An innovative approach to measuring maternal mortality at the community level in low-resource settings using mid-level providers: a feasibility study in Tigray, Ethiopia.

This paper proposes a new, community-based approach to the measurement of maternal mortality, and presents results from a feasibility study in 2010–11 of that approach in rural Tigray, Ethiopia. The study was implemented in three health posts and one health centre with a total catchment area of approximately 22,000 people. Priests, traditional birth attendants and community-based reproductive health agents were responsible for locating and reporting all births and deaths in their areas and assisted mid-level providers in locating key informants for verbal autopsy. Community-based health workers were trained to report all births and deaths to the local health post, where vital registries were kept. Once a month, each health post compiled a list of all deaths of women aged 12–49, which were registered in government logbooks. Nurses and nurse-midwives were trained to administer verbal autopsies on these deaths, and assign primary cause of death using WHO ICD-10 classifications. The study drew on the theory of task-shifting, shifting the task of cause-of-death attribution from physicians to mid-level providers. It aimed to build a sustainable methodology for maximizing existing local health care infrastructure and human capacity, leading to community-based solutions to improve maternal health. While the approach has not yet been implemented outside the initial study area, the results are promising as regards its feasibility.

本文提出了一种基于社区的孕产妇死亡率测量新方法，并展示了2010 - 2011年在埃塞俄比亚提格雷州农村地区对该方法进行可行性研究的结果。该研究在三个卫生站和一个卫生中心实施，其覆盖总人口约22000人。牧师、传统接生员和社区生殖健康工作人员负责查找并报告其所在地区的所有出生和死亡情况，并协助中级医疗服务提供者寻找进行口头尸检的关键知情人。社区卫生工作者接受培训，向当地卫生站报告所有出生和死亡情况，卫生站设有生命登记处。每个卫生站每月编制一份12 - 49岁女性死亡名单，这些信息登记在政府日志中。护士和助产士接受培训，对这些死亡案例进行口头尸检，并使用世界卫生组织《国际疾病分类第十版》（WHO ICD - 10）确定主要死因。该研究借鉴了任务转移理论，将死因判定任务从医生转移到中级医疗服务提供者。其目的是建立一种可持续的方法，最大限度地利用现有的当地医疗基础设施和人力，从而找到改善孕产妇健康的基于社区的解决方案。虽然该方法尚未在初始研究区域之外实施，但就其可行性而言，结果是有希望的。