title: Developing a Pictorial Sisterhood Method in collaboration with illiterate Maasai traditional birth attendants in northern Tanzania.
abstract: OBJECTIVE
  To study whether data on maternal mortality can be gathered while maintaining local ownership of data in a pastoralist setting where a scarcity of data sources and a culture of silence around maternal death amplifies limited awareness of the magnitude of maternal mortality.
  
  
  METHODS
  As part of a participatory action research project, investigators and illiterate traditional birth attendants (TBAs) collaboratively developed a quantitative participatory tool-the Pictorial Sisterhood Method-that was pilot-tested between March 12 and May 30, 2011, by researchers and TBAs in a cross-sectional study.
  
  
  RESULTS
  Fourteen TBAs interviewed 496 women (sample), which led to 2241 sister units of risk and a maternal mortality ratio of 689 deaths per 100000 live births (95% confidence interval 419-959). Researchers interviewed 474 women (sample), leading to 1487 sister units of risk and a maternal mortality ratio of 484 (95% confidence interval 172-795).
  
  
  CONCLUSIONS
  The Pictorial Sisterhood Method is an innovative application that might increase the participation of illiterate individuals in maternal health research and advocacy. It offers interesting opportunities to increase maternal mortality data ownership and awareness, and warrants further study and validation.
authors.affiliation: Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands; Department of Obstetrics and Gynecology, VU University Medical Centre, Amsterdam, Netherlands. Electronic address: y.roggeveen@vu.nl.
authors.forename: Yadira
authors.initials: Y
authors.lastname: Roggeveen
authors.affiliation: Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands.
authors.forename: Renske
authors.initials: R
authors.lastname: Schreuder
authors.affiliation: Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Zweekhorst
authors.affiliation: Department of Anatomy, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors.forename: Mange
authors.initials: M
authors.lastname: Manyama
authors.affiliation: Global Health and International Partnerships, University of Calgary, Calgary, AB, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hatfield
authors.affiliation: Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands; Department of Obstetrics and Gynecology, VU University Medical Centre, Amsterdam, Netherlands.
authors.forename: Fedde
authors.initials: F
authors.lastname: Scheele
authors.affiliation: Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D002423:Cause of Death; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys / Q000379:methods*; D006801:Humans; D000067010:Literacy; D008428:Maternal Mortality; D008880:Midwifery; D010865:Pilot Projects; D011247:Pregnancy; D012307:Risk Factors; D012424:Rural Population; D013636:Tanzania
keywords: Advocacy; Maasai; Maternal mortality; Participatory action research; Quantitative participatory approach; Sisterhood method; Tanzania