Measuring maternal mortality: An overview of opportunities and options for developing countries

Department of Obstetrics and Gynaecology, University of Aberdeen, UK.
BMC Medicine (Impact Factor: 7.25). 02/2008; 6(1):12. DOI: 10.1186/1741-7015-6-12
Source: PubMed


There is currently an unprecedented expressed need and demand for estimates of maternal mortality in developing countries. This has been stimulated in part by the creation of a Millennium Development Goal that will be judged partly on the basis of reductions in maternal mortality by 2015.
Since the launch of the Safe Motherhood Initiative in 1987, new opportunities for data capture have arisen and new methods have been developed, tested and used. This paper provides a pragmatic overview of these methods and the optimal measurement strategies for different developing country contexts.
There are significant recent advances in the measurement of maternal mortality, yet also room for further improvement, particularly in assessing the magnitude and direction of biases and their implications for different data uses. Some of the innovations in measurement provide efficient mechanisms for gathering the requisite primary data at a reasonably low cost. No method, however, has zero costs. Investment is needed in measurement strategies for maternal mortality suited to the needs and resources of a country, and which also strengthen the technical capacity to generate and use credible estimates.
Ownership of information is necessary for it to be acted upon: what you count is what you do. Difficulties with measurement must not be allowed to discourage efforts to reduce maternal mortality. Countries must be encouraged and enabled to count maternal deaths and act.

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    • "Via the DS method, women provide mortality information for all their sisters. It is widely used to establish PRMRs via large household surveys because it provides population-representative data, generates a recent estimate, and is easily included in multipurpose surveys [7] [8] [9]. With the HH method, household heads report on deaths occurring within their household. "
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    ABSTRACT: To compare sociodemographic and pregnancy characteristics of pregnancy-related deaths identified by the direct sisterhood and the verbal autopsy with household mortality (HHVA) methods. Nationally representative data for 1997-2001 were obtained from the household, verbal autopsy, and women's questionnaires of the Bangladesh Maternal Health Services and Maternal Mortality Services Survey, 2001. Sociodemographic and pregnancy characteristics were compared for maternal deaths identified by the two methods. Characteristics of deceased women were reported directly with HHVA, but extrapolated in the direct sisterhood method using the reporting sister as proxy. Overall, 201 pregnancy-related deaths were identified via HHVA and 388 through DS reporting. There were no significant differences between reporting sister characteristics and deceased women's characteristics in educational attainment, working status, husband's educational attainment, and spouse educational parity. However, timing of death relative to pregnancy phase, number of previous live births, and years since death did differ (P<0.05). The sociodemographic characteristics of women with pregnancy-related deaths identified via the two methods were similar. However, some pregnancy characteristics differed significantly, suggesting that different policy interventions are required. Before considering using sister proxy characteristics to target services, issues responsible for these differences should be resolved, and generalizability of evaluated indicators must be considered. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
    International Journal of Gynecology & Obstetrics 02/2015; 129(3). DOI:10.1016/j.ijgo.2014.12.003 · 1.54 Impact Factor
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    • "Supported sites might have underreported deaths, because investigation requires extra work and (despite assurances to the contrary) providers and administrators may feel defensive or apprehensive about an audit. Related reviews have shown that, although maternal death audit is becoming more common in some low-income countries, facility-level data may underestimate the number of deaths [19] [20]. "
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    ABSTRACT: Objective To describe the mortality risk associated with surgical treatment of female genital fistula and the contributory and contextual factors. Methods In a descriptive study, confidential inquiries and clinical audits were conducted at 14 fistula repair sites in seven resource-poor countries between January 2005 and March 2013. Data collection included interviews with key personnel involved in the clinical management of the deceased, and a review of hospital records and patient files following an audit protocol. Results Overall, 26 060 fistula repairs were performed at 44 sites located in 13 countries; 30 deaths were reported in this period. Twenty-one deaths were attributable to surgery, yielding a case fatality of 0.08 per 100 procedures. The cause of death in nearly half of the cases was various manifestations of sepsis and inflammation. Conclusion The case fatality rate for fistula repair surgery in resource-poor countries was in the same range as that for comparable gynecologic operations in high-resource settings. Clinical and systemic issues to be addressed to reduce the case fatality rate include improvement of perioperative care and follow-up, assuring prudent referral or deferral of difficult cases, and maintaining better records.
    International Journal of Gynecology & Obstetrics 08/2014; 126(2). DOI:10.1016/j.ijgo.2014.02.015 · 1.54 Impact Factor
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    • "However, because maternal mortality is a relatively rare event, even the largest of these surveys cannot accurately estimate maternal mortality at the subnational level and may not provide information on location of death [14]. Some studies have used expensive techniques such as surveys on reproductive-age mortality and case finding [14] [15] [16] [17]. Model-based approaches have also been used to obtain subnational estimates in Bangladesh [14], and some countries are including questions on maternal mortality in their national censuses. "
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    ABSTRACT: Objective To review national data on HIV and malaria as causes of maternal death and to determine the importance of looking at maternal mortality at a subnational level in Mozambique. Methods Three national data surveys were used to document HIV and malaria as causes of maternal mortality and to assess HIV and malaria prevention services for pregnant women. Data were collected between 2007 and 2011, and included population-level verbal autopsy data and household survey data. Results Verbal autopsy data indicated that 18.2% of maternal deaths were due to HIV and 23.1% were due to malaria. Only 19.6% of recently pregnant women received at least two doses of sulfadoxine-pyrimethamine for intermittent preventive treatment, and only 42.3% of pregnant women were sleeping under an insecticide-treated net. Only 37.5% of recently pregnant women had been counseled, tested, and received an HIV test result. Coverage of prevention services varied substantially by province. Conclusion Triangulation of information on cause of death and coverage of interventions can enable appropriate targeting of maternal health interventions. Such information could also help countries in Sub-Saharan Africa to recognize and take action against malaria and HIV in an effort to decrease maternal mortality.
    International Journal of Gynecology & Obstetrics 06/2014; DOI:10.1016/j.ijgo.2014.05.002 · 1.54 Impact Factor
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