An option for measuring maternal mortality in developing countries: a survey using community informants

BMC Pregnancy and Childbirth

Research Article

Siti Nurul Qomariyah¹  Kamaluddin Latief¹  Trisari Anggondowati¹  Eko Setyo Pambudi¹  Endang L Achadi¹  Karen H Witten²  Wendy J Graham²  David Braunholtz² 

[1] Centre for Family Welfare, Faculty of Public Health, University of Indonesia, 16424, Depok, West Java, Indonesia;Immpact, School of Medicine and Dentistry, University of Aberdeen, UK;

关键词: Maternal Death;    Verbal Autopsy;    Maternal Mortality Ratio;    Demographic Health Survey;    Pregnancy Related Death;   

DOI  :  10.1186/1471-2393-10-74

 received in 2010-02-20, accepted in 2010-11-17,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundThe maternal mortality ratio (MMR) remains high in most developing countries. Local, recent estimates of MMR are needed to motivate policymakers and evaluate interventions. But, estimating MMR, in the absence of vital registration systems, is difficult. This paper describes an efficient approach using village informant networks to capture maternal death cases (Maternal Deaths from Informants/Maternal Death Follow on Review or MADE-IN/MADE-FOR) developed to address this gap, and examines its validity and efficiency.MethodsMADE-IN used two village informant networks - heads of neighbourhood units (RTs) and health volunteers (Kaders). Informants were invited to attend separate network meetings - through the village head (for the RT) and through health centre for the kaders. Attached to the letter was a form with written instructions requesting informants list deaths of women of reproductive age (WRA) in the village during the previous two years. At a 'listing meeting' the informants' understanding on the form was checked, informants could correct their forms, and then collectively agreed a consolidated list. MADE-FOR consisted of visits relatives of likely pregnancy related deaths (PRDs) identified from MADE-IN, to confirm the PRD status and gather information about the cause of death. Capture-recapture (CRC) analysis enabled estimation of coverage rates of the two networks, and of total PRDs.ResultsThe RT network identified a higher proportion of PRDs than the kaders (estimated 0.85 vs. 0.71), but the latter was easier and cheaper to access. Assigned PRD status amongst identified WRA deaths was more accurate for the kader network, and seemingly for more recent deaths, and for deaths from rural areas. Assuming information on live births from an existing source to calculate the MMR, MADE-IN/MADE-FOR cost only $0.1 (US) per women-year risk of exposure, substantially cheaper than alternatives.ConclusionsThis study shows that reliable local, recent estimates of MMR can be obtained relatively cheaply using two independent informant networks to identify cases. Neither network captured all PRDs, but capture-recapture analysis allowed self-calibration. However, it requires careful avoidance of false-positives, and matching of cases identified by both networks, which was achieved by the home visit.

【 授权许可】

CC BY   
© Qomariyah et al; licensee BioMed Central Ltd. 2010