Estimates of the maternal mortality ratio in two districts of the Brong-Ahafo region, Ghana

Objective To estimate the maternal mortality ratio (MMR) by the sisterhood method in two districts of the Brong-Ahafo region of Ghana, and to determin e the impact of different assumptions and analytical decisions on these est imates. Methods Indirect estimates of the MMR were calculated from data collected i n 1995 by Family Health international (FHI) on 5202 women aged 15-49 years, using a household screen of randomly selected areas in the two districts, Other data from the nationally representative 1994 Ghana Infant, Child and Maternal Mortality Survey (ICMMS) and from the 1997 Kassena-Nankana Distric t study were also used for comparison. Findings Based on the FHI data, the MMR was estimated to be 269 maternal de aths per 100 000 live births for both districts combined, a figure higher t han ICMMS estimates. Biases during data collection may account for this dif ference, including the fact that biases underestimating mortality are more common than those overestimating it, Biases introduced during data analysis were also considered, but only the total fertility rate used to calculate the MMR seemed to affect the estimates significantly. Conclusions The results indicate that the sisterhood method is still being refined and the extent and impact of biases have only recently received att ention, Users of this method should be aware of limitations when interpreti ng results. We recommend using confidence limits around estimates, both to dispel false impressions of precision and to reduce overinterpretation of d ata.