Muhammad Masood Kadir

Publications of Muhammad Masood Kadir

• Preventable lifestyle risk factors for non-communicable diseases in the Pakistan Adolescents Schools Study 1 (PASS-1).

  Authors: Ali Khan Khuwaja, Saleem Khawaja, Komal Motwani, Adeel Akbar Khoja, Iqbal Syed Azam, Zafar Fatmi, Badar Sabir Ali, Muhammad Masood Kadir

  Journal of preventive medicine and public health = Yebang Ŭihakhoe chi. 09/2011; 44(5):210-7.

  The rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDsThe rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDs in adolescents. In a school-based study, pre-tested structured questionnaires were completed by 414 adolescents (14 to 17 years) at six schools in three cities in Pakistan. The chi-squared test and adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated in a multinomial logistic regression analysis. Over 80% of the adolescents had unhealthy diets, and 54% were physically inactive. Most adolescents were exposed to passive smoking, and 14% were also current smokers. More than one-third of participants chewed betel nut, and one-quarter used oral tobacco. More girls were physically inactive (OR, 4.07; 95% CI, 2.69 to 6.17), whereas a greater proportion of boys were current smokers (OR, 2.17; 95% CI, 1.19 to 3.91), exposed to passive smoking (OR, 2.57; 95% CI, 1.72 to 3.83), and using betel nut (OR, 2.03; 95% CI, 1.34 to 3.06). Only 3.1% of the participants were without any preventable lifestyle risk factor for NCDs, and over 80% had ≥2 factors. Co-existence of risk factors was independently associated with fathers being blue-collar workers (aOR, 3.57; 95% CI, 1.07 to 11.92) and parents not treating their child fairly (aOR, 5.05; 95% CI, 1.29 to 19.78). Most of the adolescents studied had preventable risk factors for NCDs. These results warrant comprehensive and integrated interventions to prevent lifestyle risk factors, and parents are front-line stakeholders.

• Indoor air pollution (PM2.5) due to secondhand smoke in selected hospitality and entertainment venues of Karachi, Pakistan.

  Authors: Asaad Ahmed Nafees, Tahir Taj, Muhammad Masood Kadir, Zafar Fatmi, Kiyoung Lee, Nalini Sathiakumar

  Tobacco control. 06/2011;

  Objective To determine particulate matter smaller than 2.5 μm (PM(2.5)) levels at various hospitality and entertainment venues of Karachi, Pakistan. Methods This was a descriptive cross-sectionalObjective To determine particulate matter smaller than 2.5 μm (PM(2.5)) levels at various hospitality and entertainment venues of Karachi, Pakistan. Methods This was a descriptive cross-sectional study conducted at various locations in Karachi, during July 2009. Sampling was performed at 20 enclosed public places, including hospitality (restaurants and cafés) and entertainment (snooker/billiard clubs and gaming zones) venues. PM(2.5) levels were measured using an aerosol monitor. Results All entertainment venues had higher indoor PM(2.5) levels as compared to the immediate outdoors. The indoor PM(2.5) levels ranged from 25 to 390 μg/m(3) and the outdoor PM(2.5) levels ranged from 18 to 96 μg/m(3). The overall mean indoor PM(2.5) level was 138.8 μg/m(3) (±112.8). Among the four types of venues, the highest mean indoor PM(2.5) level was reported from snooker/billiard clubs: 264.7 μg/m(3) (±85.4) and the lowest from restaurants: 66.4 μg/m(3) (±57.6) while the indoor/outdoor ratio ranged from 0.97 to 10.2, highest being at the snooker/billiard clubs. The smoking density ranged from 0.21 to 0.57, highest being at gaming zones. The indoor PM(2.5) concentration and smoking density were not significantly correlated (Spearman's correlation coefficient=0.113; p=0.636). Conclusions This study demonstrates unacceptably high levels of PM(2.5) exposure associated with secondhand smoke (SHS) at various entertainment venues of Karachi even after 8 years since the promulgation of smoke-free ordinance (2002) in Pakistan; however, better compliance may be evident at hospitality venues. The results of this study call for effective implementation and enforcement of smoke-free environment at public places in the country.

