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

Siti Nurul Qomariyah, David Braunholtz, Endang L Achadi, Karen H Witten, Eko Setyo Pambudi, Trisari Anggondowati, Kamaluddin Latief, Wendy J Graham

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Abstract

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.
Original languageEnglish
Article number74
Number of pages8
JournalBMC Pregnancy and Childbirth
Volume10
DOIs
Publication statusPublished - 17 Nov 2010

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Maternal Mortality
Developing Countries
Pregnancy
Maternal Death
Head
Surveys and Questionnaires
House Calls
Health
Live Birth
Calibration
Cause of Death
Volunteers
Costs and Cost Analysis

Cite this

Qomariyah, S. N., Braunholtz, D., Achadi, E. L., Witten, K. H., Pambudi, E. S., Anggondowati, T., ... Graham, W. J. (2010). An option for measuring maternal mortality in developing countries: a survey using community informants. BMC Pregnancy and Childbirth, 10, [74]. https://doi.org/10.1186/1471-2393-10-74

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.

In: BMC Pregnancy and Childbirth, Vol. 10, 74, 17.11.2010.

Research output: Contribution to journalArticle

Qomariyah, SN, Braunholtz, D, Achadi, EL, Witten, KH, Pambudi, ES, Anggondowati, T, Latief, K & Graham, WJ 2010, 'An option for measuring maternal mortality in developing countries: a survey using community informants', BMC Pregnancy and Childbirth, vol. 10, 74. https://doi.org/10.1186/1471-2393-10-74
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. In: BMC Pregnancy and Childbirth. 2010 ; Vol. 10.
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AU - Braunholtz, David

AU - Achadi, Endang L

AU - Witten, Karen H

AU - Pambudi, Eko Setyo

AU - Anggondowati, Trisari

AU - Latief, Kamaluddin

AU - Graham, Wendy J

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N2 - 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.

AB - 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.

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