Estimation of maternal and neonatal mortality at the subnational level in Liberia

Abstract

Objective: To establish representative local-area baseline estimates of maternal and neonatal mortality using a novel adjusted sisterhood method. Methods: The status of maternal and neonatal health in Bomi County, Liberia, was investigated in June 2013 using a population-based survey (n= 1985). The standard direct sisterhood method wasmodified to account for place and time of maternal death to enable calculation of subnational estimates. Results: Themodified method of measuringmaternalmortality successfully enabled the calculation of area-specific estimates. Of 71 reported deaths of sisters, 18 (25.4%) were due to pregnancy-related causes and had occurred in the past 3 years in Bomi County. The estimated maternal mortality ratio was 890 maternal deaths for every 100 000 live births (95% CI, 4971301]. The neonatal mortality rate was estimated to be 47 deaths for every 1000 live births (95% CI, 4252). In total, 322 (16.9%) of 1900 womenwith accurate age data reported having had a stillbirth. Conclusion: The modified direct sisterhood method may be useful to other countries seeking a more regionally nuanced understanding of areas in which neonatal and maternal mortality levels still need to be reduced to meet Millennium Development Goals.