delivery, observed in a randomized clinical trial of misoprostol for the prevention of PPH, conducted in rural India. Although the women in the misoprostol group had a significantly lower probability of having a PPH, we also noted a reduction in the rate of PPH in the placebo group over the course of the study. We hypothesized that this was due to the changing skills of the auxiliary nurse midwives (ANMs) over the course of the study. We conducted a post-hoc analysis examining variation in PPH rates over the duration of the trial among the women randomized to the placebo arm (n = 808). Descriptive, correlation analysis and generalized estimating equations (GEE) were used to predict PPH rates. With no direct measure of ANM skills, we used proxy measures, including: (1) the ANM's point of entry into the study (original ANMs at the initiation of the trial were less skilled than replacement ANMs); (2) the study duration, representing exposure of the ANM to ongoing training and monitoring; and (3) duration of the second stage of labor as a measure of improved delivery practices. As the study duration increased, the duration of the second stage of labor decreased (-0.12, p = 0.001) and as the duration of the second stage of labor decreased, the rate of PPH decreased (0.0282; 95% CI 0.0201-0.0363). For each 10-minute increase in the duration of second stage labor increased PPH odds by 7.1% and each 30-day duration of the trial decreased PPH odds by 3.4%. Additionally, a patient delivered by an original ANM was 3.14 times more likely to have a PPH compared to a patient delivered by a replacement ANM. Declining PPH rates were associated with improved skills and delivery practices that decreased duration of the second stage of labor. These improvements appeared to be consistent with the introduction of the more skilled replacement ANMs as well as ongoing training and monitoring for all ANMs over the duration of the trial.The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 07/2008; 21(8):559-64. · 1.36 Impact Factor -
Article: Anemia prevalence and risk factors in pregnant women in an urban area of Pakistan.
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ABSTRACT: Anemia affects almost two-thirds of pregnant women in developing countries and contributes to maternal morbidity and mortality and to low birthweight. To determine the prevalence of anemia and the dietary and socioeconomic factors associated with anemia in pregnant women living in an urban community setting in Hyderabad, Pakistan. This was a prospective, observational study of 1,369 pregnant women enrolled at 20 to 26 weeks of gestation and followed to 6 weeks postpartum. A blood sample was obtained at enrollment to determine hemoglobin levels. Information on nutritional knowledge, attitudes, and practice and dietary history regarding usual food intake before and during pregnancy were obtained by trained interviewers within 1 week of enrollment. The prevalence of anemia (defined by the World Health Organization as hemoglobin < 11.0 g/dL) in these subjects was 90.5%; of these, 75.0% had mild anemia (hemoglobin from 9.0 to 10.9 g/dL) and 14.8% had moderate anemia (hemoglobin from 7.0 to 8.9 g/dL). Only 0.7% were severely anemic (hemoglobin < 7.0 g/ dL). Nonanemic women were significantly taller, weighed more, and had a higher body mass index. Multivariate analysis after adjustment for education, pregnancy history, iron supplementation, and height showed that drinking more than three cups of tea per day before pregnancy (adjusted prevalence odds ratio [aPOR], 3.2; 95% confidence interval [CI], 1.3 to 8.0), consumption of clay or dirt during pregnancy (aPOR, 3.7; 95% CI, 1.1 to 12.3), and never consuming eggs or consuming eggs less than twice a week during pregnancy (aPOR, 1.7; 95% CI, 1.1 to 2.5) were significantly associated with anemia. Consumption of red meat less than twice a week prior to pregnancy was marginally associated with anemia (aPOR, 1.2; 95% CI, 0.8 to 1.8) but was significantly associated with lower mean hemoglobin concentrations (9.9 vs. 10.0 g/dL, p = .05) during the study period. A subanalysis excluding women with mild anemia found similar associations to those of the main model, albeit even stronger. A high percentage of women at 20 to 26 weeks of pregnancy had mild to moderate anemia. Pica, tea consumption, and low intake of eggs and red meat were associated with anemia. Women of childbearing age should be provided nutritional education regarding food sources of iron, especially prior to becoming pregnant, and taught how food choices can either enhance or interfere with iron absorption.Food and nutrition bulletin 06/2008; 29(2):132-9. · 1.92 Impact Factor -
Article: A behavioral intervention to improve obstetrical care.
