Maternal Death Surveillance And Response Research Articles

IJCM_211A: Evaluation of Maternal Death Surveillance In Relation To Eclampsia In Jabalpur Division Of Madhya Pradesh

Background: The GOI is striving towards bringing down the MMR. Objective: To describe the Maternal Death Surveillance and Response (MDSR) Programme and to assess the maternal deaths due to Eclampsia and factors associated with it in Jabalpur Division of M.P. Methodology: A descriptive Cross-sectional study was conducted in four purposively selected districts of Jabalpur Divisions from April 2021 to March 2022. In debth Interview was conducted with all stakeholders and verbal autopsy for 68 maternal deaths. Triangulation of data from district, verbal autopsies and in-depth interviews of stakeholders (health care providers) was done to identify the factors responsible for maternal deaths due to eclempsia at various levels. Results: There was only maternal death review being done but no surveillance and response system was found. 57.35% deceased women received >4 Antenatal checkups and 25% 3 ANC checkups. 54.38%, 52.63% and 36.84% antenatal deceased women had Anaemia, Edema and High Blood Pressure respectively. Which were diagnosed at First or Second trimester of pregnancy but were not corrected timely or treated effectively. Most of the deaths occurred in postnatal period, women had early marriage and early pregnancy and 55.88% belonged to ST category. Conclusion: Families faith on Quacks, Faith healer and Jhad Funk, Poor compliance against medical advice, various delays and multiple refferals found as contributors in maternal deaths. Most of the women died during or after third trimester and 84% had symptoms during first and second semester and those symptoms were treatable. Timely, correct and quality treatment could have been save those deceased women and their precious children.

Maternal death surveillance and response system reports from 32 low-middle income countries, 2011-2020: What can we learn from the reports?

Maternal Death Surveillance and Response (MDSR) systems generate information that may aid efforts to end preventable maternal deaths. Many countries report MDSR data, but comparability over time and across settings has not been studied. We reviewed MDSR reports from low-and-middle income countries (LMICs) to examine core content and identify how surveillance data and data dissemination could be improved to guide recommendations and actions. We conducted deductive content analysis of 56 MDSR reports from 32 LMICs. A codebook was developed assessing how reports captured: 1) MDSR system implementation, 2) monitoring of maternal death notifications and reviews, and 3) response formulation and implementation. Reports published before 2014 focused on maternal death reviews only. In September 2013, the World Health Organization and partners published the global MDSR guidance, which advised that country reports should also include identification, notification and response activities. Of the 56 reports, 33 (59%) described their data as incomplete, meaning that not all maternal deaths were captured. While 45 (80%) reports presented the total number of maternal deaths that had been notified (officially reported), only 16 (29%) calculated notification rates. Deaths were reported at both community and facility levels in 31 (55%) reports, but 25 (45%) reported facility deaths only. The number of maternal deaths reviewed was reported in 33 (59%) reports, and 17 (30%) calculated review completion rates. While 48 (86%) reports provided recommendations for improving MDSR, evidence of actions based on prior recommendations was absent from 40 (71%) of subsequent reports. MDSR reports currently vary in content and in how response efforts are documented. Comprehensive reports could improve accountability and effectiveness of the system by providing feedback to MDSR stakeholders and information for action. A standard reporting template may improve the quality and comparability of MDSR data and their use for preventing future maternal deaths.

Causes of maternal deaths in Sierra Leone from 2016 to 2019: analysis of districts’ maternal death surveillance and response data

IntroductionSierra Leone is among the top countries with the highest maternal mortality rates. Although progress has been made in reducing maternal mortality, challenges remain, including limited access to skilled care...

Factors influencing maternal death surveillance and review implementation in Dodoma City, Tanzania. A qualitative case study.

