A decade of change: maternal mortality trends in Sudan, 2009-2019

Unacceptably high levels of preventable maternal deaths persist across sub-Saharan Africa. Due to limited research on maternal mortality in Sudan, a thorough examination is crucial to develop effective reduction strategies. This study aims to analyze maternal mortality trends at national and subnational levels in Sudan from 2009 to 2019.

In this retrospective-comparative study, the researchers reviewed mortality data covering 2009 to 2019 from the reports issued by the national maternal death surveillance and response. The maternal mortality ratios for the national and state levels were adjusted based on the population of women of reproductive age. The trends were assessed for statistical significance using the Mann-Kendall test, implemented in Python (version 3.12). The cut-off p-value for significance was taken as < 0.05.

The national maternal mortality ratio declined significantly by nearly 60% from 2009 to 2019 (S = -53, p < 0.001). The states of Kassala (S = -51, p < 0.001), Gadarif (S = -43, p < 0.001), Gezira (S = -41, p = 0.002), White Nile (S = -41, p = 0.002), Blue Nile (S = -39, p = 0.003), Red Sea (S = -39, p = 0.003), Khartoum (S = -39, p = 0.003), Northern State (S = -27, p = 0.043), River Nile (S = -27, p = 0.043), and Sinnar (S = -27, p = 0.043) showed significant declining trends. Blue Nile state recorded the highest average maternal mortality ratio in the study period (339.76), while Southern Darfur (66.46) and River Nile (89.59) recorded the lowest ratios. Major causes of maternal death include Obstetric hemorrhage (45.5%), hypertensive disorders (16%), and sepsis (12.6%). Important characteristics of pregnancy-related death include condition at admission, gestational age, antenatal care, mode of delivery, and areas of delay.

The national maternal mortality ratio significantly declined between 2009 and 2019, with wide regional disparities. Direct causes of maternal death remain a critical challenge. Effective strategies or frameworks focused on reducing maternal mortality ratios in Sudan are strongly solicited.