PMID- 33334359 OWN - NLM STAT- MEDLINE DCOM- 20210614 LR - 20220310 IS - 1742-4755 (Electronic) IS - 1742-4755 (Linking) VI - 17 IP - Suppl 3 DP - 2020 Dec 17 TI - Development of the Global Network for Women's and Children's Health Research's socioeconomic status index for use in the network's sites in low and lower middle-income countries. PG - 193 LID - 10.1186/s12978-020-01034-2 [doi] LID - 193 AB - BACKGROUND: Socioeconomic status (SES) is an important determinant of health globally and an important explanatory variable to assess causality in epidemiological research. The 10th Sustainable Development Goal is to reduce disparities in SES that impact health outcomes globally. It is easier to study SES in high-income countries because household income is representative of the SES. However, it is well recognized that income is poorly reported in low- and middle- income countries (LMIC) and is an unreliable indicator of SES. Therefore, there is a need for a robust index that will help to discriminate the SES of rural households in a pooled dataset from LMIC. METHODS: The study was nested in the population-based Maternal and Neonatal Health Registry of the Global Network for Women's and Children's Health Research which has 7 rural sites in 6 Asian, sub-Saharan African and Central American countries. Pregnant women enrolling in the Registry were asked questions about items such as housing conditions and household assets. The characteristics of the candidate items were evaluated using confirmatory factor analyses and item response theory analyses. Based on the results of these analyses, a final set of items were selected for the SES index. RESULTS: Using data from 49,536 households of pregnant women, we reduced the data collected to a 10-item index. The 10 items were feasible to administer, covered the SES continuum and had good internal reliability and validity. We developed a sum score-based Item Response Theory scoring algorithm which is easy to compute and is highly correlated with scores based on response patterns (r = 0.97), suggesting minimal loss of information with the simplified approach. Scores varied significantly by site (p < 0.001). African sites had lower mean SES scores than the Asian and Central American sites. The SES index demonstrated good internal consistency reliability (Cronbach's alpha = 0.81). Higher SES scores were significantly associated with formal education, more education, having received antenatal care, and facility delivery (p < 0.001). CONCLUSIONS: While measuring SES in LMIC is challenging, we have developed a Global Network Socioeconomic Status Index which may be useful for comparisons of SES within and between locations. Next steps include understanding how the index is associated with maternal, perinatal and neonatal mortality. Trial Registration NCT01073475 Socioeconomic status (SES) is an important determinant of health globally, and improving SES is important to reduce disparities in health outcomes. It is easier to study SES in high-income countries because it can be measured by income and what income is spent on, but this concept does not translate easily to low and middle income countries. We developed a questionnaire that includes 10 items to determine SES in low-resource settings that was added to an ongoing Maternal and Neonatal Health Registry that is funded by the National Institutes of Child Health and Human Development's Global Network. The Registry includes sites that collect outcomes of pregnancies in women and their babies in rural areas in 6 countries in South Asia, sub-Saharan Africa and Central America. The Registry is population based and tracks women from early in pregnancy to day 42 post-partum. The questionnaire is easy to administer and has good reliability and validity. Next steps include understanding how the index is associated with maternal, fetal and neonatal mortality. FAU - Patel, Archana B AU - Patel AB AD - Lata Medical Research Foundation, Nagpur, India. AD - Datta Meghe Institute of Medical Sciences, Wardha, India. FAU - Bann, Carla M AU - Bann CM AD - RTI International, Research Triangle Park, NC, USA. FAU - Garces, Ana L AU - Garces AL AD - INCAP, Guatemala City, Guatemala. FAU - Krebs, Nancy F AU - Krebs NF AD - University of Colorado, Denver, CO, USA. FAU - Lokangaka, Adrien AU - Lokangaka A AD - Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo. FAU - Tshefu, Antoinette AU - Tshefu A AD - Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo. FAU - Bose, Carl L AU - Bose CL AD - University of North Carolina At Chapel Hill, Chapel Hill, NC, USA. FAU - Saleem, Sarah AU - Saleem S AD - Aga Khan University, Karachi, Pakistan. FAU - Goldenberg, Robert L AU - Goldenberg RL AD - Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA. FAU - Goudar, Shivaprasad S AU - Goudar SS AD - KLE Academy of Higher Education and Research's J N Medical College, Belagavi, India. FAU - Derman, Richard J AU - Derman RJ AD - Thomas Jefferson University, Philadelphia, PA, USA. FAU - Chomba, Elwyn AU - Chomba E AD - University of Zambia, Lusaka, Zambia. FAU - Carlo, Waldemar A AU - Carlo WA AD - University of Alabama At Birmingham, Birmingham, AL, USA. FAU - Esamai, Fabian AU - Esamai F AD - Moi University, Eldoret, Kenya. FAU - Liechty, Edward A AU - Liechty EA AD - Indiana University, Indianapolis, IN, USA. FAU - Koso-Thomas, Marion AU - Koso-Thomas M AD - Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA. FAU - McClure, Elizabeth M AU - McClure EM AUID- ORCID: 0000-0001-8659-5444 AD - RTI International, Research Triangle Park, NC, USA. FAU - Hibberd, Patricia L AU - Hibberd PL AD - Department of Global Health, Boston University School of Public Health, Boston, MA, USA. plh0@bu.edu. LA - eng SI - ClinicalTrials.gov/NCT01073475 GR - UG1 HD076461/HD/NICHD NIH HHS/United States GR - UG1 HD078439/HD/NICHD NIH HHS/United States GR - UG1 HD076465/HD/NICHD NIH HHS/United States GR - U24 HD092094/HD/NICHD NIH HHS/United States GR - UG1 HD078438/HD/NICHD NIH HHS/United States GR - UG1 HD076457/HD/NICHD NIH HHS/United States GR - UG1 HD076474/HD/NICHD NIH HHS/United States PT - Journal Article DEP - 20201217 PL - England TA - Reprod Health JT - Reproductive health JID - 101224380 SB - IM MH - Child MH - *Child Health MH - Developing Countries MH - Female MH - Global Health MH - Healthcare Disparities MH - Humans MH - Infant, Newborn MH - *Maternal Health MH - Pregnancy MH - Reproducibility of Results MH - *Social Class MH - *Social Determinants of Health MH - Surveys and Questionnaires PMC - PMC7745356 OTO - NOTNLM OT - Determinants of health OT - Disparities OT - Global Network for Women' and Children's Health Research OT - Global health OT - Lower and middle income countries (LMIC) OT - Socioeconomic status COIS- The authors declare no competing interests. EDAT- 2020/12/19 06:00 MHDA- 2021/06/16 06:00 PMCR- 2020/12/17 CRDT- 2020/12/18 05:29 PHST- 2020/09/28 00:00 [received] PHST- 2020/10/30 00:00 [accepted] PHST- 2020/12/18 05:29 [entrez] PHST- 2020/12/19 06:00 [pubmed] PHST- 2021/06/16 06:00 [medline] PHST- 2020/12/17 00:00 [pmc-release] AID - 10.1186/s12978-020-01034-2 [pii] AID - 1034 [pii] AID - 10.1186/s12978-020-01034-2 [doi] PST - epublish SO - Reprod Health. 2020 Dec 17;17(Suppl 3):193. doi: 10.1186/s12978-020-01034-2.