About 3ie The International Initiative for Impact Evaluation (3ie) promotes evidence-informed, equitable, inclusive and sustainable development. We support the generation and effective use of high-quality evidence to inform decision-making and improve the lives of people living in poverty in low-and middle-income countries. We provide guidance and support to produce, synthesise and quality assure evidence of what works, for whom, how, why and at what cost. 3ie impact evaluations 3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design and that use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report 3ie accepted the final version of the report, Rebuilding the social compact: urban service delivery and property taxes in Pakistan, as partial fulfilment of requirements under grant DPW1.1005 awarded through Development Priorities Window 1. The report is technically sound and 3ie is making it available to the public in this final report version as it was received. No further work has been done. The 3ie technical quality assurance team for this report comprises Francis Rathinam, Neeta Goel, Kanika Jha Kingra and Deeksha Ahuja, an anonymous external impact evaluation design expert reviewer and an anonymous external sector expert reviewer, with overall technical supervision by Marie Gaarder. The 3ie editorial production team for this report comprises Anushruti Ganguly and Akarsh Gupta.

Objectives:To determine the association between medications intake in early pregnancy and variation in the fetal fraction (FF) in pregnant women undergoing cell-free DNA (cfDNA) testing. Methods:We performed a retrospective cohort study of women (n = 1051) undergoing cfDNA testing at an academic center. The exposed group included women taking medications (n = 400; 38.1%), while the nonexposed group consisted of women taking no medications (n = 651; 61.9%). Our primary outcome was FF. We performed univariate and multivariate analyses as appropriate. Results:The FFs were 8.8% (6.6-12.1), 8.7% (6.3-11.6), and 7.7% (5.1-9.3) among women taking 0, 1, and two or more medications, respectively (P < 0.01). Using multivariable linear mixed effects model, the mean FF was significantly lower among those taking two or more medications compared with the nonexposed group. FF was directly correlated with gestational age at the time of cfDNA testing and inversely correlated with maternal obesity. Exposure to metformin was associated with 1.8% (0.2-3.4) lower mean FF when compared with the nonexposed group (P = 0.02). Obesity and intake of two or more medications were associated with higher hazard ratio of having a low FF less than 4%.Conclusions: Exposure to metformin or two or more medications was associated with decreased FF, and obesity is associated with delay in achieving adequate FF percentage. These findings should be considered while counseling patients on test limitations.

Objective The aim of the study was to validate a Spanish-translated survey assessing patients’ perceptions of mesh use in pelvic floor surgery. Methods An English-language survey evaluating perceptions of mesh use underwent a process of Spanish translation and validation, using a forward-backward translation validation protocol. Self-identified bilingual Latinas with symptoms of pelvic floor disorders were recruited to participate in cognitive interviews after completing the survey in English and Spanish. κ coefficient and Cronbach α were calculated for measurement of reliability and internal consistency in responses. A P value of 0.05 was considered statistically significant. Results A total of 30 women were randomized to complete the initial survey in either English or Spanish. Demographics for the 2 cohorts were similar. For the Spanish-translated survey overall, 86% described the questions as “somewhat easy” or “very easy” to understand, and 93% reported that it was “clear” or “very clear” that the survey aimed to investigate their thoughts regarding mesh use. Approximately 63% of the participants expressed confusion over the use of the Spanish medical term “cabestrillo,” translated for “sling.” There were no significant differences in the responses on cognitive interview between the 2 groups. Overall, the responses between English and Spanish versions of the survey demonstrated good reliability and internal consistency. Conclusions This study demonstrated face validity of a Spanish-translated survey assessing perceptions of mesh use in pelvic surgery in a Latina population. Participants’ feedback was crucial to optimizing the quality of the survey for future studies that will evaluate Spanish-speaking patients’ views of mesh implants in pelvic reconstructive surgery.