An innovative approach to measuring maternal mortality at the community level in low-resource settings using mid-level providers: a feasibility study in Tigray, Ethiopia.
This paper proposes a new, community-based approach to the measurement of maternal mortality, and presents results from a feasibility study in 2010-11 of that approach in rural Tigray, Ethiopia. The study was implemented in three health posts and one health centre with a total catchment area of approximately 22,000 people. Priests, traditional birth attendants and community-based reproductive health agents were responsible for locating and reporting all births and deaths in their areas and assisted mid-level providers in locating key informants for verbal autopsy. Community-based health workers were trained to report all births and deaths to the local health post, where vital registries were kept. Once a month, each health post compiled a list of all deaths of women aged 12-49, which were registered in government logbooks. Nurses and nurse-midwives were trained to administer verbal autopsies on these deaths, and assign primary cause of death using WHO ICD-10 classifications. The study drew on the theory of task-shifting, shifting the task of cause-of-death attribution from physicians to mid-level providers. It aimed to build a sustainable methodology for maximizing existing local health care infrastructure and human capacity, leading to community-based solutions to improve maternal health. While the approach has not yet been implemented outside the initial study area, the results are promising as regards its feasibility.
University of California, Berkeley School of Public Health, USA. ndola@berkeley.edu
Ndola
N
Prata
Caitlin
C
Gerdts
Amanuel
A
Gessessew
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D003150:Community Health Workers / Q000193:education / Q000458:organization & administration*; D003625:Data Collection / Q000191:economics / Q000379:methods*; D005002:Ethiopia / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D008428:Maternal Mortality / Q000639:trends*; D008875:Middle Aged; D011247:Pregnancy; D012042:Registries; D055815:Young Adult