title: Estimates of the maternal mortality ratio in two districts of the Brong-Ahafo region, Ghana.
abstract: OBJECTIVE
  To estimate the maternal mortality ratio (MMR) by the sisterhood method in two districts of the Brong-Ahafo region of Ghana, and to determine the impact of different assumptions and analytical decisions on these estimates.
  
  
  METHODS
  Indirect estimates of the MMR were calculated from data collected in 1995 by Family Health International (FHI) on 5202 women aged 15-49 years, using a household screen of randomly selected areas in the two districts. Other data from the nationally representative 1994 Ghana Infant, Child and Maternal Mortality Survey (ICMMS) and from the 1997 Kassena-Nankana District study were also used for comparison.
  
  
  RESULTS
  Based on the FHI data, the MMR was estimated to be 269 maternal deaths per 100,000 live births for both districts combined, a figure higher than ICMMS estimates. Biases during data collection may account for this difference, including the fact that biases underestimating mortality are more common than those overestimating it. Biases introduced during data analysis were also considered, but only the total fertility rate used to calculate the MMR seemed to affect the estimates significantly.
  
  
  CONCLUSIONS
  The results indicate that the sisterhood method is still being refined and the extent and impact of biases have only recently received attention. Users of this method should be aware of limitations when interpreting results. We recommend using confidence limits around estimates, both to dispel false impressions of precision and to reduce overinterpretation of data.
authors: Maternal Health Center, Family Health International, Box 13950, Research Triangle Park, NC 27709, USA. jbsmith@fhi.org
authors: J B
authors: JB
authors: Smith
authors: J A
authors: JA
authors: Fortney
authors: E
authors: E
authors: Wong
authors: R
authors: R
authors: Amatya
authors: N A
authors: NA
authors: Coleman
authors: J
authors: J
authors: de Graft Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D015982:Bias; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008428:Maternal Mortality; D008875:Middle Aged; D011247:Pregnancy