Maternal Mortality in Rural South Ethiopia: Outcomes of Community-Based Birth Registration by Health Extension Workers

Abstract

IntroductionRural communities in low-income countries lack vital registrations to track birth outcomes. We aimed to examine the feasibility of community-based birth registration and measure maternal mortality ratio (MMR) in rural south Ethiopia.MethodsIn 2010, health extension workers (HEWs) registered births and maternal deaths among 421,639 people in three districts (Derashe, Bonke, and Arba Minch Zuria). One nurse-supervisor per district provided administrative and technical support to HEWs. The primary outcomes were the feasibility of registration of a high proportion of births and measuring MMR. The secondary outcome was the proportion of skilled birth attendance. We validated the completeness of the registry and the MMR by conducting a house-to-house survey in 15 randomly selected villages in Bonke.ResultsWe registered 10,987 births (81·4% of expected 13,492 births) with annual crude birth rate of 32 per 1,000 population. The validation study showed that, of 2,401 births occurred in the surveyed households within eight months of the initiation of the registry, 71·6% (1,718) were registered with similar MMRs (474 vs. 439) between the registered and unregistered births. Overall, we recorded 53 maternal deaths; MMR was 489 per 100,000 live births and 83% (44 of 53 maternal deaths) occurred at home. Ninety percent (9,863 births) were at home, 4% (430) at health posts, 2·5% (282) at health centres, and 3·5% (412) in hospitals. MMR increased if: the male partners were illiterate (609 vs. 346; p= 0·051) and the villages had no road access (946 vs. 410; p= 0·039). The validation helped to increase the registration coverage by 10% through feedback discussions.ConclusionIt is possible to obtain a high-coverage birth registration and measure MMR in rural communities where a functional system of community health workers exists. The MMR was high in rural south Ethiopia and most births and maternal deaths occurred at home.

Using the Three Delays Model to Examine Civil Registration Barriers in Indonesia

“…In Ghana and Ethiopia, community health workers were trained to register births to reduce the transportation burden in remote areas [27–29]. In Bangladesh, birth registration was incorporated into the Expanded Program for Immunization, and health workers helped to collect and transfer birth certificate application materials [27].…”

Reducing Maternal Deaths in Ethiopia: Results of an Intervention Programme in Southwest Ethiopia

“…In our area of working, we used the skills of these workers to register births and maternal deaths, and also to monitor whether there was a decline in maternal and neonatal deaths during our intervention [16]. During this period, the government also discussed the need to set up vital registration systems, including birth registration and the Central Statistical Agency suggested, thereby that the HEWs found in all local communities could be responsible for such registration.…”

“…During this period, the government also discussed the need to set up vital registration systems, including birth registration and the Central Statistical Agency suggested, thereby that the HEWs found in all local communities could be responsible for such registration. We therefore set up, field tested and implemented a pilot scheme to register births and neonatal deaths [8, 16]. Simultaneously, the WHO started with the maternal death review and maternal death surveillance and response guidelines as part of an international effort to monitor the work to reduce maternal deaths [17].…”

“…We strengthened the clinical infrastructure by training non-physician clinicians to carry out CEmOC [6], thereby improving the essential skills of midwives and nurses for BEmOC [7] by equipping institutions with essential instruments to do basic and comprehensive emergency procedures, and by establishing a system of close supervision and monitoring. The main tool for monitoring was through a birth registration at three districts with a population of 700,000 [8]. …”

“…Although indirect methods such as the modelling of proxy data (for example sisterhood methods) provide important information for global and national planning, they have a limited use in monitoring progress in reducing maternal deaths at the district level. In our programme to reduce maternal deaths in Southwest Ethiopia, we developed and validated a population-based birth registry to monitor the progress of the interventions to reduce maternal and neonatal deaths [8]. …”