Variability in the Causes and Delay Factors Contributing to Maternal Mortality: Evidence From Maternal Death Surveillance Reports of 22 African Countries

OBJECTIVE: To examine the variability in causes of maternal deaths in African countries using the World Health Organization (WHO) International Classification of Diseases Maternal Mortality (ICD-MM) framework and the contributing factors using the three delays framework.

DESIGN: Secondary data analysis.

SETTING: African countries.

SAMPLE: National maternal death review reports.

METHODS: A framework analysis of data extracted from maternal death review reports utilising the ICD-MM and three delays analytical frameworks.

MAIN OUTCOME MEASURES: Proportions of the causes of maternal death and contributing factors.

RESULTS: Twenty-two reports published between 2009 and 2022 were included, comprising 18,321 maternal deaths. The mean proportions were: 73% direct, 20% indirect, 8% unspecified, and 1% coincidental. The causes of death consisted of: 6% abortion-related; 16% hypertensive disorders; 33% obstetric haemorrhage; 9% infection; 10% other direct complications; 3% complications of management; 20% non-obstetric complications; 8% unknown; and 1% coincidental. All three delays contributed to maternal deaths. The third delay: receiving adequate care, was the most common in all countries except Ethiopia, where the first delay: deciding to seek care, dominated. On average, the first, second, and third delays contributed to 26%, 15%, and 61% of deaths, respectively.

CONCLUSION: A renewed focus on the quality of care within health facilities, alongside addressing pre-facility contributing factors, could re-ignite progress in reducing the burden of preventable maternal deaths.