Dear Friends, It is really interesting discussion. This has been discussed in many of the WHO documents and interestingly there is no definite answer to this. pls check the link below and the relevant hyperlinks from it for details. http://www.who.int/whosis/indicators/2007compendium/en/index.html Cut off could be decided for the area(state or nation) by consensus and pragmatism. Once decided, we should stick to it for reasonable time for getting any meaningful trend analysis. This could be done in a simper way using mid-year population(pop), crude birth rate(cbr) and the lost factor. for example in India it could be as follows
ANC coverage denominator = pop*cbr*115% Deliveries denominator = pop*cbr*112% live births denominator = pop*cbr*110% Crude Birth Rates are usually available up to district level in many countries. Assumptions for deciding 115%, 112% and 110% are the same as explained by Calle. However these could vary based on the ANC coverage (when and what %), rates of abortion, rates of still births, rates of twins etc. Could be based on some micro studies(longitudinal where-in all pregnancies in a limited pop is followed up till birth) or by consensus among public health professionals(they are the best bid in this aspect than obstetricians) -- Biju Soman India(Kerala) Voice +91 944 786 2736
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