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An option for measuring maternal mortality in developing countries: a survey using community informants
BACKGROUND: The 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...
Autores principales: | , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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BioMed Central
2010
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998457/ https://www.ncbi.nlm.nih.gov/pubmed/21083883 http://dx.doi.org/10.1186/1471-2393-10-74 |
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author | Qomariyah, Siti Nurul Braunholtz, David Achadi, Endang L Witten, Karen H Pambudi, Eko Setyo Anggondowati, Trisari Latief, Kamaluddin Graham, Wendy J |
author_facet | Qomariyah, Siti Nurul Braunholtz, David Achadi, Endang L Witten, Karen H Pambudi, Eko Setyo Anggondowati, Trisari Latief, Kamaluddin Graham, Wendy J |
author_sort | Qomariyah, Siti Nurul |
collection | PubMed |
description | BACKGROUND: The 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. METHODS: MADE-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. RESULTS: The 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. CONCLUSIONS: This 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. |
format | Text |
id | pubmed-2998457 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-29984572010-12-08 An option for measuring maternal mortality in developing countries: a survey using community informants Qomariyah, Siti Nurul Braunholtz, David Achadi, Endang L Witten, Karen H Pambudi, Eko Setyo Anggondowati, Trisari Latief, Kamaluddin Graham, Wendy J BMC Pregnancy Childbirth Research Article BACKGROUND: The 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. METHODS: MADE-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. RESULTS: The 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. CONCLUSIONS: This 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. BioMed Central 2010-11-17 /pmc/articles/PMC2998457/ /pubmed/21083883 http://dx.doi.org/10.1186/1471-2393-10-74 Text en Copyright ©2010 Qomariyah et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Qomariyah, Siti Nurul Braunholtz, David Achadi, Endang L Witten, Karen H Pambudi, Eko Setyo Anggondowati, Trisari Latief, Kamaluddin Graham, Wendy J An option for measuring maternal mortality in developing countries: a survey using community informants |
title | An option for measuring maternal mortality in developing countries: a survey using community informants |
title_full | An option for measuring maternal mortality in developing countries: a survey using community informants |
title_fullStr | An option for measuring maternal mortality in developing countries: a survey using community informants |
title_full_unstemmed | An option for measuring maternal mortality in developing countries: a survey using community informants |
title_short | An option for measuring maternal mortality in developing countries: a survey using community informants |
title_sort | option for measuring maternal mortality in developing countries: a survey using community informants |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998457/ https://www.ncbi.nlm.nih.gov/pubmed/21083883 http://dx.doi.org/10.1186/1471-2393-10-74 |
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