2025/08/28 by Francis G. Muriithi, Charles Ameh, Ruth W. Gakuo +4 · 1 voice
Medicine · Health Professions · #Global Maternal and Child Health #Maternal and fetal healthcare #Maternal and Neonatal Healthcare
paper · pdf · doi:10.1111/1471-0528.18342
openalex publication_date 2025/08/28 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/28
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.