House-to-house survey vs. snowball technique for capturing maternal deaths in India: a search for a cost-effective method.

BACKGROUND & OBJECTIVE: Estimation of maternal mortality has been difficult because of large sample size requirement. A study using snowball technique for identification of households where maternal death has taken place and its related causes was conducted. We present here the feasibility of carrying out the snowball technique for capturing maternal deaths as against house-to-house survey and to obtain the estimates of maternal mortality ratio (MMR) in some selected States of India. METHODS: Five states representing high MMR (Uttar Pradesh), medium MMR (Maharashtra, Karnataka, Uttranchal) and low MMR (Delhi) were selected. A total of 8 PHCs and 3 (UFS) were covered. Study used both house-to-house survey and snowball technique to enumerate the maternal deaths in the selected PHCs in rural area and urban frame survey (UFS) in urban area. RESULTS: In all, 94 maternal deaths were captured through snowball technique as against 83 through house-to-house survey. The estimate of MMR for the five States combined was 356 per 100,000 live births, as compared to assumed 400 per 100,000 live births for the country as a whole. The relative standard error of the estimate of MMR was about 10 per cent. INTERPRETATION & CONCLUSION: Snowball technique captured more maternal deaths than those in house-to-house survey particularly in rural areas. The estimates also indicated the feasibility of replicating the proposed methodology for estimation of MMR as a time and cost-effective methodology.

Survey of village informants--an alternate method to estimate paralytic poliomyelitis prevalence in rural area.

Lameness surveys were conducted among children of 0-14 year age group in 60 villages of a Community Development Block of district Ambala in Haryana State. The methods used were: village informants survey and house-to-house survey. Village informants were village chief, school teachers, primary health care workers, traditional birth attendants and several prominent persons from each street/neighbourhood of the village. These informants located lame children in their locality. Subsequently, a house-to-house search for identification of lame children was made in all the 60 sampled villages. Physicians later on, examined the lame children to diagnose paralytic poliomyelitis. Estimate of the prevalence rate of lower extremity paralytic poliomyelitis in 0-14 year age group was found to be 7.9/1000 in village informants survey. This did not differ significantly from the rate of 8.8/1000 revealed by house-to-house survey in the same community (p greater than 0.05). Time required to complete village informants survey was almost one third and costs were also about half as compared to house-to-house survey. Therefore, village informants based lameness survey is a rapid and economical alternative for the estimation of poliomyelitis prevalence in rural communities.