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ABSTRACT: Implementation of evidence-based obstetrical practices remains a significant challenge. Effective strategies to disseminate and implement such practices are needed. We randomly assigned 19 hospitals in Argentina and Uruguay to receive a multifaceted behavioral intervention (including selection of opinion leaders, interactive workshops, training of manual skills, one-on-one academic detailing visits with hospital birth attendants, reminders, and feedback) to develop and implement guidelines for the use of episiotomy and management of the third stage of labor or to receive no intervention. The primary outcomes were the rates of prophylactic use of oxytocin during the third stage of labor and of episiotomy. The main secondary outcomes were postpartum hemorrhage and birth attendants' readiness to change their behavior with regard to episiotomies and management of the third stage of labor. The outcomes were measured at baseline, at the end of the 18-month intervention, and 12 months after the end of the intervention. The rate of use of prophylactic oxytocin increased from 2.1% at baseline to 83.6% after the end of the intervention at hospitals that received the intervention and from 2.6% to 12.3% at control hospitals (P=0.01 for the difference in changes). The rate of use of episiotomy decreased from 41.1% to 29.9% at hospitals receiving the intervention but remained stable at control hospitals, with preintervention and postintervention values of 43.5% and 44.5%, respectively (P<0.001 for the difference in changes). The intervention was also associated with reductions in the rate of postpartum hemorrhage of 500 ml or more (relative rate reduction, 45%; 95% confidence interval [CI], 9 to 71) and of 1000 ml or more (relative rate reduction, 70%; 95% CI, 16 to 78). Birth attendants' readiness to change also increased in the hospitals receiving the intervention. The effects on the use of episiotomy and prophylactic oxytocin were sustained 12 months after the end of the intervention. A multifaceted behavioral intervention increased the prophylactic use of oxytocin during the third stage of labor and reduced the use of episiotomy. (ClinicalTrials.gov number, NCT00070720 [ClinicalTrials.gov]; Current Controlled Trials number, ISRCTN82417627 [controlled-trials.com].).New England Journal of Medicine 05/2008; 358(18):1929-40. · 53.30 Impact Factor -
Article: Factors associated with acute postpartum hemorrhage in low-risk women delivering in rural India.
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ABSTRACT: Postpartum hemorrhage (PPH), a major cause of maternal mortality and morbidity in low-income countries, can occur unpredictably. This study examined the sociodemographic, clinical, and perinatal characteristics of low-risk women who experienced PPH. This analysis was conducted using data on 1620 women from a randomized trial testing oral misoprostol for prevention of PPH in rural India. Of the women, 9.2% experienced PPH. No maternal or sociodemographic factors and few perinatal factors differed between women with PPH and those without, other than treatment with misoprostol. Having fewer than 4 prenatal visits and lack of iron supplementation increased the risk for PPH (P<0.001 and P=0.037, respectively). Several factors unknown until the second stage of labor (perineal tear and birth weight) were also associated (P=0.003). Among women at low risk for PPH, there were few factors associated with further risk. Given that PPH can occur without warning, rural communities should consider ways to increase both primary prevention (iron supplementation, AMTSL) and secondary prevention of PPH (availability of obstetric first aid, availability of transport, and availability of emergency obstetric care).International Journal of Gynecology & Obstetrics 04/2008; 101(1):94-9. · 2.05 Impact Factor -
Article: Tobacco use and secondhand smoke exposure during pregnancy: an investigative survey of women in 9 developing nations.
