Estimating maternal mortality by sisterhood method in rural Zimbabwe.

Abstract

The maternal mortality ratio (maternal deaths per 100,000 live births) is a good indicator of development and is influenced by basic health status, socioeconomic factors, health care and transportation, cultural and religious beliefs, level of education, and reproduction behavior. Estimation can be expensive, time consuming, and labor intensive. In Zimbabwe, maternal mortality has shown variation from 51/100,000 from a Harare hospital study in 1981 to 168/100,000 in a community-based incident case study in Masvingo province in 1991. This article describes an indirect estimation technique for estimating maternal mortality levels from sisters' data in Gutu District, Masvingo province, Zimbabwe. Data were obtained from community residents on the deaths of sisters during pregnancy, childbirth, or 42 days after termination of pregnancy. Data was collected during June-July, 1991, from all residents in a 5 km catchment area of 6 rural health centers and a residential area of the city of Mpandawana. Respondents were 37.3% male and 62.7% female. Survey results indicate 31.6 maternal deaths per year in the district. Unpublished observations from recorded deaths in heath centers, hospitals, and referral hospitals was estimated for the district over the past 4 years as 5.5. The suggestion is that institutional records are not representing 25% to 58% of total maternal mortality. These missed deaths occur in home-based deliveries by traditional birth attendants and reflect complications of pregnancy not referred to hospitals. Concern is raised about the preference for home delivery and the need for increased coverage of prenatal care and institutional deliveries. Future studies might include questioning traditional birth attendants about maternal deaths.