[Verbal autopsy to measure maternal mortality in rural Senegal]

The aim of this paper is to study the use of verbal autopsy in order to assess maternal mortality indicators in rural settings and to determine the limits and difficulties related to that practice.

This study was carried out in 3 rural sites (Niakhar in the region of Fatick, Bandafassi in Tambacounda region and Mlomp in the region of Ziguinchor). These sites had been under demographic and epidemiological surveillance for several years. Data were collected through two sources: a questionnaire filled out by data collectors during the demographic surveillance and a complementary survey done by an epidemiologist among families completed by information from the registers of health structures. For all female deaths (15-49 years), the detailed sequence of the events leading to the death were stated in a clinical file of verbal autopsy. All the files had been submitted to two independent obstetricians for analysis. The character of maternal death and the cause of the death (direct, indirect ou undetermined) were processed. The discordant cases were submitted to another expert epidemiologist for analysis. The 10th international classification of diseases of WHO was used as a reference to identify maternal deaths and their causes.

This demographic surveillance has led to a complete registration of female deaths and the analysis of female deaths has helped to measure maternal indicators during the observed time period. Among the 471 female deaths, 97 maternal deaths were identified in Niakhar, 36 in Bandafassi and 10 in Mlomp. The proportion of maternal deaths was 30.6% in Niakhar, 32.7% in Bandafassi and 22.7% in Mlomp. The ratio of maternal mortality was 575 per 100,000 live births (LB) in Niakhar, 930/100,000 live births in Bandafassi and 436/100,000 LB in Mliomp. The risk of maternal death was 1 women in 21 in Niakhar, 1 in 16 in Bandafassi and 1 in 41 in Mlomp. Maternal mortality rate was 13.3/10,000 reproductive age women in Niakhar, 17/10,000 in Bandafassi and 6.9/10,000 in Mlomp. Sociocultural limits related to interdiction in the society, and language barriers are seen as limits for applying verbal autopsy practices. Also, a lack of precision in data collection because of lack of information delivered by the interviewee or because of lack of experience of the interviewer could be limitations. This study carried out in a rural setting could not show national maternal mortality level. It takes time to complete verbal autopsy leading to excessive cost.

Verbal autopsy remains an interesting method for measuring maternal mortality. It has advantages in rural areas where many deliveries still occur at home. Further accuracy in data collection is needed for a precise analysis of each case.