Study on Reducing Maternal Mortality from Direct Obstetric Causes during 2013 in Sudan

Despite global commitments to improving maternal health, measuring, monitoring, and comparing mortality estimates remains difficult. This study was conducted in Sudan in 2013 to assess maternal mortality from direct obstetric causes (obstetric haemorrhage, hypertensive disorders, and sepsis) after appropriate interventions.  Since 2009, Sudan has been conducting facility and community-based MDR (maternal death review). MDRCs (Maternal Death Review Committees) were established at the national and state levels.Each state, health facility, and locality was assigned a focal point.MD (maternal deaths) were notified by phone, and all notified maternal deaths were reviewed using a structured format. Recommendations have been developed to reduce MM (maternal mortality) caused by obstetric haemorrhage, hypertensive disorders, and sepsis.Management protocols, care provider training, and the availability of necessary requirements for these cases have all been approved and implemented in all states. The reported MD were reviewed and analysed with SPSS, version 18.0, and the resulting MMR (maternal mortality ratio) was compared to years 2010-2012 to assess improvement. In 2013, 1,110 maternal deaths were reported out of a total of 645,881 LB (live births).The MMR was 172/100,000 LB, with variations between states. There were 937 maternal deaths in facilities (84.4 %) and 173 deaths in the community (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 have significantly decreased, while MDs from haemorrhage have remained persistently high compared to 2010-2012.The main causes of maternal deaths are home birth, late presentation, a lack of blood, and a poor referral system. MDs from hypertension and sepsis have decreased significantly, whereas MDs from haemorrhage have remained persistently high.