Hill Kenneth, Queiroz Bernardo L, Wong Laura, Plata Jorge, Del Popolo Fabiana, Rosales Jimmy, Stanton Cynthia
Harvard University, Cambridge, MA, USA.
Bull World Health Organ. 2009 Apr;87(4):288-95. doi: 10.2471/blt.08.052233.
To assess the feasibility of measuring maternal mortality in countries lacking accurate birth and death registration through national population censuses by a detailed evaluation of such data for three Latin American countries.
We used established demographic techniques, including the general growth balance method, to evaluate the completeness and coverage of the household death data obtained through population censuses. We also compared parity to cumulative fertility data to evaluate the coverage of recent household births. After evaluating the data and adjusting it as necessary, we calculated pregnancy-related mortality ratios (PRMRs) per 100 000 live births and used them to estimate maternal mortality.
The PRMRs for Honduras (2001), Nicaragua (2005) and Paraguay (2002) were 168, 95 and 178 per 100 000 live births, respectively. Surprisingly, evaluation of the data for Nicaragua and Paraguay showed overreporting of adult deaths, so a downward adjustment of 20% to 30% was required. In Honduras, the number of adult female deaths required substantial upward adjustment. The number of live births needed minimal adjustment. The adjusted PRMR estimates are broadly consistent with existing estimates of maternal mortality from various data sources, though the comparison varies by source.
Census data can be used to measure pregnancy-related mortality as a proxy for maternal mortality in countries with poor death registration. However, because our data were obtained from countries with reasonably good statistical systems and literate populations, we cannot be certain the methods employed in the study will be equally useful in more challenging environments. Our data evaluation and adjustment methods worked, but with considerable uncertainty. Ways of quantifying this uncertainty are needed.
通过对三个拉丁美洲国家的此类数据进行详细评估，以评估在缺乏准确出生和死亡登记的国家中，利用全国人口普查来衡量孕产妇死亡率的可行性。
我们使用既定的人口统计学技术，包括一般增长平衡法，来评估通过人口普查获得的家庭死亡数据的完整性和覆盖范围。我们还将产次与累积生育数据进行比较，以评估近期家庭出生情况的覆盖范围。在对数据进行评估并在必要时进行调整后，我们计算了每10万例活产的妊娠相关死亡率（PRMR），并使用这些数据来估计孕产妇死亡率。
洪都拉斯（2001年）、尼加拉瓜（2005年）和巴拉圭（2002年）的每10万例活产PRMR分别为168、95和178。令人惊讶的是，对尼加拉瓜和巴拉圭的数据评估显示成人死亡报告过多，因此需要向下调整20%至30%。在洪都拉斯，成年女性死亡人数需要大幅向上调整。活产数量只需进行最小程度的调整。经调整后的PRMR估计值与来自各种数据来源的现有孕产妇死亡率估计值大致一致，不过不同来源的比较结果有所不同。
在死亡登记不完善的国家，普查数据可用于衡量妊娠相关死亡率，以此作为孕产妇死亡率的替代指标。然而，由于我们的数据来自统计系统相当完善且人口识字率较高的国家，我们无法确定本研究中采用的方法在更具挑战性的环境中是否同样有用。我们的数据评估和调整方法是有效的，但存在相当大的不确定性。需要有量化这种不确定性的方法。
