Measuring Maternal Mortality from a Census: Guidelines for Potential UsersName: Measuring Maternal Mortality from a Census: Guidelines for Potential Users Purpose: The purpose of this publication is to produce guidelines for countries interested in using the census as a source of data for maternal mortality measures. Type of design: National Population Census Sample size: All households Where used: Developing countries, particularly where civil registration systems are deficient To Tool: English, Français, Español BASIC INFORMATION:Name: Measuring Maternal Mortality from a Census: Guidelines for Potential Users Origin / Source: The manual was written by Kenneth Hill, Cynthia Stanton and Neeru Gupta under the MEASURE Evaluation Project. Technical Area: Maternal health Basic Description: This publication is a result of the MEASURE Evaluation meeting, "Workshop for the Evaluation of Maternal Mortality Data Collected via a Census" held in November 1998 in Nairobi, Kenya. Its objectives are to document and evaluate experiences of measuring maternal mortality from a recent census in developing countries, to encourage countries to build upon these experiences, and to compile recommendations for Statistical Offices considering using the census methodology for maternal mortality estimates. Country Applications: At the time the document was written, only a handful of developing countries had been identified as having produced maternal mortality estimates from a recent census. They included Benin, Iran, Laos, Madagascar and Zimbabwe. The Guidelines use illustrative applications of the census methodology to data from Benin and Zimbabwe. Languages Available: English (full text); French (abridged verdion); Spanish (abridged version) Technical Scope: Maternal Mortality Measurement Purpose: The purpose of this publication is to produce guidelines for countries interested in using the census as a source of data for maternal mortality measures. Design: National Population Census Method: Quantitative Frequency of Administration: It is recommended that the interval between national population censuses be 10 years, or at least not more than 15 years. Key Users of Information: The Guidelines were designed to aid Statistical Offices in developing countries to plan for and implement data collection and publish estimates of maternal mortality from a national population census. It is also recommended that other interested parties, including representatives of the Ministry of Health and the donor community, be involved in the planning from the beginning. Objectives and Scope of Tool: The purpose of this publication is to produce guidelines for countries interested in using the census as a source of data for maternal mortality measures. The methods described in the manual cover data requirements; questionnaire development; interviewer training and fieldwork; data evaluation, adjustment and analysis; data dissemination and use. Key Indicators: A number of different indicators for the measurement of maternal mortality are covered:
Research design: The Guidelines were designed to aid Statistical Offices in developing countries to plan for and implement data collection and publish estimates of maternal mortality from a national population census. The methods described cover data requirements; questionnaire development; interviewer training and fieldwork; data evaluation, adjustment and analysis; data dissemination and use. Along with representatives from the Statistical Office, it is recommended that representatives of the Ministry of Health, as well as the donor community, be involved in the planning from the beginning. Implementation and Training: Measures of maternal mortality require information on the population by age and sex, the number of all deaths and the number of maternal deaths over a given period of reference, and the number of live births over the same period. The collection of information on deaths in a census involves the identification of all household members who have died within a specified time period, as well as the sex and age, in completed years, of each deceased person. In order to distinguish maternal from non-maternal deaths, questions should be asked to determine the timing of adult female deaths relative to pregnancy, childbirth and the postpartum period. Additional training time to cover the questions related to maternal mortality must be provided in the census timetable in all steps of fieldwork implementation, from central office staff to field interviewers. Lessons from experience: The Guidelines present recommendations for using the census methodology based on the lessons learned formulated during the course of the Workshop for the Evaluation of Maternal Mortality Data Collected via a Census. Aspects described in the manual include data requirements; questionnaire development; interviewer training and fieldwork; data evaluation, adjustment and analysis; data dissemination and use. Repeating the exercise in successive censuses is likely to lead to improvements in the estimation and evaluation procedures. Analysis: Data quality evaluation for census measures of maternal mortality requires four steps: 1) evaluation of the population structure; 2) evaluation of the completeness of recording the number of deaths; 3) evaluation of the completeness of recording the number of births; and 4) evaluation of the classification of adult female deaths as maternal. This implies that the raw census data on the distribution of the population and deaths, maternal deaths and births be kept in a machine-readable form following data entry and cleaning. Subsequent adjustment may be necessary in cases of deficiencies to arrive at a reliable estimate of maternal mortality indicators. The publication describes methods for each step and provides illustrative examples using data from the 1992 Zimbabwe census and the 1992 Benin census. Reporting and dissemination of results: The publication presents recommendations for the tabulation of maternal mortality data collected in a national census, as well as ways in which interest and demand for census-based estimates of maternal mortality can be maintained. The tabulation layout should include the distribution of the population and numbers of deaths by five-year age group and sex, as well as the numbers of deaths due to maternal causes and births by maternal age group. It is also recommended that, where numbers are sufficient, maternal mortality data be tabulated and presented by region, urban/rural residence, and some socio-economic characteristics of the household. References: Maternal
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