With 295 000 maternal deaths in 2017, 94% in low- and middle-income countries, maternal death is a matter of global public health concern. To address it, Maternal Death Surveillance and Response (MDSR) strategy was introduced in 2013 by the World Health Organization. With a reported maternal mortality ratio of 556:100000 per live births, Tanzania adopted the strategy in 2015. Studies are needed to understand factors influencing the implementation of MDSR in this specific setting. The study aimed to assess the processes influencing MDSR implementation in Dodoma city council. A qualitative case study was conceptualized according to the Consolidated Framework for Implementation Research, focusing on implementation process domain. Members of MDSR committees were enrolled by purposeful sampling in the five health centres in Dodoma where the strategy was fully implemented and functional. In-depth interviews were conducted with key informants concerning the implementation processes influencing MDSR. Saturation was reached with the 15th respondent. Qualitative inductive content analysis was used to analyse data. The inclusiveness in participatory planning process, stakeholders' readiness and accountability and collective learning were acknowledged as factors positively influencing the implementation of MDSR strategy by respondents. The interaction and alignment of influential factors were essential for successful implementation. MDSR implementation is positively influenced by factors that interact and converge in the building of a learning health system, to increase knowledge through practice and improve practice through knowledge. Further studies are needed to analyse the influence of additional factors at different levels of implementation to fully understand and empower the MDSR implementation network, and to better target the goal of closing the knowledge to practice loop.

Barriers and facilitators to maternal death surveillance and response at a busy urban National Referral Hospital in Uganda.

Background: Preventable maternal and newborn deaths remain a global concern, particularly in low- and- middle-income countries (LMICs) Timely maternal death surveillance and response (MDSR) is a recommended strategy to account for such deaths through identifying contextual factors that contributed to the deaths to inform recommendations to implement in order to reduce future deaths. Implementation of MDSR is still suboptimal due to barriers such as inadequate skills and leadership to support MDSR. With the leadership of WHO and UNFPA, there is momentum to roll out MDSR, however, the barriers and enablers for implementation have received limited attention. These have implications for successful implementation. The aim of this study was: To assess barriers and facilitators to implementation of MDSR at a busy urban National Referral Hospital as perceived by health workers, administrators, and other partners in Reproductive Health. Methods: Qualitative study using in-depth interviews (24), 4 focus-group discussions with health workers, 15 key-informant interviews with health sector managers and implementing partners in Reproductive-Health. We conducted thematic analysis drawing on the Theory of Planned Behaviour (TPB). Results: The major barriers to implementation of MDSR were: inadequate knowledge and skills; fear of blame / litigation; failure to implement recommendations; burn out because of workload and inadequate leadership- to support health workers. Major facilitators were involving all health workers in the MDSR process, eliminate blame, strengthen leadership, implement recommendations from MDSR and functionalize lower health facilities (especially Health Centre -IVs). Conclusions: The barriers of MDSR include knowledge and skills gaps, fear of blame and litigation, and other health system factors such as erratic emergency supplies, and leadership/governance challenges. Recommendation: Efforts to strengthen MDSR for impact should use health system responsiveness approach to address the barriers identified, constructive participation of health workers to harness the facilitators and addressing the required legal framework.

Maternal death surveillance efforts: notification and review coverage rates in 30 low-income and middle-income countries, 2015–2019

ObjectivePerformance of maternal death surveillance and response (MDSR) relies on the system’s ability to identify and notify all maternal deaths and its ability to review all maternal deaths by a...

Target areas to reduce the burden of maternal death due to obstetric hemorrhage in Ethiopia.