• Gender differences and clustering pattern of behavioural risk factors for chronic non-communicable diseases: community-based study from a developing country.

  Authors: Ali Khan Khuwaja, Muhammad Masood Kadir

  Chronic illness. 05/2010; 6(3):163-70.

  This study estimates the burden of behavioural risk factors for chronic non-communicable diseases (CNDs) to evaluate the degree of clustering and the differential of these factors by gender inThis study estimates the burden of behavioural risk factors for chronic non-communicable diseases (CNDs) to evaluate the degree of clustering and the differential of these factors by gender in adults. In a community-based survey, information was obtained about behavioural risk factors for CNDs among 534 adults in Karachi, Pakistan. Chi-square test and odds ratio (OR) with 95% confidence interval (CI) were calculated to evaluate the differences of these factors by gender. Overall, 22.5% of adults had anxiety/depression, 47.8% did not have adequate intake of fruits and vegetables, 60.1% were physically inactive while 49.8% were overweight/obese. More women had anxiety/ depression (OR = 2.1; 95% CI = 1.4-3.1), were physically inactive (OR=2.1; 95% CI = 1.5-3.1) and overweight/ obese (OR= 6.2; 95% CI = 4.3-9.1). On the contrary, greater number of men were found to have inadequate fruit and vegetable consumption (OR = 1.8; 95% CI = 1.3-2.5). Only 1.1% of study subjects had none of the studied risk factors, 16.9% had one while 82% had > or =2 factors. The clustering of these risk factors was significantly higher in women (p<0.001). This study shows that almost all of the adults in the study had behavioural risk factors for CNDs and clustering of these factors is very common and significantly higher in women. The tendency of clustering risk factors in individuals provides opportunities to address factors with integrated approaches to prevent/delay the onset of CNDs.

• Exposure of pregnant women to indoor air pollution: a study from nine low and middle income countries.

  Authors: Muhammad Masood Kadir, Elizabeth M McClure, Shivaprasad S Goudar, Ana L Garces, Janet Moore, Marie Onyamboko, Christine Kaseba, Fernando Althabe, Eduardo E Castilla, Salvio Freire, Sailajanandan Parida, Sarah Saleem, Linda L Wright, Robert L Goldenberg

  Acta obstetricia et gynecologica Scandinavica. 12/2009;

  Abstract Objective. We studied exposure to solid fuel and second-hand tobacco smoke among pregnant women in south Asia, Africa and Latin America. Design. Prospective cross-sectional survey. Setting.Abstract Objective. We studied exposure to solid fuel and second-hand tobacco smoke among pregnant women in south Asia, Africa and Latin America. Design. Prospective cross-sectional survey. Setting. Antenatal clinics in Argentina, Brazil, Ecuador, Guatemala, Uruguay, Democratic Republic of Congo, Zambia, India and Pakistan. Sample. A total of 7,961 pregnant women in ten sites in nine countries were interviewed between October 2004 and September 2005. Methods. A standardized questionnaire on exposure to indoor air pollution (IAP) and second-hand smoke was administered to pregnant women during antenatal care. Main outcome measures. Exposure to IAP and second-hand tobacco smoke. Results. South Asian pregnant women commonly reported use of wood (49.1-89.7%), crop residue and animal dung as cooking and heating fuel. African pregnant women reported higher use of charcoal (85.4-93.5%). Latin American pregnant women had greater use of petroleum gas. Among south Asian women, solid fuel use and cooking on an open flame inside the home were common. There was a significant association between solid fuel use and allowing smoking within the home at the Asian sites and in Zambia (p < 0.05). Conclusions. Pregnant women from low/middle income countries were commonly exposed to IAP secondary to use of solid fuels. Among these populations, exposure to second-hand tobacco smoke was also common. This combination of exposures likely increases the risk of poor pregnancy outcomes among the most vulnerable women. Our study highlights the importance of further research on the combined impact of IAP and second-hand tobacco smoke exposures on adverse maternal and perinatal outcomes.

• Trends in Mycobacterium tuberculosis resistance, Pakistan, 1990-2007.

