DHS maternal mortality indicators : an assessment of data quality and implications for data use

Three aspects of data quality in the sibling histories are assessed: data completeness, possible omissions, and the plausibility of sibling birth and death patterns. In general, the data are remarkably complete in most surveys, with adjustments made for two variables that show particularly high levels of incompletion: the number of years since the occurrence of a sibling"s death, and the timing of death relative to pregnancy, childbirth, and the postpartum period for adult female deaths. Despite concerns to the contrary, the data reflect nearly identical patterns for brothers and sisters. As for underreporting, comparisons of DHS sibling estimates of adult mortality with external sources suggest, though not conclusively, that the sibling measures are more likely to be underestimates than overestimates of actual adult mortality for the 7- year period preceding the surveys, with underreporting probably somewhat greater for females than males. As MM is a subset of adult female mortality, it is assumed to be also underreported for the recent period. The MM indicators presented in the report show implausible increases between the periods 7 to 13 and 0 to 6 years before the surveys for a majority of the 14 countries considered -- most likely due to underreporting or inaccurate reporting. Although increases for some of the countries range from 50% to over 100%, few of the increases are statistically significant. The 95% confidence intervals for the MMRatio estimates average plus or minus 30% of the estimate. The imprecision of the individual estimates, coupled with the implausible increases seen for a number of the countries, clearly imply that these data cannot support trend analyses for adult nor maternal mortality. It is important for users of DHS MM indicators to realize the limitations of the data, serious misinterpretation of which is common. In most cases, current measurement techniques available at the national level will not permit meaningful monitoring of MM over time. Attention thus needs to be focused on measuring and monitoring indicators of the components or processes determining a positive or adverse pregnancy outcome. Only experimentation in data collection and analysis will yield the most effective package of indicators. (Author abstract, modified)