Success and opportunities: maternal mortality and health services in Sierra Leone

Sierra Leone has made significant improvements in maternal mortality reduction; however, disparities in maternal healthcare delivery services still exist. This analysis examined the characteristics and disparities in maternal health service indicators and mortality data. The findings guided evidence-based public health interventions and informed the monitoring of their effectiveness.

We conducted a secondary analysis of maternal deaths and health services data reported in the National Maternal Deaths Surveillance and Response (MDSR) system and the District Health Information System (DHIS2) and supplemented it with line lists using Microsoft Excel 2016.from 2019 to 2024. We excluded uninvestigated deaths or deaths with missing key variables. Using QGIS version 3.12.2, and Microsoft Excel 2016, descriptive and spatial analyses were conducted to examine patterns and disparities in maternal health indicators, with findings presented in tables, graphs, and maps.

Overall, Maternal Mortality Rate (MMR) for the six years was 216 deaths per 100,000 live births, whereas the MMR from January through November 2024 was 183.8 per 100,000 live births (95% CI: 166-201.6). The MMR declined over the period under review, from 241 per 100,000 live births in 2019 to 184 per 100,000 in 2024. Skilled Birth Attendance (SBA) remained high, averaging 95% throughout the six years, while 36% women (n = 119) attended four or more antenatal care visits. Approximately 40% (n = 769) of the maternal deathsresulted from postpartum hemorrhage.

In Sierra Leone, maternal mortality declined over the study period; however, disparities in service utilization persist. While SBA remains high, coverage of at least 4 ANC visits was suboptimal. Postpartum hemorrhage (PPH) was the leading cause of maternal death. Targeted efforts to improve access to quality antenatal and delivery services in high-burden districts, are essential to accelerating reductions in maternal mortality.