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.