Reduction in maternal mortality ratio varies by district in Sidama Regional State, southern Ethiopia: Estimates by cross-sectional studies using the sisterhood method and a household survey of pregnancy and birth outcomes

IntroductionMaternal mortality studies conducted at national level do not provide subnational and local estimates useful for program planning and monitoring maternal mortality at lower administrative level. The aim of this study was to estimate life time risk (LTR) of maternal death and maternal mortality ratio (MMR), assess variations and reduction in MMR in Sidama Regional State, southern Ethiopia. MethodsThis is cross-sectional study employed the sisterhood method as part of larger household maternal mortality survey that used a 5-year recall of pregnancy and birth outcomes. We visited 8880 households and interviewed 17444 respondents 15-49 years age. We assessed reduction in MMR using the sisterhood method (main focus of this paper) and a household survey of pregnancy and birth outcomes. ResultWe analysed 17374 (99.6%) respondents; 8884 (51.1%) men and 8490 (48.9%) women. The 17,374 respondents reported 64,387 maternal sisters who had reached reproductive age. Among these, 2,402 (3.7%) sisters had died; 776 (32.3%) were pregnancy related deaths. The LTR of maternal death was 3.2% and MMR was 623 (95% CI: 573-658) per 100000 live births (LB), with reference to year 2010. The remote district (Aroresa) had a MMR of 1210 (95% CI: 1027-1318) per 100,000 LB. Assessment of MMR reduction using the two maternal mortality estimation methods showed that the MMR in Sidama Regional State declined over the past years. Significant reduction in MMR was observed in districts located near the regional centre. However, no reduction was observed in districts located distant to the regional centre. ConclusionThe high MMR with district level variations and lack of mortality reduction in districts located distant to the centre highlights the need for instituting interventions tailored to the local context to save mothers and accelerate reduction in MMR.