Using community informants to estimate maternal mortality in a rural district in Pakistan: a feasibility study.
BACKGROUND
We aimed to assess the feasibility of using community-based informants' networks to identify maternal deaths that were followed up through verbal autopsies (MADE-IN MADE-FOR technique) to estimate maternal mortality in a rural district in Pakistan.


METHODS
We used 4 community networks to identify deaths in women of reproductive age in the past 2 years in Chakwal district, Pakistan. The deaths recorded by the informants were followed up through verbal autopsies.


RESULTS
In total 1,143 Lady Health Workers (government employees who provide primary health care), 1577 religious leaders, 20 female lady councilors (elected representatives), and 130 nikah registrars (persons who register marriages) identified 2001 deaths in women of reproductive age. 1424 deaths were followed up with verbal autopsies conducted with the relatives of the deceased. 169 pregnancy-related deaths were identified from all reported deaths. Through the capture-recapture technique probability of capturing pregnancy-related deaths by LHWs was 0.73 and for religious leaders 0.49. Maternal mortality in Chakwal district was estimated at 309 per 100,000 live births.


CONCLUSIONS
It is feasible and economical to use community informants to identify recent deaths in women of reproductive age and, if followed up through verbal autopsies, obviate the need for conducting large scale surveys.
Population Council, Islamabad 44000, Pakistan.
Ali Mohammad
0000-0001-8613-1228
AM
Mir
Population Council, Islamabad 44000, Pakistan.
Mohammad Saleem
MS
Shaikh
Center for Family Welfare, Faculty of Public Health, University of Indonesia, Jakarta 16424, Indonesia.
Siti Nurul
SN
Qomariyah
Population Council, Islamabad 44000, Pakistan.
Gul
G
Rashida
Population Council, Islamabad 44000, Pakistan.
Mumraiz
M
Khan
Population Council, Islamabad 44000, Pakistan.
Irfan
I
Masood
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D003150:Community Health Workers / Q000191:economics / Q000706:statistics & numerical data; D019058:Community Networks / Q000191:economics / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D003625:Data Collection / Q000191:economics / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000401:mortality*; D012423:Rural Health / Q000191:economics / Q000706:statistics & numerical data; D055815:Young Adult