 The Sisterhood Method is a household survey to estimate maternal deaths recommended by the World Health Organization  . Although maternal deaths are a major problem in developing countries, high quality data are rare. Yet, numbers are needed for planning in order to reduce the problem of maternal death. Several methods have been used to estimate maternal deaths. According to the WHO, "The approach was designed to overcome the problem of large sample sizes and thus reduce cost."The sisterhood method for estimating maternal mortality: Guidance notes for potential users, page 5. WHO. Geneva, Switzerland. 1997.Indirect estimation of maternal mortality: The sisterhood method. Graham W, Brass W, Snow RW. Stud Fam Planning. 1989:20(3):125-35. Background The death of a woman during or shortly after a pregnancy is an important medical problem in developing countries. 99\% of all maternal deaths occur in developing countries.Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA. AbouZahar C, Wardlaw T (Eds). WHO. Geneva, Switzerland. 2003. In the poorest countries in the world, e.g. Sierra Leone, the lifetime risk for a woman dying because of a maternal death is approx 1 in 6, whereas in developed countries, e.g. Sweden, the same lifetime risk is approx 1 in 30,000.Maternal mortality: Who, when, where, and why. Ronsmans C, Graham WJ; Lancet Maternal Survival Series Steering Group. Lancet. 2006;368(9542): 1189-200. Half of all maternal deaths occur in six countries only: Afghanistan, Democratic Republic of Congo, Ethiopia, India, Nigeria, and Pakistan. Worldwide, maternal deaths decreased from approx 500,000 in 1980 to approx 350,000 in 2008. This decline in maternal deaths was associated mainly with better maternal education, maternal income, increased availability of trained birth attendants, and decreased pregnancy rates.  Maternal mortality for 181 countries, 1980-2008: A systematic analysis of progress towards Millennium Development Goal 5. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJ. Lancet. 2010;375(9726):1609-23. Estimating maternal deaths Although maternal deaths are a major problem in developing countries, seen globally, the numbers are not very large, and there is an absence of high quality data. Yet, numbers are needed for planning in order to reduce maternal deaths. Several methods have been used to estimate maternal deaths. They include analysing census records and medical/death certificates,  Underreporting of maternal deaths on death certificates and the magnitude of the problem of maternal mortality  . Horon IL. Am J Public Health. 2005;95(3): 478-82. and Reproductive Age Mortality Studies (RAMOS).National maternal mortality study, 2005. Carried out by: Haceteppe University Medical School, Institute of Population Studies. For the Turkish Ministry of Health, the General Directorate of Mother and Child Health and Family Planning, and the Delegation of European Commission to Turkey. Ankara, Turkey. 2006. Also, household surveys are used. All of these methods are not totally precise, but they can provide some useful information to decrease maternal mortality. In contrast, full surveillance programmes would be too costly and too unrealistic for many developing countries.  Measuring maternal mortality: An overview of opportunities and options for developing countries  . Graham WJ, Ahmed S, Stanton C, Abou-Zahr C, Campbell OM. BMC Med. 2008;6:12. Variant The original Sisterhood Method is an indirect method. The newer Direct Sisterhood Method targets a more limited reference period for sister deaths and uses more in depth questions (e.g., deaths among all siblings, all deaths that are pregnancy related, and when these deaths occurred). This variant relies on fewer assumptions than the original Sisterhood Method. However, it requires a larger sample size, data gathering and analysis are more complex, and has large confidence intervals. Despite these limitations, the Direct Sisterhood Method can result in greater specificity of information. A retrospective maternal mortality ratio (MMR) can be calculated. This variant is used by Demographic and Health Surveys (DHS).Direct and indirect estimates of maternal mortality from the Sisterhood Method. Rutenberg N, Sullivan JM (Eds). Washington DC , USA . 1991.  An assessment of DHS maternal mortality indicators. Stud Fam Planning  . 2000:31(2): 111-23.
