A community evaluation of post-partum quality of life using a locally adapted mother-generated-index: the Delhi Delivery Care (DELCARE) Survey (2009-2011)

ABSTRACT

Post-partum quality of life is an inadequately studied and poorly understood outcome of delivery care, especially in low- and middle-income countries. Hence, we evaluated the postpartum quality of life and its clinic-demographic context as part of a 3-stage cluster randomized community survey (DECLARE; covered quality of care as primary outcome) conducted in 2009–2011 in Delhi. In stage 1 of participant selection(sampling), 20 wards (of 150; geographically defined administrative units) were selected using a probability-proportionate-to-size systematic method. In stage 2, one from each income stratum (high, middle, and low; multiple colonies within each ward) was selected from each ward by simple random sampling (total 60 colonies of 2311). In stage 3, a house-to-house survey was conducted to recruit ~1800 recently delivered women for the multidimensional work, which included quality-of-care, cost-of-care, and PPQOL. Among the participants, those with high school or above education were invited to administer the Mother-Generated Index and calculate the primary and secondary index scores (PIS and SIS). A total of 794 (of 857 eligible; 118846 households) women were administered MGI. The mean PIS was 4.6[95 percent CI 4.4–4.7] while the average SIS was 4.0[95 percent CI 3.8–4.2]. The PIS was worse for primiparous vs. multiparous mothers. On multivariate analysis, poorer psychological state, obstetric complications, and premature delivery correlated with poorer QOL scores, while better gestational weight gain, higher age, and labor-pain relief correlated with better QOL scores. The study benchmarks the poor status of post-partum quality-of-life and documents the spectrum, severity, and complexity of its key social, psychological, physical, and demographic determinants.

KEYWORDS:

• Delivery
• India
• post-partum
• quality of life
• survey

Acknowledgments

We want to acknowledge the commendable efforts of our DELCARE team- Research Fellows-Ms Aarti Sachdeva, Ms. Mahak Sharma, Ms. Sarita Yadav, Ms. Tanu Jain, Ms. Deepika Madan, Ms. Kusumlata, Ms. Swati Srivastava; Data Entry Operator- Mr. Awadesh Kumar; Field Workers- Ms. Hemlata, Ms. Archana, Ms. Seema, Ms. Nazneen, Ms. Sajida, Ms. Amba.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contribution

JN contributed to the concept and design of the study. JN and SR were involved in Data analysis, finalization of the manuscript, and paper writing. JN will act as guarantor for the project. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

Ethical approval

The project was approved by the Institutional Ethics Committee at Sitaram Bhartia Institute of Science and Research (Dated 3/10/2008; SBISR/IEC/2008/03).

Additional information

Funding

This study was funded by the Indian Council of Medical Research, New Delhi. The Indian Council of Medical Research approved the project protocol for funding but had no role in data collection, analysis or interpretation, in the writing of the report or in the decision to submit the article for publication. The researchers were completely independent from the funders.