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Despite the worldwide commitment to improve maternal health, measuring, monitoring and comparing mortality estimates remain a challenge. This study was done to assess maternal mortality from direct obstetric causes (obstetric haemorrhage, hypertensive disorders and sepsis) after suitable interventions in Sudan during 2013. Facility and community-based MDR (maternal death review) was conducted in Sudan since 2009. National and states’ MDRCs (Maternal Death Review Committees) were established. A focal person for each state, health facility and locality was nominated. Notification of MD (maternal deaths) was done by telephone, followed by review of all notified maternal deaths using a structured format. Recommendations for reducing MM (maternal mortality) from obstetric haemorrhage, hypertensive disorders and sepsis have been generated. Management protocols, training of care providers and availing of necessary requirements for these cases have been approved and implemented in all states. Reported MD were reviewed and analyzed using SPSS, version 18.0 and the resulting MMR (maternal mortality ratio) was compared with years 2010-2012 to assess improvement. During 2013, 1,110 maternal deaths were notified, out of 645,881 LB (live births). MMR was 172/100,000 LB, with different variation between states. Facility maternal deaths were 937 (84.4%) and community deaths were 173 (15.6%). Direct obstetric deaths were 678 (61.1%), mainly due to haemorrhage 311 (28.0%), hypertensive disorders 116 (10.5%) and sepsis 110 (9.9%). Indirect causes were 432 (38.9%), mainly due to hepatitis and anemia. Most of the hospital deaths 707 (75.5%) were admitted late from home and 559 (59.7%) died within 24 hours. MDs from hypertensive disorders and sepsis decreased significantly, while MDs from haemorrhage are persistently high compared to 2010-2012. Home delivery, late presentation, unavailability of blood and poor referral system, are the main factors behind maternal deaths. MDs from hypertensive disorder and sepsis decreased significantly, while MDs from haemorrhage are persistently high.

Reducing Maternal Mortality from Direct Obstetric Causes during 2013 in Sudan