Demographic and Health Surveys Methodology - Measure DHS
Demographic and Health Surveys Methodology - Measure DHS
Demographic and Health Surveys Methodology - Measure DHS
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Notes <strong>and</strong> ConsiderationsThe <strong>DHS</strong> maternal mortality module questionnaire collects information from respondents (female <strong>and</strong>male) about the maternal status of the death of their sisters born to the same mother by asking if the sisterdied while pregnant, during delivery or within two months after the end of a pregnancy or a childbirth.Younger (<strong>and</strong> male) respondents may not know that their older sister was even pregnant if the sister wasseveral years older or died during pregnancy or from an induced abortion, thus biasing maternal mortalityrates downward. Women who intend to have an induced abortion may also not disclose their pregnancystatus to family members. On the other h<strong>and</strong>, deaths due to non-maternal causes, such as accidents <strong>and</strong>illnesses, will be included as maternal deaths if they occurred during pregnancy or within two monthsafter the end of the pregnancy or childbirth. Simulation models show that up to one-third of classified asmaternal may not be due to maternal causes, resulting in an upward bias. The final result of both thesebiases, which operate simultaneously, is unknown.Another important issue is location. The <strong>DHS</strong> does not collect information on the residence of neithersisters who died nor of the residence during the exposure period of both living <strong>and</strong> dead sisters. Theresidence at the time of interview of respondents is not necessarily the same as that of their sisters.Therefore, <strong>DHS</strong> usually does not publish maternal mortality rates <strong>and</strong> maternal mortality ratios by area.Maternal mortality rates <strong>and</strong> ratios are subject to high levels of relative sampling error due to theirrelatively rare occurrence. For example, a maternal mortality ratio of 500 maternal deaths per 100,000births has the same sampling error as an infant mortality rate of 5 infant deaths per 1000 births. For asample of about 15,000 respondents, the 95% confidence interval of the MMR would be about 406 to 594maternal deaths per 100,000 births.ReferencesRutenberg, N. <strong>and</strong> Sullivan, J.M. Direct <strong>and</strong> indirect estimates of maternal mortality from the sisterhoodmethod. IRD/Macro International Inc., Washington DC, 1991.Hanley, J.A., Hagen, C.A. <strong>and</strong> Shiferaw, T. Confidence intervals <strong>and</strong> sample size calculations for thesisterhood method of estimating maternal mortality. Studies in Family Planning 27(4) July/August 1996.WHO/UNICEF. The Sisterhood method to estimate maternal mortality. Report of a technical meeting,5-6 December 1996.Stanton, C., Abderrahim, N. <strong>and</strong> Hill, K. <strong>DHS</strong> maternal mortality indicators: An assessment of dataquality <strong>and</strong> implications for data use. <strong>Demographic</strong> <strong>and</strong> <strong>Health</strong> <strong>Surveys</strong> Analytical Report No 4, MacroInternational Inc. Calverton, Maryl<strong>and</strong>, USA, September 1997.Guide to <strong>DHS</strong> Statistics 157 Updated September 2006