Sisterhood method

From WikiMD's Wellness Encyclopedia

The Sisterhood Method is a household survey to estimate maternal deaths recommended by the World Health Organization. Although maternal deaths are a major problem in developing countries, high quality data are rare. Yet, numbers are needed for planning in order to reduce the problem of maternal death. Several methods have been used to estimate maternal deaths. According to the WHO, "The approach was designed to overcome the problem of large sample sizes and thus reduce cost."[1][2]

Background[edit | edit source]

The death of a woman during or shortly after a pregnancy is an important medical problem in developing countries. 99% of all maternal deaths occur in developing countries.[3] In the poorest countries in the world, e.g. Sierra Leone, the lifetime risk for a woman dying because of a maternal death is approx 1 in 6, whereas in developed countries, e.g. Sweden, the same lifetime risk is approx 1 in 30,000.[4] Half of all maternal deaths occur in six countries only: Afghanistan, Democratic Republic of Congo, Ethiopia, India, Nigeria, and Pakistan. Worldwide, maternal deaths decreased from approx 500,000 in 1980 to approx 350,000 in 2008. This decline in maternal deaths was associated mainly with better maternal education, maternal income, increased availability of trained birth attendants, and decreased pregnancy rates.[5]

Estimating maternal deaths[edit | edit source]

Although maternal deaths are a major problem in developing countries, seen globally, the numbers are not very large, and there is an absence of high quality data. Yet, numbers are needed for planning in order to reduce maternal deaths. Several methods have been used to estimate maternal deaths. They include analysing census records and medical/death certificates,[6] and Reproductive Age Mortality Studies (RAMOS).[7] Also, household surveys are used. All of these methods are not totally precise, but they can provide some useful information to decrease maternal mortality.

In contrast, full surveillance programmes would be too costly and too unrealistic for many developing countries.[8]

Sisterhood Method[edit | edit source]

The Sisterhood Method is the most common household survey for estimating maternal deaths. It is time- and cost-effective, and reduces sample size requirements; in countries or areas with high levels of maternal deaths, i.e. over 500 maternal deaths per 100,000 live births, a sample size of 4000 households or less is acceptable for this method.[9] But the method still provides a useful means of assessing maternal mortality.

This method includes four questions about the sisters of the woman in question:[10]

  • How many sisters have you ever had, born to the same mother, who ever reached the age 15 (or who were ever married), including those who are now dead?
  • How many of your sisters who reached the age of 15 are alive now?
  • How many of these sisters are dead?
  • How many of your sisters who are dead died during a pregnancy or during childbirth, or during the six weeks after the end of a pregnancy?

Application[edit | edit source]

Deaths occurring over a large interval of time are documented. The overall estimate of maternal mortality is determined for 10–12 years before the survey. The Sisterhood Method is useful because usually maternal mortality changes slowly. It provides some meaningful data in countries or areas where there are no alternative means of generating estimates.

When should the Sisterhood Method not be used[edit | edit source]

The Sisterhood Method is not appropriate in countries or areas where the total fertility rate is less than four children per family, in areas of significant migration, as well as during civil war, civil unrest or other significant social disruption.

Variant[edit | edit source]

The original Sisterhood Method is an indirect method. The newer Direct Sisterhood Method targets a more limited reference period for sister deaths and uses more in depth questions (e.g., deaths among all siblings, all deaths that are pregnancy related, and when these deaths occurred). This variant relies on fewer assumptions than the original Sisterhood Method. However, it requires a larger sample size, data gathering and analysis are more complex, and has large confidence intervals. Despite these limitations, the Direct Sisterhood Method can result in greater specificity of information. A retrospective maternal mortality ratio (MMR) can be calculated. This variant is used by Demographic and Health Surveys (DHS).[11][12]

References[edit | edit source]

  1. ↑ The sisterhood method for estimating maternal mortality: Guidance notes for potential users, page 5. WHO. Geneva, Switzerland. 1997.
  2. ↑ Indirect estimation of maternal mortality: The sisterhood method. Graham W, Brass W, Snow RW. Stud Fam Planning. 1989:20(3):125-35.
  3. ↑ Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA. AbouZahar C, Wardlaw T (Eds). WHO. Geneva, Switzerland. 2003.
  4. ↑ Maternal mortality: Who, when, where, and why. Ronsmans C, Graham WJ; Lancet Maternal Survival Series Steering Group. Lancet. 2006;368(9542):1189-200.
  5. ↑ Maternal mortality for 181 countries, 1980-2008: A systematic analysis of progress towards Millennium Development Goal 5. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJ. Lancet. 2010;375(9726):1609-23.
  6. ↑ Underreporting of maternal deaths on death certificates and the magnitude of the problem of maternal mortality. Horon IL. Am J Public Health. 2005;95(3):478-82.
  7. ↑ National maternal mortality study, 2005. Carried out by: Haceteppe University Medical School, Institute of Population Studies. For the Turkish Ministry of Health, the General Directorate of Mother and Child Health and Family Planning, and the Delegation of European Commission to Turkey. Ankara, Turkey. 2006.
  8. ↑ Measuring maternal mortality: An overview of opportunities and options for developing countries. Graham WJ, Ahmed S, Stanton C, Abou-Zahr C, Campbell OM. BMC Med. 2008;6:12.
  9. ↑ "WHO - Publications". Who.int. Retrieved 4 March 2019.
  10. ↑ "The Sisterhood Method for Estimating Maternal Mortality: Guidance notes for potential users" (PDF). Who.org. World Health Organization. Retrieved 13 March 2015.
  11. ↑ Direct and indirect estimates of maternal mortality from the Sisterhood Method. Rutenberg N, Sullivan JM (Eds). Washington DC, USA. 1991.
  12. ↑ An assessment of DHS maternal mortality indicators. Stud Fam Planning. 2000:31(2):111-23.
WikiMD
Navigation: Wellness - Encyclopedia - Health topics - Disease Index‏‎ - Drugs - World Directory - Gray's Anatomy - Keto diet - Recipes

Search WikiMD

Ad.Tired of being Overweight? Try W8MD's physician weight loss program.
Semaglutide (Ozempic / Wegovy and Tirzepatide (Mounjaro / Zepbound) available.
Advertise on WikiMD

WikiMD's Wellness Encyclopedia

Let Food Be Thy Medicine
Medicine Thy Food - Hippocrates

Medical Disclaimer: WikiMD is not a substitute for professional medical advice. The information on WikiMD is provided as an information resource only, may be incorrect, outdated or misleading, and is not to be used or relied on for any diagnostic or treatment purposes. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. WikiMD expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site. By visiting this site you agree to the foregoing terms and conditions, which may from time to time be changed or supplemented by WikiMD. If you do not agree to the foregoing terms and conditions, you should not enter or use this site. See full disclaimer.
Credits:Most images are courtesy of Wikimedia commons, and templates Wikipedia, licensed under CC BY SA or similar.

Retrieved from "https://wikimd.com/w/index.php?title=Sisterhood_method&oldid=5213660"

Contributors: Prab R. Tumpati, MD