Validation of patient-reported outcome measures for postpartum depression, fatigue, maternal-infant bonding, and quality of life in Nigeria

BackgroundPostpartum anaemia significantly impacts maternal health globally. It is associated with depression, fatigue, lack of maternal-infant bonding, and poor quality of life in affected mothers. In this study we translated and validated patient-reported outcome measures (PROMs) for complications associated with postpartum anaemia in Nigerian women. MethodsThe Edinburgh Postnatal Depression Scale (EPDS), the Fatigue Severity Scale (FSS-5R), the Maternal-Infant Bonding Scale (MIBS), and the World Health Organization Quality of Life Brief Scale (WHOQOL-BREF) were translated in duplicate into Hausa, Nigerian Pidgin English (NPE) and Yoruba languages, and back-translated into English. We assessed face validity and internal consistency of the translated instruments during preparation for the IVON-PP trial (Intravenous ferric carboxymaltose versus oral ferrous sulphate for the treatment of moderate to severe postpartum anaemia in Nigerian women) among postpartum women (N=2,452). Logistic regression models evaluated the relationship of the PROMs to the odds of postpartum anaemia. We also assessed estimated intra-cluster correlation coefficients (ICC) for test-retest reliability among 335 women with repeated visits during the IVON-PP trial. ResultsThe Cronbachs alpha was good (>0.7) for the original English version of all PROMs, the FSS-5R in all languages, and the MIBS in Hausa and NPE. Test-retest reliability was moderate for EPDS (ICC=0.61), MIBS (ICC=0.60), and WHOQOL-BREF (ICC=0.60) in English, and for EPDS (ICC=0.77), FSS-5R (ICC=0.76), and WHOQOL-BREF (ICC=0.58) in Yoruba. Test-retest reliability was poor for the Hausa versions and could not be assessed for NPE, as there were too few participants (n=4). Postpartum anaemia was observed among 16.1% (395/2,452) of participants, and was significantly associated with the scores obtained with the instruments. ConclusionWe translated and validated four postpartum anaemia PROMs in Nigeria, finding mixed reliability and predictive ability, making them valid alternatives to the English versions but we recommend re-evaluating the Hausa and NPE versions in larger studies.