Estimating Maternal Mortality in Remote Rural Regions: an Application of the Sisterhood Method in Tajikistan.

Kylea Laina Liese,Heather Pauls,Sarah Robinson,Crystal Patil

doi:10.5195/cajgh.2019.341

Abstract

IntroductionThe sisterhood method of maternal mortality data collection and analysis provides a validated framework for estimating maternal mortality ratios in situations of limited infrastructure. The aim of this study is to assess sub-national maternal mortality in the Badakhshan region of Tajikistan using the sisterhood method as part of a larger ethnographic study on maternal risk.MethodsIn 2006–2007, 1004 married women of reproductive age in Gorno-Badakhshan Autonomous Oblast, Tajikistan were surveyed using the sisterhood method. Respondents were asked eleven questions about the sex, age and survivorship of all children born to the respondent’s mother.ResultsUsing a national total fertility rate (TFR) estimate of 4.88, the maternal mortality ratio (MMR) in Tajik Badakhshan was 141 maternal deaths per 100,000 live births (95% CI 49–235). The lifetime risk of maternal death was 1 in 141 (95% CI 34–103).ConclusionGiven the inherent time-lag of the sisterhood method, precise estimates of maternal mortality are dependent on accurate TFRs, which may vary based upon regional experiences of demographic transitions. Socio-political instability and the dismantling of Soviet welfare programs and civil war following Tajikistan’s independence from the Soviet Union in 1991 likely impacted TFR in Tajik Badakhshan. Socio-political trends influencing TFR in rural regions compared to urban, and the investigation of factors associated with maternal mortality, require additional investigation.

Highlights

The sisterhood method of maternal mortality data collection and analysis provides a validated framework for estimating maternal mortality ratios in situations of limited infrastructure
Countries with the highest rates of maternal mortality typically do not have strong health information systems. These systems are vital to generate accurate maternal mortality ratio (MMR), the statistical backbone on which millions of dollars are spent through research, programming, monitoring, and evaluation
The sisterhood method embedded in Demographic and Health Surveys (DHS) produce maternal mortality ratios for at least 28 countries, comprising 16% of global births.[3]

Summary

Introduction

The sisterhood method of maternal mortality data collection and analysis provides a validated framework for estimating maternal mortality ratios in situations of limited infrastructure. Maternal mortality ratios are complex indicators with estimation requiring both the accurate identification of cause of death and large sample sizes.[1,2] The sisterhood method of maternal mortality data collection and analysis provides a validated framework for estimating maternal mortality ratios in situations of limited infrastructure.[2,3] The sisterhood method embedded in Demographic and Health Surveys (DHS) produce maternal mortality ratios for at least 28 countries, comprising 16% of global births.[3] With better estimates of maternal mortality at the

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