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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Revealing the burden of maternal mortality: A probabilistic model for determining pregnancy-related causes of death from verbal autopsies
Population Health Metrics, Volume 5, Article 1, Year 2007
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Description
Background: Substantial reductions in maternal mortality are called for in Millennium Development Goal 5 (MDG-5), thus assuming that maternal mortality is measurable. A key difficulty is attributing causes of death for the many women who die unaided in developing countries. Verbal autopsy (VA) can elicit circumstances of death, but data need to be interpreted reliably and consistently to serve as global indicators. Recent developments in probabilistic modelling of VA interpretation are adapted and assessed here for the specific circumstances of pregnancy-related death. Methods: A preliminary version of the InterVA-M probabilistic VA interpretation model was developed and refined with adult female VA data from several sources, and then assessed against 258 additional VA interviews from Burkina Faso. Likely causes of death produced by the model were compared with causes previously determined by local physicians. Distinction was made between free-text and closed-question data in the VA interviews, to assess the added value of free-text material on the model's output. Results: Following rationalisation between the model and physician interpretations, cause-specific mortality fractions were broadly similar. Case-by-case agreement between the model and any of the reviewing physicians reached approximately 60%, rising to approximately 80% when cases with a discrepancy were reviewed by an additional physician. Cardiovascular disease and malaria showed the largest differences between the methods, and the attribution of infections related to pregnancy also varied. The model estimated 30% of deaths to be pregnancy-related, of which half were due to direct causes. Data derived from free-text made no appreciable difference. Conclusion: InterVA-M represents a potentially valuable new tool for measuring maternal mortality in an efficient, consistent and standardised way. Further development, refinement and validation are planned. It could become a routine tool in research and service settings where levels and changes in pregnancy-related deaths need to be measured, for example in assessing progress towards MDG-5. © 2007 Fottrell et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Fottrell, Edward F.
United Kingdom, Aberdeen
University of Aberdeen
Byass, P.
United Kingdom, Aberdeen
University of Aberdeen
Ouedraogo, T. W.
Burkina Faso, Ouagadougou
Centre Muraz
Tamini, Cecile
Burkina Faso, Ouagadougou
Centre Muraz
Gbangou, Adjima
Burkina Faso, Nouna
Centre de Recherche en Sante de Nouna
Sombié, Issiaka
Burkina Faso, Ouagadougou
Centre Muraz
Högberg, Ulf
Sweden, Umea
Umeå Universitet
Witten, Karen Hanna
United Kingdom, Aberdeen
University of Aberdeen
Bhattacharya, Sohinee
United Kingdom, Aberdeen
University of Aberdeen
Desta, Teklay
Ethiopia, Adi-daero
Tigray Regional Health Bureau
Deganus, Sylvia A.
Ghana
Tema Hospital
Tornui, Janet
Ghana, Accra
Noguchi Memorial Institute for Medical Research
Fitzmaurice, Ann E.
United Kingdom, Aberdeen
University of Aberdeen
Méda, Nicolas Yelbomkan
Burkina Faso, Ouagadougou
Centre Muraz
Graham, Wendy Jane
United Kingdom, Aberdeen
University of Aberdeen
Statistics
Citations: 444
Authors: 15
Affiliations: 7
Identifiers
Doi:
10.1186/1478-7954-5-1
e-ISSN:
14787954
Research Areas
Infectious Diseases
Maternal And Child Health
Noncommunicable Diseases
Sexual And Reproductive Health
Study Locations
Burkina Faso
Participants Gender
Female