title: Improving survey data on pregnancy-related deaths in low-and middle-income countries: a validation study in Senegal.
abstract: OBJECTIVE
  In low- and middle-income countries (LMICs), siblings' survival histories (SSH) are often used to estimate maternal mortality, but SSH data on causes of death at reproductive ages have seldom been validated. We compared the accuracy of two SSH instruments: the standard questionnaire used during the demographic and health surveys (DHS) and the siblings' survival calendar (SSC), a new questionnaire designed to improve survey reports of deaths among women of reproductive ages.
  
  
  METHODS
  We recruited 1189 respondents in a SSH survey in Niakhar, Senegal. Mortality records from a health and demographic surveillance system (HDSS) constituted the reference data set. Respondents were randomly assigned to an interview with the DHS or SSC questionnaires. A total of 164 respondents had a sister who died at reproductive ages over the past 15 years before the survey according to the HDSS.
  
  
  RESULTS
  The DHS questionnaire led to selective omissions of deaths: DHS respondents were significantly more likely to report their sister's death if she had died of pregnancy-related causes than if she had died of other causes (96.4% vs. 70.9%, P < 0.007). Among reported deaths, both questionnaires had high sensitivity (>90%) in recording pregnancy-related deaths. But the DHS questionnaire had significantly lower specificity than the SSC (79.5% vs. 95.0%, P = 0.015). The DHS questionnaire overestimated the proportion of deaths due to pregnancy-related causes, whereas the SSC yielded unbiased estimates of this parameter.
  
  
  CONCLUSIONS
  Statistical models informed by SSH data collected using the DHS questionnaire might exaggerate maternal mortality in Senegal and similar settings. A new questionnaire, the SSC, could permit better tracking progress towards the reduction in maternal mortality.
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Helleringer
authors.affiliation: Institut National d'Etudes Démographiques, Paris, France.|Muséum National d'Histoire Naturelle, UMR 7206 Eco-Anthropologie et Ethnobiologie, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Pison
authors.affiliation: Centre de Recherche en Démographie, Université Catholique de Louvain-la-Neuve, Louvain-la-Neuve, Belgium.
authors.forename: Bruno
authors.initials: B
authors.lastname: Masquelier
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, USA.|Ifakara Health Institute, Dar-es-Salaam, Tanzania.
authors.forename: Almamy Malick
authors.initials: AM
authors.lastname: Kanté
authors.affiliation: Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes, Institut de Recherche sur le Développement, Dakar, Senegal.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Douillot
authors.affiliation: Agence Nationale de la Statistique et de la Démographie, Dakar, Senegal.
authors.forename: Cheikh Tidiane
authors.initials: CT
authors.lastname: Ndiaye
authors.affiliation: Institut National d'Etudes Démographiques, Paris, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Duthé
authors.affiliation: Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes, Institut de Recherche sur le Développement, Dakar, Senegal.
authors.forename: Cheikh
authors.initials: C
authors.lastname: Sokhna
authors.affiliation: Laboratoire Population Environnement Développement, Institut de Recherche sur le Développement, Marseille, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Delaunay
keywords: Senegal; Sénégal; datos de encuestas; données de surveillance; histoires de survie de sœurs; historias de supervivencia de hermanos; maternal mortality; mortalidad materna; mortalité maternelle; sensibilidad y especificidad; sensibilité et spécificité; sensitivity and specificity; siblings’ survival histories; survey data