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ABSTRACT: We examined pregnant women's use of cigarettes and other tobacco products and the exposure of pregnant women and their young children to secondhand smoke (SHS) in 9 nations in Latin America, Asia, and Africa. Face-to-face surveys were administered to 7961 pregnant women (more than 700 per site) between October 2004 and September 2005. At all Latin American sites, pregnant women commonly reported that they had ever tried cigarette smoking (range: 78.3% [Uruguay] to 35.0% [Guatemala]). The highest levels of current smoking were found in Uruguay (18.3%), Argentina (10.3%), and Brazil (6.1%). Experimentation with smokeless tobacco occurred in the Democratic Republic of the Congo and India; one third of all respondents in Orissa, India, were current smokeless tobacco users. SHS exposure was common: between 91.6% (Pakistan) and 17.1% (Democratic Republic of the Congo) of pregnant women reported that smoking was permitted in their home. Pregnant women's tobacco use and SHS exposure are current or emerging problems in several low- and middle-income nations, jeopardizing ongoing efforts to improve maternal and child health.American Journal of Public Health 03/2008; 98(10):1833-40. · 3.93 Impact Factor -
Article: Antioxidant therapy to prevent preeclampsia: a randomized controlled trial.
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ABSTRACT: To study whether antioxidant supplementation will reduce the incidence of preeclampsia among patients at increased risk. A randomized, placebo-controlled, double-blind clinical trial was conducted at four Brazilian sites. Women between 12 0/7 weeks and 19 6/7 weeks of gestation and diagnosed to have chronic hypertension or a prior history of preeclampsia were randomly assigned to daily treatment with both vitamin C (1,000 mg) and vitamin E (400 International Units) or placebo. Analyses were adjusted for clinical site and risk group (prior preeclampsia, chronic hypertension, or both). A sample size of 734 would provide 80% power to detect a 40% reduction in the risk of preeclampsia, assuming a placebo group rate of 21% and alpha=.05. The alpha level for the final analysis, adjusted for interim looks, was 0.0458. Outcome data for 707 of 739 randomly assigned patients revealed no significant reduction in the rate of preeclampsia (study drug, 13.8% [49 of 355] compared with placebo, 15.6% [55 of 352], adjusted risk ratio 0.87 [95.42% confidence interval 0.61-1.25]). There were no differences in mean gestational age at delivery or rates of perinatal mortality, abruptio placentae, preterm delivery, and small for gestational age or low birth weight infants. Among patients without chronic hypertension, there was a slightly higher rate of severe preeclampsia in the study group (study drug, 6.5% [11 of 170] compared with placebo, 2.4% [4 of 168], exact P=.11, odds ratio 2.78, 95% confidence interval 0.79-12.62). This trial failed to demonstrate a benefit of antioxidant supplementation in reducing the rate of preeclampsia among patients with chronic hypertension and/or prior preeclampsia. ClinicalTrials.gov, www.ClinicalTrials.gov, NCT00097110 I.Obstetrics and Gynecology 01/2008; 110(6):1311-8. · 4.73 Impact Factor -
Article: Stillbirths in an urban community in Pakistan.
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ABSTRACT: The purpose of this study was to determine stillbirth risk factors and gestational age at delivery in a prospective developing country birth cohort. At 20-26 weeks of gestation, 1369 Pakistani women were prospectively enrolled in the study; the gestational age was determined by ultrasound evaluation, and risk factors and pregnancy outcomes were assessed. The stillbirth rate was 33.6 of 1000 births, despite the fact that 96% of the women received prenatal care, 83% of the women were attended by skilled providers in the hospital, and a 20% of the women underwent cesarean delivery. Fifty-one percent of stillbirths occurred at > or = 37 weeks of gestation and 19% occurred from 34-36 weeks of gestation. Only 4% of the births had congenital anomalies. Hemoglobin of < 8 g/dL, vaginal bleeding, and preeclampsia were associated with increased stillbirth risk. In this developing country with reasonable technical resources defined by hospital delivery and a high cesarean delivery rate, stillbirth rates were much higher than rates in the United States. That most of the stillbirths were term and did not have congenital anomalies and that the death appeared to be recent suggests that many Pakistani stillbirths may be preventable with higher quality obstetric care.American journal of obstetrics and gynecology 09/2007; 197(3):257.e1-8. · 3.28 Impact Factor -
Article: Diagnostic validity of two instruments for assessing anxiety and depression among pregnant women in Hyderabad, Pakistan.
