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Stud Fam Plann. 1997 Jun;28(2):132-42.

Accuracy of indirect estimates of maternal mortality: a simulation model.

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1
Directeur de Recherche, CEPED, Paris, France.

Abstract

A simulation model was developed to test the accuracy of indirect estimates of maternal mortality (the sisterhood method). The model generated a first generation of grandmothers, a second generation of mothers (with brothers and sisters), and a third generation of children (births). In the second generation, maternal mortality was introduced. Empirical values for the parameters of fertility and mortality were taken from a prospective survey in Senegal (Niakhar). Results based on 100 simulations of the same situation revealed several limitations of the sisterhood method: The indirect estimates could fall as far as 33 percent from the true values on individual cases; the indirect estimates tended to be systematically higher than the direct estimates; their range was wider, as were their confidence intervals; and biases were particularly strong for the younger age groups of respondents. Reasons for these biases are explored.

PIP:

A simulation method was used to assess the accuracy of indirect estimates of maternal mortality (sisterhood method). The model generated a first generation of grandmothers, a second generation of mothers (with brothers and sisters), and a third generation of children (births). Maternal mortality was introduced in the second generation. Fertility and mortality parameters for the simulations were derived from a prospective study conducted in Niakhar, Senegal, in 1983-89. Results based on 100 simulations of the same situation revealed several limitations of the sisterhood method. The indirect estimates were as far as 33% from the true values on individual cases, despite the assumed perfect quality of the data. The indirect estimates tended to be systematically higher than the direct estimates, with wider ranges and confidence intervals. Biases were especially marked for the younger age group (15-39 years). The only justification for use of indirect rather than direct estimates seems to be the avoidance of questions about age differences between the respondent and the sister and the age of the sister at time of death, when applicable. Recommended, instead of indirect estimates, are two methods of computing direct estimates of maternal mortality: 1) direct computation of the maternal mortality quotient, followed by conversion to the maternal mortality rate through use of the total fertility rate, and 2) use of information on parity by age from maternity histories to compute the maternal mortality rate in each age group directly.

PMID:
9216033
[Indexed for MEDLINE]
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