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Mothers Child. 1989;8(2 Suppl):1-2.

The sisterhood method for estimating maternal mortality.



Currently, 3 main sources of information are available on maternal deaths: vital registration, health service statistics, and community-based surveys. These vary in availability and suitability for studying various aspects of maternal mortality. A new indirect technique for deriving population-based estimates called the sisterhood method provides an approach for estimating maternal mortality at a national and subnational level. This method uses the proportion of adult sisters dying during pregnancy, childbirth, or the puerperium to derive a variety of indicators of maternal mortality. The information is collected during a census or survey, by interviewing all adults over age 15. 4 questions, together with the age of the adult respondent (grouped into 5-year intervals) form the basic data required. The questions ascertain the total number of sisters now dead or alive, who ever reached age 15 (or menarche) or who were ever married, and the number of sisters who have died while pregnant, during a delivery, or up to 6 weeks after the end of a pregnancy. The wording of questions is critical and needs to be culturally appropriate for each situation to ensure that all sisters at risk of maternal death are accounted for. The 1st field trial of the method was carried out in The Gambia in late 1987. Over 5 days, interviews were carried out with 2163 man and women over age 15 living in 6 rural villages. The results were compared with those of earlier prospective studies in the same area to assess accuracy. The lifetime risk of maternal mortality among this rural population was found to be 0.058 or 1 in 17 chance of death from pregnancy-related causes during the reproductive period, or a maternal mortality ratio of about 1005 maternal deaths/100,000 live births. The previous study estimates were 1050 and 950/100,000 live births covering the period 1951-75 for 2 nearby villages.

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