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ABSTRACT: The objective of this study was to compare the diagnostic validity of two measures, the Aga Khan University Anxiety and Depression Scale (AKUADS) and the How I Feel scale, for assessing anxiety and depression among pregnant women in Pakistan. The sample included 200 pregnant women in Hyderabad, Pakistan. Using psychiatrist-administered Diagnostic and Statistical Manual of Mental Disorders-fourth edition (DSM-IV) criteria, 71 (36%) of the women were diagnosed with depression or anxiety or both. Receiver operating characteristic (ROC) analyses indicated that the two scales had similar levels of discrimination. This study represents an important initial step in developing measures to assess the psychological well-being of Pakistani pregnant women. Additional research is needed, however, to improve the sensitivity and specificity of these scales by removing items that do not function well in this population.Health Care For Women International 08/2007; 28(6):556-72. · 0.63 Impact Factor -
Article: Oral Misoprostol in Preventing Postpartum Hemorrhage in Resource-Poor Communities: A Randomized Controlled Trial
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ABSTRACT: The commonest cause of maternal deaths worldwide is postpartum bleeding, and the great majority of such deaths take place in developing countries such as India where women frequently do not deliver their children in a hospital setting. The major cause is uterine atony, which can be prevented by administering a uterotonic agent such as oxytocin. Such treatment remains impractical for much of the developing world, where women giving birth are cared for by untrained attendants. In addition, injected uterotonic agents must be stored in the cold and require active management of the third stage of labor. Orally administered misoprostol, a prostaglandin E1 analogue, is a comparatively inexpensive alternative to oxytocin that has proved to be effective and safe, does not need to be refrigerated, and has a long shelf life. The investigators report a trial, conducted in rural India, which compared a single oral dose of 600 μg of misoprostol (n = 812) with placebo (n = 808) for preventing acute postpartum hemorrhage, defined as 500 mL or more within 2 hours after delivery. Medication was administered within 5 minutes of cutting the umbilical cord. The rate of acute severe bleeding (1000 mL or more within 2 hours) also was estimated. The actively treated women and placebo recipients were similar with respect to demographic, clinical, and perinatal features. The overall incidence of acute postpartum hemorrhage was 9.2%, occurring in 6.4% of misoprostol-treated women compared to 12% of placebo recipients, a highly significant difference (P < 0.0001). The relative risk for actively treated women compared with the placebo group was 0.53 (95% confidence interval, 0.39-0.74). All but 2 of 10 women with acute severe postpartum bleeding had received the placebo. Overall mean blood loss was lessened by misoprostol (214 versus 262 mL; P < 0.0001). Actively treated women were less likely to require transfer to a higher-level facility, blood transfusion, and surgical interventions. There were no group differences in delayed postpartum bleeding or infection. Rates of neonatal fever, vomiting, and diarrhea did not differ in the two groups. Oral administration of the prostaglandin analogue misoprostol is an effective, safe, inexpensive, and easily administered means of limiting the risk of postpartum bleeding in areas where medical resources may be scarce.Obstetrical and Gynecological Survey 01/2007; 62(2):95-96. · 2.51 Impact Factor -
Article: Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial.
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ABSTRACT: Postpartum haemorrhage is a major cause of maternal mortality in the developing world. Although effective methods for prevention and treatment of such haemorrhage exist--such as the uterotonic drug oxytocin--most are not feasible in resource-poor settings where many births occur at home. We aimed to investigate whether oral misoprostol, a potential alternative to oxytocin, could prevent postpartum haemorrhage in a community home-birth setting. In a placebo-controlled trial undertaken between September, 2002, and December, 2005, 1620 women in rural India were randomised to receive oral misoprostol (n=812) or placebo (n=808) after delivery. 25 auxiliary nurse midwives undertook the deliveries, administered the study drug, and measured blood loss. The primary outcome was the incidence of acute postpartum haemorrhage (defined as > or =500 mL bleeding) within 2 h of delivery. Analysis was by intention-to-treat. The trial was registered with the US clinical trials database (http://www. clinicaltrials.gov) as number NCT00097123. Oral misoprostol was associated with a significant reduction in the rate of acute postpartum haemorrhage (12.0% to 6.4%, p<0.0001; relative risk 0.53 [95% CI 0.39-0.74]) and acute severe postpartum haemorrhage (1.2% to 0.2%, p<0.0001; 0.20 [0.04-0.91]. One case of postpartum haemorrhage was prevented for every 18 women treated. Misoprostol was also associated with a decrease in mean postpartum blood loss (262.3 mL to 214.3 mL, p<0.0001). Postpartum haemorrhage rates fell over time in both groups but remained significantly higher in the placebo group. Women taking misoprostol had a higher rate of transitory symptoms of chills and fever than the control. Oral misoprostol was associated with significant decreases in the rate of acute postpartum haemorrhage and mean blood loss. The drug's low cost, ease of administration, stability, and a positive safety profile make it a good option in resource-poor settings.The Lancet 10/2006; 368(9543):1248-53. · 38.28 Impact Factor -
Article: Measuring antenatal depression and anxiety: findings from a community-based study of women in Hyderabad, Pakistan.
