Erhardt-Ohren Blake, McCoy Sandra I, Feehan Dennis M, Haar Rohini J, Prata Ndola
Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, Berkeley, USA.
Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, USA.
Confl Health. 2024 Dec 19;18(1):75. doi: 10.1186/s13031-024-00636-y.
Around the world, a maternal death occurs approximately every two minutes-most of these deaths are preventable. The maternal mortality ratio is a key indicator for the Sustainable Development Goals, yet we have no reliable way to estimate maternal deaths in refugee or internally displaced persons (IDP) camps and settlements. The goal of this study was to understand the methodologies most suited for adaptation for use to estimate the proportion of maternal mortality due to abortion complications in these settings.
We conducted a scoping review of methodologies to estimate maternal mortality and evaluated them using a predetermined set of criteria. We evaluated nine original methodologies using eleven categories related to implementation in refugee or IDP camps and settlements: data sources, definitions, sample size, timing of point estimate relative to data collection, bias, human resources, time needed for implementation, data collection training, statistical training, digitalization, and cost. Each category could be assigned zero to four points, for a total score of 44 points. After evaluating each original methodology, we reviewed the original publication's citations or searched for other implementations through October 2022. We revised the original scores and developed a rank-order list of the methodologies according to their suitability for implementation in refugee and IDP camps.
We identified 124 publications that estimated maternal mortality. The Maternal Deaths from Informants/Maternal Death Follow on Review (MADE-IN/MADE-FOR) (33.5), hospital- or facility-based (33.5), and community informant-based (32.5) methodologies ranked highest due to low costs, short time interval needed for implementation, small sample sizes and close timing of point estimate relative to data collection, easy digitalization, and the need for no statistical training.
Similar to the lack of a "perfect" methodology to estimate maternal mortality in stable settings, there are compromises to consider when applying these methodologies to humanitarian settings. The most promising methodologies are adaptable to practical constraints in refugee and IDP camps and settlements. New methodologies that adapt and strengthen the MADE-IN/MADE-FOR, hospital- or facility-based, and community informant-based methodology show promise and must be further developed.
在全球范围内，大约每两分钟就有一名孕产妇死亡——其中大多数死亡是可以预防的。孕产妇死亡率是可持续发展目标的一项关键指标，但我们没有可靠的方法来估计难民营或境内流离失所者营地及定居点中的孕产妇死亡情况。本研究的目的是了解最适合改编用于估计这些环境中因堕胎并发症导致的孕产妇死亡比例的方法。
我们对估计孕产妇死亡率的方法进行了范围审查，并使用一组预先确定的标准对其进行评估。我们使用与在难民营或境内流离失所者营地及定居点实施相关的11个类别评估了9种原始方法：数据来源、定义、样本量、点估计相对于数据收集的时间、偏差、人力资源、实施所需时间、数据收集培训、统计培训、数字化和成本。每个类别可分配0至4分，总分为44分。在评估每种原始方法后，我们查阅了原始出版物的参考文献，或截至2022年10月搜索其他实施情况。我们修订了原始分数，并根据方法在难民营和境内流离失所者营地实施的适用性制定了排名列表。
我们确定了124篇估计孕产妇死亡率的出版物。由信息提供者提供的孕产妇死亡情况/孕产妇死亡后续审查（MADE-IN/MADE-FOR）（33.5分）、基于医院或机构的方法（33.5分）以及基于社区信息提供者的方法（32.5分）排名最高，原因是成本低、实施所需时间间隔短、样本量小、点估计相对于数据收集的时间接近、易于数字化且无需统计培训。
与在稳定环境中缺乏估计孕产妇死亡率的“完美”方法类似，在将这些方法应用于人道主义环境时也需要权衡考虑。最有前景的方法适用于难民营和境内流离失所者营地及定居点的实际限制。改编并强化MADE-IN/MADE-FOR、基于医院或机构的方法以及基于社区信息提供者的方法的新方法显示出前景，必须进一步开发。
