Estimates of maternal mortality ratio in Rajasthan & Orissa State of India: An adapted Approach
An adapted Snowball sampling was adopted to estimate the maternal mortality ratio (MMR) in another two states ,Orissa and Rajasthan of India. This paper presents the estimates of MMR in these two states and associated medical causes of maternal deaths using adapted methodology.
METHODS:
A sample of 13 Primary Health Centres (PHCs) in Orissa and 15 PHCs in Rajasthan were covered. Snowball sampling was adopted to capture the maternal deaths while numbers of live births were collected from the records of the system.
RESULTS:
Snowball sampling captures 17% additional maternal deaths as compared to the official record. The overall MMR 271 (95% CI: 198-344) of Orissa is comparable to AHS estimate of 277 (95% CI:246-307). In Rajasthan the overall MMR 222 (95% CI: 172- 271) as compared to AHS MMR of 331(95% CI: 300-362).. The decline shows the progress in reduction of MMR. The probable cause may be effective implementation of Janani Surashka Yojna (JSY) in the recent past in Rajasthan state of India.
The main causes of maternal deaths were post partum haemorrhage (PPH), anaemia and septicaemia followed by abortion. More than 30% maternal deaths in Orissa and 25% in Rajasthan occurred due to indirect causes including suicide, road accident and other infectious diseases such as TB and viral hepatitis
CONCLUSIONS:
Adapted Snowball sampling is an effective methodology for capturing maternal deaths. About 30% maternal deaths due to indirect causes could be prevented. The importance of safe delivery particularly institutional deliveries may be advocated to rural women to improve in averting these maternal deaths.