  Authors: Rumina Hasan, Kauser Jabeen, Vikram Mehraj, Farhan Zafar, Faisal Malik, Qaiser Hassan, Iqbal Azam, Muhammad Masood Kadir

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 04/2009;

  OBJECTIVE: To determine resistance trends including the emergence of extensive drug resistance (XDR) in Mycobacterium tuberculosis (MTB) isolates from Pakistan. METHODS: This was a retrospectiveOBJECTIVE: To determine resistance trends including the emergence of extensive drug resistance (XDR) in Mycobacterium tuberculosis (MTB) isolates from Pakistan. METHODS: This was a retrospective analysis of MTB isolates (January 1990-June 2007) collected from the four provinces of Pakistan. Standard methods were used to isolate MTB. Susceptibility against rifampin, isoniazid, streptomycin, ethambutol, ethionamide, capreomycin, cycloserine, and ciprofloxacin was tested using the agar proportion method, while susceptibility to pyrazinamide was determined using BACTEC. Resistance over the study period was assessed using Chi-square for trend analysis. RESULTS: Resistance in 15343 MTB isolates showed a steady increase over the study period; a significant trend of increasing resistance was noted in three of the four provinces included in the study. XDR-tuberculosis was first seen in 1998; to date 22 XDR cases have been documented. MTB resistance was significantly lower (p<0.001) in patients under 5 and over 60 years of age, and significantly higher in males than females (p<0.001). MTB resistance was also higher in pulmonary than extrapulmonary isolates (p<0.001). CONCLUSION: This study documenting a steady increase in resistance among MTB isolates and the emergence of XDR strains is concerning. The data highlight the need to ensure adequate treatment of cases in order to prevent a further increase in multidrug resistance within the country. The importance of developing systems for monitoring drug resistance through nationwide surveillance is emphasized.

• Status of children's blood lead levels in Pakistan: Implications for research and policy.

  Authors: Muhammad Masood Kadir, Naveed Zafar Janjua, Sibylle Kristensen, Zafar Fatmi, Nalini Sathiakumar

  Public health. 08/2008; 122(7):708-15.

  OBJECTIVES: Data on blood lead levels, sources of lead and health effects were reviewed among children in Pakistan. METHODS: A systematic review was conducted of published studies found throughOBJECTIVES: Data on blood lead levels, sources of lead and health effects were reviewed among children in Pakistan. METHODS: A systematic review was conducted of published studies found through PubMed, an index of Pakistani medical journals PakMediNet and unpublished reports from governmental and non-governmental agencies in Pakistan. RESULTS: With the exception of a few studies that had adequate sample sizes and population-based samples, most studies were small and used convenience sampling methods to select study subjects. Overall, blood lead levels declined from 38mug/dl in 1989 to 15mug/dl in 2002. The major sources of lead that directly or indirectly resulted in lead exposure of children included: leaded petrol; father's occupation in lead-based industry; leaded paint; traditional cosmetics; and remedies. Apart from leaded petrol, there was no information regarding the level of lead in other sources such as paints and the household environment. Very little information was available regarding the adverse health effects of lead among children. CONCLUSION: The phasing out of leaded petrol was a commendable mitigation measure undertaken in July 2001 in Pakistan. A comprehensive assessment is now needed urgently to explore other sources of lead contributing to adverse health effects, and to plan intervention options with the ultimate goal of reducing the burden of disease due to lead exposure.

• Tobacco Use and Secondhand Smoke Exposure During Pregnancy: An Investigative Survey of Women in 9 Developing Nations.

  Authors: Michele Bloch, Fernando Althabe, Marie Onyamboko, Christine Kaseba-Sata, Eduardo E Castilla, Salvio Freire, Ana L Garces, Sailajanandan Parida, Shivaprasad S Goudar, Muhammad Masood Kadir, Norman Goco, Jutta Thornberry, Magdalena Daniels, Janet Bartz, Tyler Hartwell, Nancy Moss, Robert Goldenberg

  American journal of public health. 03/2008;

  Objectives. 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 LatinObjectives. 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. Methods. Face-to-face surveys were administered to 7961 pregnant women (more than700 per site) between October 2004 and September 2005. Results. 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. Conclusions. 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.

