title: Estimating pregnancy-related mortality from census data: experience in Latin America.
abstract: OBJECTIVE
  To assess the feasibility of measuring maternal mortality in countries lacking accurate birth and death registration through national population censuses by a detailed evaluation of such data for three Latin American countries.
  
  
  METHODS
  We used established demographic techniques, including the general growth balance method, to evaluate the completeness and coverage of the household death data obtained through population censuses. We also compared parity to cumulative fertility data to evaluate the coverage of recent household births. After evaluating the data and adjusting it as necessary, we calculated pregnancy-related mortality ratios (PRMRs) per 100 000 live births and used them to estimate maternal mortality.
  
  
  RESULTS
  The PRMRs for Honduras (2001), Nicaragua (2005) and Paraguay (2002) were 168, 95 and 178 per 100 000 live births, respectively. Surprisingly, evaluation of the data for Nicaragua and Paraguay showed overreporting of adult deaths, so a downward adjustment of 20% to 30% was required. In Honduras, the number of adult female deaths required substantial upward adjustment. The number of live births needed minimal adjustment. The adjusted PRMR estimates are broadly consistent with existing estimates of maternal mortality from various data sources, though the comparison varies by source.
  
  
  CONCLUSIONS
  Census data can be used to measure pregnancy-related mortality as a proxy for maternal mortality in countries with poor death registration. However, because our data were obtained from countries with reasonably good statistical systems and literate populations, we cannot be certain the methods employed in the study will be equally useful in more challenging environments. Our data evaluation and adjustment methods worked, but with considerable uncertainty. Ways of quantifying this uncertainty are needed.
authors: Harvard University, Cambridge, MA, USA. kenneth_hill@harvard.edu
authors: Kenneth
authors: K
authors: Hill
authors: Bernardo L
authors: BL
authors: Queiroz
authors: Laura
authors: L
authors: Wong
authors: Jorge
authors: J
authors: Plata
authors: Fabiana
authors: F
authors: Del Popolo
authors: Jimmy
authors: J
authors: Rosales
authors: Cynthia
authors: C
authors: Stanton
mesh_terms: D000293:Adolescent; D000328:Adult; D001723:Birth Rate; D019352:Censuses; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008428:Maternal Mortality; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011247:Pregnancy; D018873:Pregnancy Rate; D055815:Young Adult