A Low-Cost, Community Knowledge Approach to Estimate Maternal and Jaundice-Associated Mortality in Rural Bangladesh

Repon C. Paul International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;
School of Public Health and Community Medicine, UNSW Medicine, Sydney, Australia;

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Heather F. Gidding School of Public Health and Community Medicine, UNSW Medicine, Sydney, Australia;

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Arifa Nazneen International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Kajal C. Banik International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Shariful A. Sumon International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Kishor K. Paul International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Stephen P. Luby Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California;

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Emily S. Gurley International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

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Andrew Hayen Australian Centre for Public and Population Health, Research, University of Technology Sydney, Sydney, Australia

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In the absence of a civil registration system, a house-to-house survey is often used to estimate cause-specific mortality in low- and middle-income countries. However, house-to-house surveys are resource and time intensive. We applied a low-cost community knowledge approach to identify maternal deaths from any cause and jaundice-associated deaths among persons aged ≥ 14 years, and stillbirths and neonatal deaths in mothers with jaundice during pregnancy in five rural communities in Bangladesh. We estimated the method’s sensitivity and cost savings compared with a house-to-house survey. In the five communities with a total of 125,570 population, we identified 13 maternal deaths, 60 deaths among persons aged ≥ 14 years associated with jaundice, five neonatal deaths, and four stillbirths born to a mother with jaundice during pregnancy over the 3-year period before the survey using the community knowledge approach. The sensitivity of community knowledge method in identifying target deaths ranged from 80% for neonatal deaths to 100% for stillbirths and maternal deaths. The community knowledge approach required 36% of the staff time to undertake compared with the house-to-house survey. The community knowledge approach was less expensive but highly sensitive in identifying maternal and jaundice-associated mortality, as well as all-cause adult mortality in rural settings in Bangladesh. This method can be applied in rural settings of other low- and middle-income countries and, in conjunction with hospital-based hepatitis diagnoses, used to monitor the impact of programs to reduce the burden of cause-specific hepatitis mortality, a current World Health Organization priority.

Author Notes

Address correspondence to Repon C. Paul, School of Public Health and Community Medicine, UNSW Medicine, Level 2, Samuels Bldg., Sydney 2052, New South Wales, Australia. E-mails: repon.paul@unsw.edu.au or reponpaul@yahoo.com

Authors’ addresses: Repon C. Paul, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia, and Programme for Emerging Infections, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh, E-mail: repon.paul@unsw.edu.au. Heather F. Gidding, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia, E-mail: hgidding@unsw.edu.au. Arifa Nazneen, Kajal C. Banik, Shariful A. Sumon, and Kishor K. Paul, Programme for Emerging Infections, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh, E-mails: arifa.nazneen@icddrb.org, kajal@icddrb.org, sasumon@icddrb.org, and kishorpaul@icddrb.org. Stephen P. Luby, Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, E-mail: sluby@stanford.edu. Emily S. Gurley, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Programme for Emerging Infections, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh, E-mail: egurley1@jhu.edu. Andrew Hayen, Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, Australia, E-mail: andrew.hayen@uts.edu.au.

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