• Thirty years of Alma Ata pledges: is devolution in Pakistan an opportunity for rekindling primary health care?

  Authors: Babar T Shaikh, Muhammad Masood Kadir, Gregory Pappas

  JPMA. The Journal of the Pakistan Medical Association. 06/2007; 57(5):259-61.

  The 1978 Alma Ata Conference presented the manifesto to attain global health for the next century by providing basic health care aimed at the urban and rural poor of the developing world. While theThe 1978 Alma Ata Conference presented the manifesto to attain global health for the next century by providing basic health care aimed at the urban and rural poor of the developing world. While the goals of Alma Ata were noble, they were untenable. Today, developing countries face serious issues of equity in health care delivery and fairness in health care management with even a greater need to transform the management systems and practice. Primary health care remains a cornerstone of building the capacity of health systems. Devolution in health sector in Pakistan seems like a chance to re-exert Alma Ata agenda. To achieve the millennium development goals by 2015, revitalization and effective implementation of primary health care will be a vital reform.

• Knowledge and beliefs of adolescents regarding sexually transmitted infections and HIV/AIDS in a rural district in Pakistan.

  Authors: Hafsa Raheel, Franklin White, Muhammad Masood Kadir, Zafar Fatmi

  JPMA. The Journal of the Pakistan Medical Association. 02/2007; 57(1):8-11.

  OBJECTIVE: To assess the knowledge and beliefs of adolescents (15-19 years girls and boys) regarding sexually transmitted infections (STIs) and HIV/AIDS. METHODS: A community based cross-sectionalOBJECTIVE: To assess the knowledge and beliefs of adolescents (15-19 years girls and boys) regarding sexually transmitted infections (STIs) and HIV/AIDS. METHODS: A community based cross-sectional survey was conducted in October 2002 in a rural district (Mirpurkhas) of Sindh province, Pakistan. RESULTS: A total of 428 adolescent girls and boys were interviewed. Only 44% correctly named at least one STI, while 55% knew at least two modes of transmission for HIV/AIDS. Adolescents with education greater than or equal to secondary level, those who were able to read the newspaper, possessed electricity in their homes and were allowed to meet their friends once in six months had significantly more HIV/AIDS knowledge. CONCLUSION: We conclude that rural adolescents of Sindh need more knowledge regarding STIs including HIV/AIDS. There is a need to formulate strategies to raise the levels of awareness and knowledge among adolescents regarding these conditions. Our findings indirectly support the use of mass media and peer education strategies to provide factual information to adolescents.

• Social environment and depression among pregnant women in urban areas of Pakistan: importance of social relations.

  Authors: Ambreen Kazi, Zafar Fatmi, Juanita Hatcher, Muhammad Masood Kadir, Unaiza Niaz, Gail A Wasserman

  Social science & medicine (1982). 10/2006; 63(6):1466-76.

  Aspects of the social environment, including social conditions (socio-economic status, household situations, chronic illnesses) and social relations (attitude and behaviors of relations) are majorAspects of the social environment, including social conditions (socio-economic status, household situations, chronic illnesses) and social relations (attitude and behaviors of relations) are major determinants of depression among women. This study evaluates the relative power of social relations and social conditions in predicting depression among pregnant women in Pakistan. In the qualitative phase of the study, social environmental determinants were identified through literature search, and experts' opinions from psychologists, psychiatrists, gynecologists, sociologists and researchers. Along with this, 79 in-depth interviews were conducted with pregnant women drawn from six hospitals (public and private) and two communities in Karachi, Pakistan. Identified determinants of depression were grouped into themes of social conditions and social relations and pregnancy-related concerns. In the study's quantitative phase, the relative power of the identified themes and categories, based on their scores for predicting depression (determined by the Center for Epidemiological Studies-Depression Scale (CES-D scale)), was determined through multivariate linear regression. Social environmental determinants of pregnant women were described under the themes and categories of (1) social relations: involving husband, in-laws and children; (2) social conditions: involving the economy, illness, life events, household work, environmental circumstances and social problems; and (3) pregnancy-related concerns i.e. symptoms of pregnancy, changes during pregnancy, dependency and concern for unborn baby. Multivariate analysis found that among these themes, social relations and pregnancy-related concerns were significantly associated with total CES-D scores. Among the categories besides increasing age and less education, husband, in-laws, household work and pregnancy symptoms were significantly associated with total CES-D scores. The study highlights the importance of social relations compared to social conditions for determining depression in pregnant women.

