title: Applying the sisterhood method for estimating maternal mortality to a health facility-based sample: a comparison with results from a household-based sample.
abstract: BACKGROUND
  The sisterhood method is an indirect technique used to estimate maternal mortality in developing countries, where maternal deaths are often poorly registered in official statistics. It has been used successfully in many community-based household surveys. Because such surveys can be costly, this study investigated the suitability of using data collected in outpatient health facilities.
  
  
  METHODS
  Adults visiting any one of 91 health centres or posts in a rural region of Nicaragua were randomly sampled and interviewed by health personnel. A sample size, proportional to the population served, was assigned to each facility and 9232 adults were interviewed. Characteristics of health facility users were compared with the general population to identify factors that would allow generalization of results to other settings.
  
  
  RESULTS
  Based on these data, the lifetime risk of maternal death was 0.0144 (1 in 69). This estimate is essentially identical to that from a household-based survey in the same region 8 months earlier, which obtained a lifetime risk of 0.0145 (1 in 69). These findings correspond to a maternal mortality ratio of 241 and 243/100000 livebirths, respectively.
  
  
  CONCLUSIONS
  This is the first report comparing results of the sisterhood method from household and health facility-based samples. The sisterhood method provided a robust estimate of the magnitude of maternal mortality. Results from the opportunistic health facility-based sample were virtually identical to results from the household-based study. Guidelines need to be developed for applying this low-cost and efficient aproach to estimating maternal mortality in suitable opportunistic settings at subnational levels.
authors.affiliation: Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, GA 30333, USA.
authors.forename: I
authors.initials: I
authors.lastname: Danel
authors.forename: W
authors.initials: W
authors.lastname: Graham
authors.forename: P
authors.initials: P
authors.lastname: Stupp
authors.forename: P
authors.initials: P
authors.lastname: Castillo
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002423:Cause of Death; D003625:Data Collection / Q000379:methods; D003906:Developing Countries; D004812:Epidemiologic Methods; D005260:Female; D006306:Health Surveys; D006801:Humans; D008428:Maternal Mortality / Q000639:trends*; D008875:Middle Aged; D009527:Nicaragua / Q000453:epidemiology; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population