BackgroundObstetric hemorrhage is defined as active bleeding of more than 500 ml in vaginal delivery or 1000ml following cesarean delivery. It is the leading cause of maternal death, which contributes to up to 50% of maternal deaths in Ethiopia. This study aims to assess the relationships between adverse maternal health exposure (personal and medical factors) and delay in health care (hesitancy in opting to seek care, lag in reaching a health facility, and wait in receiving health care at the facility) and adverse outcomes of obstetric hemorrhage among reviewed maternal deaths in Ethiopia.MethodsThis study utilizes 4530 reported maternal death surveillance data obtained from Ethiopian maternal death surveillance and response (MDSR) system between 2013 to 2020. Latent class analysis was applied to identify underlying patterns of adverse maternal health exposures. Furthermore, the associations between latent classes and adverse outcomes of obstetric hemorrhage were analyzed using multilevel logistics regression model adjusted for clustering within reporting provinces.ResultsNearly 56% of the reviewed maternal deaths were due to the adverse outcome of obstetric hemorrhage, among which nearly 75% died during the postpartum period. The study identified six separate sub-groups of women based on their vulnerability to adverse maternal health conditions. The six subgroups identified by this study are 1) women who travelled for a long duration to reach a health care provider, 2) those who had no access to a health facility (HF) within a 5Km radius, 3) those who failed to decide to go to a health facility: 4) those with multiparity,5) those who were injured during delivery with history of coagulopathy, and 6) those who got injured during delivery and failed to decide to go to a health facility. Women in the class of grand multipara have demonstrated the highest risk of death due to the adverse outcomes of obstetric hemorrhage (β = 1.54, SE = 0.09, p<0.0001).ConclusionsThe study has attempted to identify women that are at a higher risk for the adverse outcomes of obstetric hemorrhage. Henceforth, targeted intervention should be taken on women of reproductive age group, and those identified as at a higher risk, to reduce the high rate of maternal death due to obstetric hemorrhage.

Barriers and facilitators to maternal death surveillance and response at a busy urban National Referral Hospital in Uganda

Background: Preventable maternal and newborn deaths remain a global concern, particularly in low- and middle-income countries. Timely maternal death surveillance and response (MDSR) is a recommended strategy to account for such deaths through identifying contextual factors that contributed to the deaths to inform recommendations to implement in order to reduce future deaths. With the leadership of WHO and UNFPA, there is momentum to roll out MDSR, however, the barriers and enablers for implementation have received limited attention. These have important implications for successful implementation. The aim of this study was: To assess barriers and facilitators to implementation of MDSR at a busy urban National Referral Hospital as perceived by health workers, administrators, and other partners in Reproductive Health. Methods: Qualitative study using in-depth interviews (24), 4 focus-group discussions with health workers, 15 key-informant interviews with health sector managers and implementing partners in Reproductive-Health. We conducted thematic analysis drawing on the Theory of Planned Behaviour (TPB). Results: The major barriers to implementation of MDSR were: inadequate knowledge and skills; fear of blame and litigation; failure to implement recommendations; burn out because of workload at the National Referral Hospital and inadequate leadership- to support health workers. Major facilitators were involving all health workers in the MDSR process, eliminate blame, strengthen leadership, implement recommendations from MDSR and functionalize lower health facilities (especially Health Centre -IVs). Conclusions: The barriers of MDSR include knowledge and skills gaps, fear of blame and litigation, and other health system factors such as erratic emergency supplies, and leadership/governance challenges. Efforts to strengthen MDSR for impact should use health system responsiveness approach to address the barriers identified, constructive participation of health workers to harness the facilitators and addressing the required legal framework.

Assessment of the maternal death surveillance and response implementation process in Burkina Faso.

To evaluate the maternal death surveillance and response (MDSR) implementation process in two health districts in Burkina Faso and identify factors that have affected implementation. We conducted a case study in two health districts selected by purposive sampling according to location (rural or urban) during the period 2015-2016. Data gathering consisted of semi-structured interviews with several health personnel involved in the implementation process. Identification and notification of deaths varied depending on the facility. Maternal death review sessions were irregular, and the completion rate was lower in urban areas The community component has not yet been implemented and review of newborn deaths is not yet standard practice. Follow-up and implementation of the review recommendations were inadequate. Implementation of the MDSR system in Burkina Faso remains in progress. Improvements are needed in notification of deaths occurring at community level, monitoring and evaluation, and integration of newborn deaths into the process.

Analysis of the implementation of maternal death surveillance and response in Chad.

