High maternal mortality in a rural south-west Ethiopia: Estimate by using the sisterhood method

Background: Maternal mortality estimation is difficult in developing countries that have no complete vital registration. The indirect sisterhood method represents an alternative in places where there is high fertility and high mortality. The objective of our study was to estimate maternal mortality indices by the sisterhood method in a rural district in southwest Ethiopia. Method: We interviewed 8,870 adults aged 15-49 years in 15 randomly selected rural villages of Bonke in Gamo Gofa. By constructing a retrospective cohort of women of reproductive age, we obtained sister units of risk exposure to maternal mortality, and calculated lifetime risk of maternal mortality. Based on the total fertility for the rural Ethiopian population, maternal mortality ratio was approximated. Findings: We analysed 8,503 of 8,870 (96%) respondents, 5262 (62%) men and 3241 (38%) women. The 8,503 respondents reported 22,473 sisters (average 2.6 sisters for each respondent) who survived up to the reproductive age. Of the 2,552 (11.4 per cent) sisters who had died, 32% (819/2552) occurred during pregnancy and childbirth. This provided a lifetime risk of 10.2 per cent from pregnancy and childbirth with corresponding maternal mortality ratio of 1667 (95% confidence interval: 1564-1769) per 100,000 live births. The time period for this estimate is around 1998. Separate analysis for male and female respondents provided similar estimates. Conclusion: The impoverished rural area of Gamo Gofa had very high maternal mortality around 1998. This highlights the need for strengthening emergency obstetric care for the Bonke population and for similar rural populations.