Ba M G, Kodio B, Etard J F
Clinique de Gynécologie-Obstétrique, Université Cheikh Anta Diop, Dakar, Sénégal.
J Gynecol Obstet Biol Reprod (Paris). 2003 Dec;32(8 Pt 1):728-35.
The aim of this paper is to study the use of verbal autopsy in order to assess maternal mortality indicators in rural settings and to determine the limits and difficulties related to that practice.
This study was carried out in 3 rural sites (Niakhar in the region of Fatick, Bandafassi in Tambacounda region and Mlomp in the region of Ziguinchor). These sites had been under demographic and epidemiological surveillance for several years. Data were collected through two sources: a questionnaire filled out by data collectors during the demographic surveillance and a complementary survey done by an epidemiologist among families completed by information from the registers of health structures. For all female deaths (15-49 years), the detailed sequence of the events leading to the death were stated in a clinical file of verbal autopsy. All the files had been submitted to two independent obstetricians for analysis. The character of maternal death and the cause of the death (direct, indirect ou undetermined) were processed. The discordant cases were submitted to another expert epidemiologist for analysis. The 10th international classification of diseases of WHO was used as a reference to identify maternal deaths and their causes.
This demographic surveillance has led to a complete registration of female deaths and the analysis of female deaths has helped to measure maternal indicators during the observed time period. Among the 471 female deaths, 97 maternal deaths were identified in Niakhar, 36 in Bandafassi and 10 in Mlomp. The proportion of maternal deaths was 30.6% in Niakhar, 32.7% in Bandafassi and 22.7% in Mlomp. The ratio of maternal mortality was 575 per 100,000 live births (LB) in Niakhar, 930/100,000 live births in Bandafassi and 436/100,000 LB in Mliomp. The risk of maternal death was 1 women in 21 in Niakhar, 1 in 16 in Bandafassi and 1 in 41 in Mlomp. Maternal mortality rate was 13.3/10,000 reproductive age women in Niakhar, 17/10,000 in Bandafassi and 6.9/10,000 in Mlomp. Sociocultural limits related to interdiction in the society, and language barriers are seen as limits for applying verbal autopsy practices. Also, a lack of precision in data collection because of lack of information delivered by the interviewee or because of lack of experience of the interviewer could be limitations. This study carried out in a rural setting could not show national maternal mortality level. It takes time to complete verbal autopsy leading to excessive cost.
Verbal autopsy remains an interesting method for measuring maternal mortality. It has advantages in rural areas where many deliveries still occur at home. Further accuracy in data collection is needed for a precise analysis of each case.
本文旨在研究使用口头尸检来评估农村地区的孕产妇死亡率指标，并确定与该做法相关的局限性和困难。
本研究在3个农村地点进行（法蒂克地区的尼亚哈、坦巴昆达地区的班达法西和济金绍尔地区的姆隆普）。这些地点已接受了数年的人口和流行病学监测。数据通过两个来源收集：数据收集人员在人口监测期间填写的问卷，以及由一名流行病学家在家庭中进行的补充调查，该调查由卫生机构登记册中的信息完成。对于所有女性死亡病例（15 - 49岁），导致死亡的详细事件序列记录在口头尸检的临床文件中。所有文件均已提交给两名独立的产科医生进行分析。对孕产妇死亡的特征和死亡原因（直接、间接或未确定）进行了处理。不一致的病例提交给另一位专家流行病学家进行分析。以世界卫生组织的第10版国际疾病分类作为参考来确定孕产妇死亡及其原因。
这种人口监测导致了女性死亡的完整登记，对女性死亡的分析有助于在观察期间衡量孕产妇指标。在471例女性死亡病例中，尼亚哈有97例孕产妇死亡，班达法西有36例，姆隆普有10例。尼亚哈的孕产妇死亡比例为30.6%，班达法西为32.7%，姆隆普为22.7%。尼亚哈的孕产妇死亡率为每10万活产575例，班达法西为930/10万活产，姆隆普为436/10万活产。尼亚哈孕产妇死亡风险为每21名女性中有1例，班达法西为每16名中有1例，姆隆普为每41名中有1例。尼亚哈的孕产妇死亡率为每10000名育龄妇女中有13.3例，班达法西为17/10000，姆隆普为6.9/10000。与社会禁忌相关的社会文化限制以及语言障碍被视为应用口头尸检做法的限制。此外，由于受访者提供信息不足或访谈者缺乏经验导致数据收集缺乏准确性也可能是限制因素。在农村地区进行的这项研究无法显示全国孕产妇死亡率水平。完成口头尸检需要时间，导致成本过高。
口头尸检仍然是衡量孕产妇死亡率的一种有趣方法。在许多分娩仍在家中进行的农村地区具有优势。为了对每个病例进行精确分析，需要进一步提高数据收集的准确性。
