A Low-Cost, Community Knowledge Approach to Estimate Maternal and Jaundice-Associated Mortality in Rural Bangladesh

Am J Trop Med Hyg. 2018 Dec;99(6):1633-1638. doi: 10.4269/ajtmh.17-0974.

Abstract

In the absence of a civil registration system, a house-to-house survey is often used to estimate cause-specific mortality in low- and middle-income countries. However, house-to-house surveys are resource and time intensive. We applied a low-cost community knowledge approach to identify maternal deaths from any cause and jaundice-associated deaths among persons aged ≥ 14 years, and stillbirths and neonatal deaths in mothers with jaundice during pregnancy in five rural communities in Bangladesh. We estimated the method's sensitivity and cost savings compared with a house-to-house survey. In the five communities with a total of 125,570 population, we identified 13 maternal deaths, 60 deaths among persons aged ≥ 14 years associated with jaundice, five neonatal deaths, and four stillbirths born to a mother with jaundice during pregnancy over the 3-year period before the survey using the community knowledge approach. The sensitivity of community knowledge method in identifying target deaths ranged from 80% for neonatal deaths to 100% for stillbirths and maternal deaths. The community knowledge approach required 36% of the staff time to undertake compared with the house-to-house survey. The community knowledge approach was less expensive but highly sensitive in identifying maternal and jaundice-associated mortality, as well as all-cause adult mortality in rural settings in Bangladesh. This method can be applied in rural settings of other low- and middle-income countries and, in conjunction with hospital-based hepatitis diagnoses, used to monitor the impact of programs to reduce the burden of cause-specific hepatitis mortality, a current World Health Organization priority.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Bangladesh / epidemiology
  • Cause of Death
  • Community Participation / economics
  • Community Participation / psychology*
  • Family Characteristics
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Health Surveys / economics
  • Health Surveys / methods*
  • Hepatitis / diagnosis
  • Hepatitis / epidemiology
  • Hepatitis / mortality*
  • Humans
  • Incidence
  • Infant
  • Infant Mortality / trends
  • Jaundice / diagnosis
  • Jaundice / epidemiology
  • Jaundice / mortality*
  • Male
  • Maternal Death / statistics & numerical data*
  • Pregnancy
  • Rural Population
  • Stillbirth