Affiliation:
1. Faculty of Science Athena Institute, VU University Amsterdam The Netherlands
2. Department of Internal Medicine Alrijne Hospital Leiderdorp The Netherlands
3. Jhpiego, Johns Hopkins University Baltimore Maryland USA
4. School of Nursing and Midwifery, College of Health and Medical Sciences Haramaya University Harar Ethiopia
5. Medical Library VU University Amsterdam The Netherlands
6. Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education University of Southampton Southampton UK
7. Department of Obstetrics Leiden University Medical Center Leiden The Netherlands
8. Institute of Applied Health Research, University of Birmingham Birmingham UK
Abstract
AbstractBackgroundIn the absence of robust vital registration systems, many low‐ and middle‐income countries (LMICs) rely on national surveys or routine surveillance systems to estimate the maternal mortality ratio (MMR). Although the importance of MMR estimates in ending preventable maternal deaths is acknowledged, there is limited research on how different approaches are used and adapted, and how these adaptations function.ObjectivesTo assess methods for estimating maternal mortality in LMICs and the rationale for these modifications.Search StrategyA literature search with the terms “maternal death”, “surveys” and “low‐ and middle‐income countries” was performed in Medline, Embase, Web of Science, Scopus, CINAHL, APA PsycINFO, ERIC, and IBSS from January 2013 to March 17, 2023.Selection CriteriaStudies were eligible if their main focus was to compare, adapt, or assess methods to estimate maternal mortality in LMICs.Data Collection and AnalysisTitles and abstracts were screened using Rayyan. Relevant articles were independently reviewed by two reviewers against inclusion criteria. Data were extracted on mortality measurement methods, their context, and results.Main ResultsNineteen studies were included, focusing on data completeness, subnational estimates, and community involvement. Routinely generated MMR estimates are more complete when multiple data sources are triangulated, including data from public and private health facilities, the community, and local authorities (e.g. vital registration, police reports). For subnational estimates, existing (e.g. the sisterhood method and reproductive‐age mortality surveys [RAMOS]) and adapted methods (e.g. RAMOS 4 + 2 and Pictorial Sisterhood Method) provided reliable confidence intervals. Community engagement in data collection increased community awareness of maternal deaths, provided local ownership, and was expected to reduce implementation costs. However, most studies did not include a cost‐effectiveness analysis.ConclusionHousehold surveys with community involvement and RAMOS can be used to increase data validity, improve local awareness of maternal mortality estimates, and reduce costs in LMICs.
Subject
Obstetrics and Gynecology,General Medicine