title: Estimation of maternal and neonatal mortality at the subnational level in Liberia.
abstract: OBJECTIVE
  To establish representative local-area baseline estimates of maternal and neonatal mortality using a novel adjusted sisterhood method.
  
  
  METHODS
  The status of maternal and neonatal health in Bomi County, Liberia, was investigated in June 2013 using a population-based survey (n=1985). The standard direct sisterhood method was modified to account for place and time of maternal death to enable calculation of subnational estimates.
  
  
  RESULTS
  The modified method of measuring maternal mortality successfully enabled the calculation of area-specific estimates. Of 71 reported deaths of sisters, 18 (25.4%) were due to pregnancy-related causes and had occurred in the past 3 years in Bomi County. The estimated maternal mortality ratio was 890 maternal deaths for every 100 000 live births (95% CI, 497-1301]. The neonatal mortality rate was estimated to be 47 deaths for every 1000 live births (95% CI, 42-52). In total, 322 (16.9%) of 1900 women with accurate age data reported having had a stillbirth.
  
  
  CONCLUSIONS
  The modified direct sisterhood method may be useful to other countries seeking a more regionally nuanced understanding of areas in which neonatal and maternal mortality levels still need to be reduced to meet Millennium Development Goals.
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. Electronic address: heidi.moseson@ucsf.edu.
authors.forename: Heidi
authors.initials: H
authors.lastname: Moseson
authors.affiliation: Clinton Health Access Initiative, Monrovia, Liberia.
authors.forename: Moses
authors.initials: M
authors.lastname: Massaquoi
authors.affiliation: Ministry of Health and Social Welfare, Monrovia, Liberia.
authors.forename: Luke
authors.initials: L
authors.lastname: Bawo
authors.affiliation: Ministry of Health and Social Welfare, Monrovia, Liberia; Bomi County Health Team/Ministry of Health and Social Welfare, Tubmanburg, Liberia.
authors.forename: Linda
authors.initials: L
authors.lastname: Birch
authors.affiliation: Ministry of Health and Social Welfare, Monrovia, Liberia.
authors.forename: Bernice
authors.initials: B
authors.lastname: Dahn
authors.affiliation: Ministry of Health and Social Welfare, Monrovia, Liberia.
authors.forename: Yah
authors.initials: Y
authors.lastname: Zolia
authors.affiliation: Clinton Health Access Initiative, Monrovia, Liberia.
authors.forename: Maria
authors.initials: M
authors.lastname: Barreix
authors.affiliation: Bixby Center for Global Reproductive Health, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Gerdts
mesh_terms: D000293:Adolescent; D000328:Adult; D003625:Data Collection; D003906:Developing Countries; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007988:Liberia / Q000453:epidemiology; D050498:Live Birth / Q000453:epidemiology; D008428:Maternal Mortality; D011247:Pregnancy; D035781:Siblings
keywords: Liberia; Low-income countries; Maternal deaths; Maternal mortality ratio; Measurement; Millennium Development Goals; Neonatal deaths; Stillbirth