Translation and Cultural Adaptation of IMMPACT Toolkit: Productivity Cost of Maternal Ill Health

The following is part of a series of project updates from the Department of Community Medicine at Rajarata University of Sri Lanka. MHTF is supporting their project, Measuring Economic Impact of Maternal Morbidity. More information on MHTF supported projects can be found here.

Written by: Department of Community Medicine

The productivity cost is commonly defined as the value of specific categories of one’s time that is adversely affected by ill health. In the broad term of public health, healthcare providers and health professionals’ role in providing individual health is not limited to looking only at the patient and the illness. Beyond the illness, the impact of illness on family, society and countries development should be taken into account even at individual level.

The global health agenda on maternal health is primarily focused on maternal mortality. Severe maternal morbidities are also increasingly discussed- mainly in developed countries. However, the impact of common mild to moderate maternal morbidities are often neglected and rarely investigated. In developing countries with poor general health status, these conditions are usually accepted as a part of normal pregnancy.

In the process of cultural adaptation of IMMPACT tool kit on productivity questionnaires for maternal health, the department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka conducted a series of focus group discussions and in-depth interviews with pregnant mothers in Anuradhapura District. This qualitative exploration to identify maternal perception on day to day activities and cost yielded a dearth of information and at the same time it showed the inability of direct adaptation of variables developed for different socio-cultural setting in a complete different country. List of household activities, occupation, type of work, household roster and, household expenses had marked differences from the original questionnaire. We had to change questions and responses accordingly. Even after several rounds of discussions new problems were continued to immerge each time we pre-tested the questionnaire. Most of the time we expected pretesting of questionnaires to take place only once. But we had to pre-test all the developed questionnaires more than once. This shows the complexity of productivity cost estimation. However the team of investigators have yet to define the point of balance in trade-off between precision of estimates and the feasibility issues.

One major finding of the qualitative study was the lack of understanding of health and ill health related to pregnancy. Especially during the first trimester where non-specific mild to moderate symptoms are common, most mothers accepted it as a normal part of pregnancy. Even debilitating hyperemesis was considered as “normal”. As a result of this observation, a separate quantitative analysis on maternal and paternal knowledge on selected medical conditions complicating pregnancy was undertaken by a group of medical students, funded by the project.

Even though analysis of determinant of maternal morbidities was not a part of main project, gestational diabetes, anaemia in pregnancy and post partum psychosis will be further dealt with within this project. Pregnancy induced hypertension should be in this list, but community based prevalence estimations is difficult at this stage of project. Questionnaires developed for productivity cost, household cost, anaemia in pregnancy and GDM will be available in project website for use of other interested researchers in Sri Lanka.