title: Maternal mortality in rural Zambia.
abstract: OBJECTIVE
  To assess maternal mortality.
  
  
  METHODS
  Sisterhood method survey and hospital data.
  
  
  METHODS
  Communities in Kalabo District, a very remote rural area in western Zambia; Kalabo District Hospital.
  
  
  RESULTS
  The number of respondents in the sisterhood method survey was 1,978. The estimated maternal mortality ratio derived from this survey was 1,238 per 100,000 live births. The hospital study involved 2,474 deliveries of 2,374 live babies. The official number of maternal deaths was 13. Further investigation of files revealed an additional 15 maternal deaths, bringing the institutional maternal mortality rate from 548 to 1,179 per 100,000 live births. The major causes of direct maternal deaths were obstructed labor and sepsis. In 71% of all cases substandard care factors contributed.
  
  
  CONCLUSIONS
  Maternal mortality in rural Zambia is among the highest as reported in the world. Official hospital data tend to underestimate maternal mortality in the community due to underreporting. The sisterhood method survey is an efficient indirect method to assess maternal mortality in rural areas of developing countries.
authors.affiliation: Department of Obstetrics and Gynaecology, Martini Hospital, Groningen, The Netherlands.
authors.forename: F C
authors.initials: FC
authors.lastname: Vork
authors.forename: S
authors.initials: S
authors.lastname: Kyanamina
authors.forename: J
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D000293:Adolescent; D000328:Adult; D003906:Developing Countries; D005190:Family; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D012307:Risk Factors; D012424:Rural Population; D011795:Surveys and Questionnaires; D014944:World Health Organization; D015024:Zambia / Q000453:epidemiology