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Background
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Prospective (Cohort) Studies

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Prospective Studies: BACKGROUND

Prospective studies follow a group of individuals (cohort or selected population) over a period of time to observe health outcomes, including mortality. Within the context of maternal mortality, a prospective study could involve following a population of pregnant women or women of reproductive age. When an entire population is followed over time, this is usually termed a Demographic Surveillance System (DSS). Prospective studies seek to test for an association between a certain exposure and the outcome of interest. Randomized controlled trials are a special form of prospective study in that the exposure (treatment) is deliberately administered at random to individuals in the cohort.

Identification of death

Active surveillance is used to identify deaths usually by asking about enumerated members of the cohort.

Ascertainment of pregnancy status

If cohort is already comprised of pregnant or recently delivered women, they are by definition pregnancy related deaths. Cause of death will need to be established to determine whether it is a maternal death (See Verbal Autopsy and ICD Coding).

If the cohort is women of reproductive age, then pregnancy status will either be ascertained from the woman herself while she was alive or from relatives.

Advantages:

Limitations:

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Prospective Studies: REFERENCES

Statistical Methods in Medical Research Bennett, DA (2003) Review of analytical methods for prospective cohort studies using time to event data: single studies and implications for meta-analysis. Statistical Methods in Medical Research; 12: 297-319.

BMC Pregnancy and Childbirth Brown, SJ; Lumley, JM; McDonald, EA; Krastev, AH and collaboration with the Maternal Health Study collaborative group (2006) Maternal health study: a prospective cohort study of nulliparous women recruited in early pregnancy. BMC Pregnancy and Childbirth; 6:12.

British Medical Journal Fenton, PM; Whitty, CJM; Reynolds, F (2003) Caesarean section in Malawi: prospective study of early maternal and perinatal mortality. BMJ; 327: 587.

Bulletin of the World Health Organisation Greenwood AM; Greenwood BM; Bradley AK; Williams K; Shenton FC; Tulloch S; Bypass P; Oldfield FS (1987) Prospective survey of the outcome of pregnancy in a rural area of the Gambia. Bulletin of the World Health Organization; 65(5): 635-43.

Bulletin of the World Health Organisation Pradhan EK, West KP Jr, Katz J, Christian P, Khatry SK, Leclerq SC, Dali SM, Shrestha SR (2002) Risk of death following pregnancy in rural Nepal. Bulletin of the World Health Organization; 80(11): 887-91.

Elsevier - European Journal of Obstetrics, Gynecology and Reproductive Biology Thonneau PF, Matsudai T, Alihonou E, De Souza J, Faye O, Moreau JC, Djanhan Y, Welffens-Ekra C, Goyaux N. (2004) Distribution of causes of maternal mortality during delivery and post-partum: results of an African multicentre hospital-based study. European Journal of Obstetrics, Gynecology and Reproductive Biology, 114(2): 150-4.

Canadian Medical Association Journal Wenman, WM; Joffres, MR; Tataryn, IV; and the Edmonton Perinatal Infections Group. (2004) A prospective cohort study of pregnancy risk factors and birth outcomes in Aboriginal women. Canadian Medical Association Journal; 171(6): 585-9.

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