A comparison of sisterhood information on causes of maternal death with the registration causes of maternal death in Matlab, Bangladesh

Abstract

Background: To explore whether causes of maternal death can be investigated using the sisterhood method, an indirect method for providing a community-based estimate of the level of maternal mortality, this study compares the sisterhood causes of maternal death with the Matlab Demographic Surveillance System's (DSS) causes of maternal death.

Methods: Data for this study came from the Matlab DSS, which has been in operation since 1966 as a field site of the International Centre for Diarrhoeal Disease Research, Bangladesh. The maternal deaths that occurred during the 15-year period from 1976 to 1990 in the Matlab DSS area are the basis of this study. A sisterhood survey was conducted in Matlab in November and December 1991 to collect information on conditions, events and symptoms that preceded death. The collected information was evaluated to assign a most likely cause of maternal death. The sisterhood survey cause of maternal death was then compared with the DSS cause of maternal death.

Results: Cause of death could not be assigned with reasonable confidence for 34 (11%) of the 305 maternal deaths for which information was collected. For the remaining deaths, the agreement between the two classification systems was generally high for most cause-of-death categories considered.

Conclusions: Though cause-of-death information obtained by the sisterhood method will always be subject to some error, it can provide an indication of an overall distribution of causes of maternal deaths. This data can be used for the planning of programmes aimed at reducing maternal mortality and for the evaluation of such programmes over time.

PIP: This study compared the sisterhood method of determining causes of maternal death, an indirect method for providing a community-based estimate of the level of maternal mortality, with the Matlab Demographic Surveillance System's (DSS) causes of maternal death. Data were derived from the Matlab DSS, which has been in operation since 1966 as a field site of the International Center for Diarrheal Disease Research, Bangladesh. The maternal deaths that occurred during the 15-year period from 1976 to 1990 in the Matlab DSS area were the basis of this study. A sisterhood survey was conducted in Matlab in November and December 1991 to collect information on conditions, events, and symptoms that preceded death. The collected information was evaluated to assign a most likely cause of maternal death. The sisterhood survey cause of maternal death was then compared with the DSS cause of maternal death. Of the 510 deaths identified as maternal deaths by the DSS, 384 siblings, 1 for each deceased woman, was interviewed. 305 of these correctly reported that they had a sister who died during pregnancy or childbirth. 16 reported that they did not know whether their sister died during pregnancy or after termination of a pregnancy. The remaining 63 respondents misreported their sisters' deaths as nonmaternal deaths. Cause of death could not be assigned with reasonable confidence for 34 (11%) of the 305 maternal deaths for which information was collected. For the remaining 271 deaths, the agreement between the 2 classification systems was generally high for most cause-of-death categories considered. The overall rate of agreement between DSS cause and survey cause was 82%. For the direct obstetric deaths as a group, the agreement was 86%, while it was around 76% for indirect obstetric deaths, and 71% for abortion-related deaths. Though the sisterhood method will always be subject to some error, it can provide an indication of an overall distribution of causes of maternal deaths.