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Context: While reasonable progress has been made worldwide in reducing maternal mortality at the end of the millennium development goal, the same cannot be said of underserved rural communities where the tragedy continuous unabated. Aim: To determine the maternal mortality ratio, causes, and some socioeconomic determinants of maternal deaths in the last triennium of the Millennium Development Goal (MDG) in a rural tertiary center in Northeast Nigeria. Materials and Methods: Retrospective descriptive study of maternal mortality at the Federal Medical center (FMC) Nguru, Northeast Nigeria from January 1st 2013 to December 31st 2015. The center attends largely to underserved rural populace. Results were presented in simple percentages and means with a P value <0.05 considered as significant. Results: The maternal mortality ratio for the triennium was 7,364/100,000 live births with 2015 having the highest MMR of 8,517/100,000. Majority of the deaths occurred in unbooked (n = 87; 46.5%) women with no formal education (n = 120; 64.2%). A third of the maternal deaths occurred in women at the peak of their reproductive age of 25 to 34 years (n = 69; 36.9%). Grandmultiparity is a major risk factor for maternal deaths (43.9%; P = 0.02) compared to nulliparous women (31.5%; P = 0.08). Eclampsia (n = 64; 34.2%), Obstetrics hemorrhages (n = 22; 11.8%) and sepsis (n = 18; 9.6%) still remain the most common direct causes of maternal deaths while anemia was responsible for nearly 60% of the indirect causes. Significant number (36%) of these women reside in communities with secondary or tertiary health care facilities. Majority (39.5%) presented to a health care facility more than 24 hours from the onset of obstetric incidence with 52% of them dying within 24 hours of presenting to the FMC. Interestingly, 82% of the deaths from Nguru local government area are in those who reside within 5 kilometers of the FMC. Conclusion: This region has consistently maintained high MMR but this ratio of 7,364/100,000 live births is the highest so far. The causes of maternal deaths are still the same as they were 2 decades ago. The question still remains unanswered: why are many women not seeking healthcare services even when it is as close as 5 km from their residence? Why do women present with obstetric emergencies when over 70% of them reside were there are health care facilities? We recommend further research to answer these questions and to guide policies and programs that will lead to the achievement of sustainable development goal 3.1 by the year 2030.

A continuing tragedy of maternal mortality in a rural referral center in Northeast Nigeria: A wake-up call