((refimprove The Sisterhood Method is a household survey to estimate maternal deaths recommended by the World Health Organization (WHO) . Although maternal deaths are a major problem in developing countries, high quality data are rare. Yet, numbers are needed for planning in order to reduce the problem of maternal death. Several methods have been used to estimate maternal deaths. According to the WHO, "The approach was designed to overcome the problem of large sample sizes and thus reduce cost."The sisterhood method for estimating maternal mortality: Guidance notes for potential users, page 5. WHO. Geneva, Switzerland. 1997.Indirect estimation of maternal mortality: The sisterhood method. Graham W, Brass W, Snow RW. Stud Fam Planning. 1989:20(3):125-35. Background The death of a woman during or shortly after a pregnancy is an important medical problem in developing countries. 99\% of all maternal deaths occur in developing countries.Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA. AbouZahar C, Wardlaw T (Eds). WHO. Geneva, Switzerland. 2003. In the poorest countries in the world, e.g. Sierra Leone, the lifetime risk for a woman dying because of a maternal death is approx 1 in 6, whereas in developed countries, e.g. Sweden, the same lifetime risk is approx 1 in 30,000.Maternal mortality: Who, when, where, and why. Ronsmans C, Graham WJ; Lancet Maternal Survival Series Steering Group. Lancet. 2006;368(9542): 1189–1200. Half of all maternal deaths occur in six countries only: Afghanistan, Democratic Republic of Congo, Ethiopia, India, Nigeria, and Pakistan. Worldwide, maternal deaths decreased from approx 500,000 in 1980 to approx 350,000 in 2008. This decline in maternal deaths was associated mainly with better maternal education, maternal income, increased availability of trained birth attendants, and decreased pregnancy rates. " Maternal mortality for 181 countries, 1980-2008: A systematic analysis of progress towards Millennium Development Goal 5". Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJ. Lancet. 2010;375(9726):1609-23. Estimating maternal deaths Although maternal deaths are a major problem in developing countries, seen globally, the numbers are not very large, and there is an absence of high quality data. Yet, numbers are needed for planning in order to reduce maternal deaths. Several methods have been used to estimate maternal deaths. They include analysing census records and medical/death certificates, " Underreporting of maternal deaths on death certificates and the magnitude of the problem of maternal mortality " . Horon IL. Am J Public Health. 2005;95(3): 478–82. and Reproductive Age Mortality Studies (RAMOS).National maternal mortality study, 2005. Carried out by: Haceteppe University Medical School, Institute of Population Studies. For the Turkish Ministry of Health, the General Directorate of Mother and Child Health and Family Planning, and the Delegation of European Commission to Turkey. Ankara, Turkey. 2006. Also, household surveys are used. All of these methods are not totally precise, but they can provide some useful information to decrease maternal mortality. In contrast, full surveillance programmes would be too costly and too unrealistic for many developing countries. " Measuring maternal mortality: An overview of opportunities and options for developing countries " . Graham WJ, Ahmed S, Stanton C, Abou-Zahr C, Campbell OM. BMC Med. 2008;6:12. Variant The original Sisterhood Method is an indirect method. The newer Direct Sisterhood Method targets a more limited reference period for sister deaths and uses more in depth questions (e.g., deaths among all siblings, all deaths that are pregnancy related, and when these deaths occurred). This variant relies on fewer assumptions than the original Sisterhood Method. However, it requires a larger sample size, data gathering and analysis are more complex, and has large confidence intervals. Despite these limitations, the Direct Sisterhood Method can result in greater specificity of information. A retrospective maternal mortality ratio (MMR) can be calculated. This variant is used by Demographic and Health Surveys (DHS).Direct and indirect estimates of maternal mortality from the Sisterhood Method. Rutenberg N, Sullivan JM (Eds). Washington DC . 1991. " An assessment of DHS maternal mortality indicators. Stud Fam Planning " . 2000:31(2): 111–23.
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((refimprove
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(WHO)
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1189-200.
1189–1200.
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5.
5".
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478-82.
478–82.
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D
, USA
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111-23.
111–23.