Maternal mortality in a rural district of southeastern Tanzania: an application of the sisterhood method

Deaths from maternal causes represent the leading cause of death among women of reproductive age in most developing countries. It is estimated that the highest risk occurs in Africa with 20% of world births but 40% of the world maternal deaths. The level of maternal mortality is difficult to assess especially in countries without an adequate vital registration system. Indirect techniques are an attractive cost-effective tool to provide estimates of orders of magnitude for maternal mortality. The level of maternal mortality estimated by the sisterhood method is presented for a rural district in Morogoro Region of Southeastern Tanzania and the main causes of maternal death are studied. Information from region-specific data using the sisterhood method is compared to data from other sources. The maternal mortality ratio was 448 maternal deaths/100000 live births (95% confidence interval 363-534 deaths/100000 live births). Maternal causes accounted for 19% of total mortality in this age group. 1 in 39 women who survive until reproductive age will die before age 50 years due to maternal causes. The main cause of death provided by hospital data was puerperal sepsis (35%) and postpartum hemorrhage (17%); this is compatible with the main causes reported for maternal death in settings with high levels of maternal mortality and similar to data for other regions in Tanzania. The sisterhood method provides data comparable with others together with a cost-effective and reliable estimate for the determination of the magnitude of maternal mortality in the rural Kilombero District. (authors)