• Acute health effects of the Tasman Spirit oil spill on residents of Karachi, Pakistan.

  Authors: Naveed Zafar Janjua, Pashtoon Murtaza Kasi, Haq Nawaz, Sadia Zohra Farooqui, Urooj Bakht Khuwaja, Najam-ul-Hassan, Syed Nadim Jafri, Shahid Ali Lutfi, Muhammad Masood Kadir, Nalini Sathiakumar

  BMC public health. 02/2006; 6:84.

  BACKGROUND: On July 27 2003, a ship carrying crude oil ran aground near Karachi and after two weeks released 37,000 tons of its cargo into the sea. Oil on the coastal areas and fumes in air raisedBACKGROUND: On July 27 2003, a ship carrying crude oil ran aground near Karachi and after two weeks released 37,000 tons of its cargo into the sea. Oil on the coastal areas and fumes in air raised health concerns among people. We assessed the immediate health impact of oil spill from the tanker Tasman Spirit on residents of the affected coastline in Karachi, Pakistan. METHODS: We conducted a study consisting of an exposed group including adults living in houses on the affected shoreline and two control groups (A and B) who lived at the distance of 2 km and 20 km away from the sea, respectively. We selected households through systematic sampling and interviewed an adult male and female in each household about symptoms relating to eyes, respiratory tract, skin and nervous system, smoking, allergies, beliefs about the effect on their health and anxiety about the health effects. We used logistic regression procedures to model each symptom as an outcome and the exposure status as an independent variable while adjusting for confounders. We also used linear regression procedure to assess the relationship exposure status with symptoms score; calculated by summation of all symptoms. RESULTS: Overall 400 subjects were interviewed (exposed, n = 216; group A, n = 83; and group B, n = 101). The exposed group reported a higher occurrence of one or more symptoms compared to either of the control groups (exposed, 96% vs. group A, 70%, group B 85%; P < 0.001). Mean summary symptom scores were higher among the exposed group (14.5) than control group A (4.5) and control group B (3.8, P < 0.001). Logistic regression models indicated that there were statistically significant, moderate-to-strong associations (Prevalence ORs (POR) ranging from 2.3 to 37.0) between the exposed group and the symptoms. There was a trend of decreasing symptom-specific PORs with increase in distance from the spill site. Multiple linear regression model revealed strong relationship of exposure status with the symptoms score (beta = 8.24, 95% CI: 6.37-10.12). CONCLUSION: Results suggest that the occurrence of increased symptoms among the exposed group is more likely to be due to exposure to the crude oil spill.

• Do community medicine residency trainees learn through journal club? An experience from a developing country.

  Authors: Saima Akhund, Muhammad Masood Kadir

  BMC medical education. 02/2006; 6:43.

  BACKGROUND: Journal clubs are an internationally recognized teaching tool in many postgraduate medical education fields. In developing countries lack of funds for current print materials may haveBACKGROUND: Journal clubs are an internationally recognized teaching tool in many postgraduate medical education fields. In developing countries lack of funds for current print materials may have limited journal club use. But with advancing information technology trainees in developing countries increasingly have more access to high quality journals online. However, we are aware of no studies describing journal club existence and effectiveness in postgraduate medical training in Pakistan. Also we have found no published effectiveness studies of this teaching modality in Community Medicine (Public Health) in any country. This study evaluated the effectiveness of Community Medicine (Public Health) Resident Journal Club (CMR-JC) in Aga Khan University, Pakistan using international criteria for successful journal clubs (2 years continuous existence and more than 50% attendance) and examining resident and alumni satisfaction. METHODS: Journal club effectiveness criteria were searched using electronic search databases. Departmental records were reviewed from September 1999-September 2005. Ninety percent of residents and alumni of Community Medicine Residency Programme participated voluntarily in a confidential survey. RESULTS: The CMR-JC was regularly conducted. More than 95% of residents attended. (Total residents in the CMR-Programme: 32). Twenty-seven out of 29 current residents/alumni responded to the anonymous questionnaire. Acquisition of critical appraisal skills (23 respondents) and keeping up with current literature (18 respondents) were the two most important objectives achieved. Respondents recommended improved faculty participation and incorporating a structured checklist for article review. CONCLUSION: CMR-JC fulfils criteria for effective journal clubs. Residents and alumni agree CMR-JC meets its objectives. Incorporating suggested recommendations will further improve standards. The journal club learning modality should be included in residency training programs in developing countries. Effective use of online resources to support journal clubs is demonstrated as a successful alternative to excessive expenditure for obtaining print journals. Those trying to start or improve journal clubs can benefit from our experience.

