Immpact Toolkit: Module 4
Version 2
Sampling at Service Sites (SSS)
This tool describes a technique for measuring rates of maternal mortality in the community which offers potential cost and time savings over traditional house-to-house type surveys. The information given here is intended to help anyone in the process of commissioning a study to decide whether Sampling at Service Sites (SSS) will be a useful method; and to help anyone planning a measurement of maternal mortality using the SSS method to design and execute a survey.The need to provide accurate statistics on health in developing countries has been highlighted by the WHO Health Metrics Network (www.who.int/healthmetrics/en/) However, no simple, low-cost method exists for estimating the levels of maternal mortality in countries where there is no reliable system of vital registration. The problems and most of the commonly used methods are outlined in the WHO publication Maternal Mortality in 2000 (WHO, 2004). Most practical methods involve gathering information through some form of survey, but to achieve a satisfactory level of precision in the estimates this normally requires sample sizes of many thousands (depending on the prevailing rates of maternal deaths and levels of fertility). Example sample sizes required in various scenarios are shown in section 4(1).5, Step 2. Surveys to measure rates of maternal mortality have often been added to other major surveys such as Demographic and Health Surveys (DHS) (/www.measuredhs.com/aboutsurveys/dhs) (Stanton et al, 1997) or censuses (Stanton et al, 2001), which take place at typically five- or ten-year intervals. Even in relatively large surveys such as the DHS, the sample sizes used usually do not permit useful estimates to be made at sub-national levels. Where it is desired to measure the rate of maternal mortality at other times or at sub-national levels, large surveys must be carried out specifically for this purpose.
Although only a small amount of information needs to be gathered from each respondent to measure maternal mortality, carrying out a house-to-house type of survey specifically for this purpose carries with it many of the same cost and logistical overheads as administering a much wider-ranging survey. SSS has been developed as an alternative survey method to improve efficiency and hence save costs compared to traditional survey methods.