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ABSTRACT: This study evaluated the psychometric properties of two possible measures of depression and anxiety among pregnant women in Pakistan for use in the Global Network for Women's and Children's Health Research project, a collaborative, international multi-site research network investigating methods for improving pregnancy and birth outcomes in developing countries. The first measure, the Aga Khan University Anxiety and Depression Scale (AKUADS), is an Urdu language scale originally developed for the general Pakistani population, whereas the second measure, the How I Feel scale, was designed for pregnant women in the United States. In an earlier pilot study, we found that the two scales demonstrated similar levels of diagnostic validity. Because neither scale was designed for the specific population of interest, item response theory analyses were conducted to evaluate the psychometric properties of the scales at three levels of measurement: scale, item, and response option. The study results provide insights that may be useful to researchers or clinicians developing or using scales in this population. In particular, our findings suggest that scales designed for populations with lower literacy, such as our target population, may improve data quality by including no more than three response options (e.g., almost always, sometimes, and never) and keeping the direction of item wording consistent throughout the scale. Based on the results from the current study, we recommend a short form of the AKUADS which removes poorly functioning items and reduces respondent burden while retaining the reliability and validity of the longer form.Women & Health 02/2006; 44(3):79-103. · 1.00 Impact Factor -
Article: A cluster randomized controlled trial of a behavioral intervention to facilitate the development and implementation of clinical practice guidelines in Latin American maternity hospitals: the Guidelines Trial: Study protocol [ISRCTN82417627].
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ABSTRACT: BACKGROUND: A significant proportion of the health care administered to women in Latin American maternity hospitals during labor and delivery has been demonstrated to be ineffective or harmful, whereas effective interventions remain underutilized. The routine use of episiotomies and the failure to use active management of the third stage of labor are good examples. METHODS/DESIGN: The aim of this trial is to evaluate the effect of a multifaceted behavioral intervention on the use of two evidence-based birth practices, the selective use of episiotomies and active management of the third stage of labor (injection of 10 International Units of oxytocin). The intervention is based on behavioral and organizational change theories and was based on formative research. Twenty-four hospitals in three urban districts of Argentina and Uruguay will be randomized. Opinion leaders in the 12 intervention hospitals will be identified and trained to develop and implement evidence-based guidelines. They will then disseminate the guidelines using a multifaceted approach including academic detailing, reminders, and feedback on utilization rates. The 12 hospitals in the control group will continue with their standard in-service training activities. The main outcomes to be assessed are the rates of episiotomy and oxytocin use during the third stage of labor. Secondary outcomes will be perineal sutures, postpartum hemorrhages, and birth attendants' opinions.BMC Women s Health 05/2005; 5(1):4.
Top co-authors
Top Journals
Institutions
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2010
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University of Zambia
Lusaka, Lusaka Province, Zambia -
Eunice Kennedy Shriver National Institute of Child Health and Human Development
Rockville, MD, USA
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2006–2009
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Aga Khan University Hospital, Karachi
Karachi, Sindh, Pakistan -
University of Missouri - Kansas City
Kansas City, MO, USA
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2008
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University of California, Davis
- Program in International and Community Nutrition
Davis, CA, USA
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