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Applications for Measuring Maternal Mortality: Three Case Studies Using Verbal Autopsy Methodology

Co-authored by Sian Curtis, Robert Mswia, and Emily Weaver and presented at the August 2013 IUSSP International Population Conference.

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Applications for Measuring Maternal Mortality: Three Case Studies Using Verbal Autopsy Methodology

  1. 1. Applications for measuringApplications for measuring maternal mortality:maternal mortality: three case studies using verbalthree case studies using verbal autopsy methodologyautopsy methodology Siân Curtis, University of North Carolina at Chapel Hill Robert Mswia, Futures Group Emily Weaver, University of North Carolina at Chapel Hill XXVII IUSSP International Population Conference, 2013
  2. 2. Study objectiveStudy objective To review and contrast three community-based platforms for measuring maternal mortality using verbal autopsy with: (1) a post-census mortality survey (2) a large-scale demographic household survey (3) a sample vital registration system
  3. 3. Maternal mortality in the spotlightMaternal mortality in the spotlight  ~287,000 women die each year from complications in pregnancy or childbirth  MDG 5 aims to reduce the maternal mortality ratio by three quarters by 2015  Lack of good quality data prohibits measurement toward progress of this goal Image source: http://mdginafrica.files.wordpress.com/2012/09/midwife_africa_1.jpg
  4. 4. Interim methods - several optionsInterim methods - several options Population-based interim methods identify deaths through ■ population census ■ sample registration systems ■ demographic surveillance sites ■ household surveys Need additional methods to identify deaths due to maternal causes Verbal autopsy
  5. 5. Three case studies using verbalThree case studies using verbal autopsy methodologyautopsy methodology Photo credit: Photobucket.com
  6. 6. Sample CharacteristicsSample Characteristics Bangladesh HHS, 2010 Mozambique PCMS, 2007 Zambia SAVVY, 2009-2010 Sample size (# households) 168,629 -- 17,000 Reference period for deaths Oct 2006 – interview Aug 2006 – July 2007 Feb 2009 – Dec 2010 Deaths (#) All household WRA (15-49) Maternal deaths 18,608 878 132 10,080 1,643 259 1,063 171 18
  7. 7. MethodsMethods Compare and contrast plaforms with regard to: 1. death identification and classification 2. estimating maternal mortality ratios and rates 3. sample sizes and periodicity of estimates 4. data quality
  8. 8. ResultsResults
  9. 9. Percent Undetermined CODPercent Undetermined COD Unweighted
  10. 10. Maternal Mortality IndicatorsMaternal Mortality Indicators Bangladesh HH Mozambique PCMS Zambia SAVVY Proportion of deaths that are maternal for WRA (%) 14.2 17.3 8.8 MMRate per 100,000 women of WRA 17.0 na 69.1 MMR for WRAa (per 100,000 live births) 197 na na Weighted
  11. 11. Maternal Deaths by TypeMaternal Deaths by Type
  12. 12. Distribution of deaths among women aged 15-Distribution of deaths among women aged 15- 49 by age group and country, weighted49 by age group and country, weighted
  13. 13. DiscussionDiscussion  Not all common maternal mortality indicators readily available from all platforms without further linking/additional information.  Plan ahead Estimating maternal mortality ratios and rates
  14. 14. DiscussionDiscussion Sample sizes and periodicity of estimates ■ Number of maternal deaths observed is small even with large sample sizes ■ Number of maternal deaths will depend on mortality level, fertility level and age structure ■ Sample size requirements will change as these change ■ Periodicity of platforms varies ■ PCMS approx every 10 years with census ■ SAVVY continual data collection
  15. 15. ConclusionsConclusions ■ 3 platforms studied are feasible for use with verbal autopsy to estimate maternal mortality indicators ■ Weigh pros and cons of each platform with required information and resources available ■ None of the platforms will provide estimates of change in maternal mortality indicators over short periods of time ■ Compliment not substitute for long term investment in vital registration systems
  16. 16. AcknowledgementsAcknowledgements Support for this activity has been provided by the U.S. Agency for International Development through MEASURE Evaluation. We are grateful to the Carolina Population Center (R24 HD050924) for general support. This study was also partially supported by Award Number T32NR008856 from the National Institute of Nursing Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health. We are grateful to the Bangladeshi National Institute for Population Research and Training (NIPORT), Government of Bangladesh, Mozambican National Institute of Statistics (INE) and Ministry of Health (MISAU), and the Zambian Central Statistical Office (CSO) for use of their data.
  17. 17. MEASURE Evaluation is funded by the U.S. Agency for International Development through Cooperative Agreement GHA-A-00-08-00003-00 and is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, in partnership with Futures Group, ICF Macro, John Snow, Inc., Management Sciences for Health, and Tulane University. The views expressed in this presentation do not necessarily reflect the views of USAID or the United States government. Visit us online at http://www.cpc.unc.edu/measure.

Co-authored by Sian Curtis, Robert Mswia, and Emily Weaver and presented at the August 2013 IUSSP International Population Conference.

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