• Smoking among adult males in an urban community of Karachi, Pakistan.

  Authors: Ali Khan Khuwaja, Muhammad Masood Kadir

  The Southeast Asian journal of tropical medicine and public health. 01/2005; 35(4):999-1004.

  Smoking is the single most important avoidable cause of premature morbidity and mortality in the world. It is a major public health problem in Pakistan. The objectives of this study were to assessSmoking is the single most important avoidable cause of premature morbidity and mortality in the world. It is a major public health problem in Pakistan. The objectives of this study were to assess smoking status and its relationship to socio-demographic characteristics, and to determine the behavior of male smokers in an urban community in Karachi, Pakistan. A cross-sectional, household survey was conducted among 396 males, aged 15 years and above in January and February 2002. The overall prevalence of current smokers was 34%. By univariate analysis, the factors associated with smoking were younger age (15-29 years) (OR=4.2, 95% CI 2.1-7.3) as compared to older age (> 45 years), unmarried as compared to married (OR=3.1, 95% CI 1.9-5.4), educated for > 12 years compared to those with an education of 0-5 years (OR=2.0, 95% CI 1.2-3.3), and being student as compared to being an office/business worker (OR=3.2, 95% CI 1.8-5.4). The majority of smokers (55%) began smoking when younger than 25 years, smoked for more than 5 years (53%), smoked more than 10 cigarettes a day (55%) and smoked in public places (82%). Forty-two percent of the smokers used tobacco in other forms as well. Fifty-eight percent of smokers smoked to relieve anger and frustration and 30% smoked due to friend or peer pressure. In conclusion, smoking is a major problem in especially in younger age groups. There is an urgent need for health promotion and anti-tobacco education in combating the epidemic of smoking in Pakistan.

• Do mothers-in-law matter? Family dynamics and fertility decision-making in urban squatter settlements of Karachi, Pakistan.

  Authors: Muhammad Masood Kadir, Fariyal F Fikree, Amanullah Khan, Fatima Sajan

  Journal of biosocial science. 11/2003; 35(4):545-58.

  The perspectives of mothers-in-law about intra-household decision-making, family size and family planning are investigated, and their views compared with those of their sons and daughters-in-law.The perspectives of mothers-in-law about intra-household decision-making, family size and family planning are investigated, and their views compared with those of their sons and daughters-in-law. Women (717 daughters-in-law), their husbands (717 sons) and their 522 mothers-in-law were interviewed in eight squatter settlements in Karachi, Pakistan. Decisions about the schooling and health care of children, and the purchase of jewellery, are perceived to lie within the nuclear family domain (i.e. husband and wife). There was a difference in mothers-in-law's, daughters-in-law's and sons' desire to have more children. Twenty-eight per cent of mothers-in-law versus 58%, of daughters-in-law did not want more grandsons/sons and 36%, of mothers-in-law versus 66% of daughters-in-law did not want more granddaughters/daughters. The difference was markedly greater among the mother-in-law/daughter-in-law pairs than in the mother/son pairs. Overall, the mother-in-law's role seems to be somewhat overshadowed by that of her son (family male member), except for limiting family size. It is suggested that mothers-in-law should be included in Information-Education-Communication (IEC) campaigns about family planning.