title: House-to-house survey vs. snowball technique for capturing maternal deaths in India: a search for a cost-effective method.
abstract: OBJECTIVE
  Estimation of maternal mortality has been difficult because of large sample size requirement. A study using snowball technique for identification of households where maternal death has taken place and its related causes was conducted. We present here the feasibility of carrying out the snowball technique for capturing maternal deaths as against house-to-house survey and to obtain the estimates of maternal mortality ratio (MMR) in some selected States of India.
  
  
  METHODS
  Five states representing high MMR (Uttar Pradesh), medium MMR (Maharashtra, Karnataka, Uttranchal) and low MMR (Delhi) were selected. A total of 8 PHCs and 3 (UFS) were covered. Study used both house-to-house survey and snowball technique to enumerate the maternal deaths in the selected PHCs in rural area and urban frame survey (UFS) in urban area.
  
  
  RESULTS
  In all, 94 maternal deaths were captured through snowball technique as against 83 through house-to-house survey. The estimate of MMR for the five States combined was 356 per 100,000 live births, as compared to assumed 400 per 100,000 live births for the country as a whole. The relative standard error of the estimate of MMR was about 10 per cent.
  
  
  CONCLUSIONS
  Snowball technique captured more maternal deaths than those in house-to-house survey particularly in rural areas. The estimates also indicated the feasibility of replicating the proposed methodology for estimation of MMR as a time and cost-effective methodology.
authors.affiliation: National Institute of Medical Statistics (ICMR), New Delhi, India.
authors.forename: Padam
authors.initials: P
authors.lastname: Singh
authors.forename: Arvind
authors.initials: A
authors.lastname: Pandey
authors.forename: Abha
authors.initials: A
authors.lastname: Aggarwal
mesh_terms: D003365:Costs and Cost Analysis; D003625:Data Collection / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008428:Maternal Mortality; D010865:Pilot Projects; D011247:Pregnancy; D012424:Rural Population