To analyze implementation of the maternal death surveillance and response (MDSR) strategy in Chad. Secondary data analysis of results from a cross-sectional study involving semistructured interviews with decision-makers at central, regional, and district levels, health providers, and technical and financial partners, and a document review. Data collection took place from June-July 2017. Maternal death reporting was incorporated into the Integrated Disease Surveillance and Response system but did not include neonatal deaths nor maternal and neonatal deaths in communities. Underreporting of maternal deaths owing to fear of repercussions was evident, likely associated with maternal deaths reported at monthly meetings held by the country's President with stakeholders in the health sector. Maternal death reviews were only undertaken between 2015 and 2016 in four regions of Chad and ceased in mid-August 2016. Reasons include the departure of foreign obstetricians, lack of motivation among health workers, weak accountability at all levels of the health system, organizational issues, and nonimplementation of review recommendations. Strong action is needed by the Ministry of Health to revive implementation of the MDSR system.

Afghan women and access to health care in the past 25 years.

Afghan women and access to health care in the past 25 years.

From Passive Surveillance to Response: Suriname's Efforts to Implement Maternal Death Surveillance and Response.

Implementation of maternal death surveillance and response (MDSR) is crucial to reduce maternal deaths. In Suriname, MDSR was not implemented until 2015. We describe the process of MDSR implementation in Suriname and share the "lessons learned," as experienced by the health care providers, national maternal death review committee members, and public health experts. Before 2015, maternal deaths were identified using death certificates and by active surveillance in the hospitals. Based on the recommendations from a 2010-2014 Reproductive Age Mortality Survey in Suriname, a maternal death review committee has improved the identification of maternal deaths and has audited every death since 2015. Although this review committee initiated several actions to implement MDSR together with health care providers, the involvement of the Ministry of Health (MOH) was crucial. Therefore, the Maternal Health Steering Committee was recently installed as a direct working arm of MOH to guide MDSR implementation. One of the main barriers to implementing MDSR in Suriname has been the lack of action following recommendations. Delineating roles and responsibilities for action, establishing accountability mechanisms, and influencing stakeholders in a position to act are critical to ensure a response to the recommendations. To implement MDSR, the 5 Cs-commitment, "no blame, no shame" culture, coordination, collaboration, and communication-are crucial.

Mismatched ambition, execution and outcomes: implementing maternal death surveillance and response system in Mtwara region, Tanzania

BackgroundSince 2015, Tanzania has been implementing the Maternal Death Surveillance and Response (MDSR) system. The system employs interactions of health providers and managers to identify, notify and review maternal deaths...

Strengthening Maternal Death Surveillance Systems for Evidence-Based Decision Making in Sub-Saharan Africa: The Case of the Center Region in Cameroon

Background:The article seeks to document the experience of implementing Maternal Death Surveillance and Response (MDSR) in the Center Region of Cameroon. The paper raises awareness on the need for implementing MDSR, shares progress and lessons learned and reflects on the implications for public health practice.Methods:A desk research involving the collection and analysis of secondary data using tables with specific themes in excel, following the review of existing resources at the Regional Delegation of Public Health-Center from the year 2016 to 2019.Results:The findings depict the existence of MDSR policies and sub-regional committees. Although, the number of regional maternal death notifications increased from 19 to 188 deaths between 2016 and 2019, the implementation of death review recommendations was only estimated at 10% in 2019. While 66% of deaths occurred in Yaoundé, 72% of these were deaths reported to have occurred in tertiary institutions out of which 75% were attributed to late referrals. Hemorrhage constituted 70/144 (48.6%) of the known direct causes of death. Maternal death related co-factors such as the use of partograph during labor had a high non-response rate (84%) and represents a weakness in the data set.Conclusion and Global Health Implications:Across the board, stakeholder engagement towards MDSR was increased through continuous awareness-raising, dissemination of surveillance tools, the institutionalization of the District Health Information Software (DHIS 2) and the “No Name No Blame” policy. However, the reporting and investigation of deaths for informed decisions remain a daunting challenge. For a resource-scarce setting with limited access to blood banks, the application of life-saving cost-effective interventions such as the use of partographs and the institution of a functional referral system among health units is likely to curb the occurrence of deaths from hemorrhage and other underlying causes. The success of these will require a robust strengthening of the health system.

Causes of maternal deaths and delays in care: comparison between routine maternal death surveillance and response system and an obstetrician expert panel in Tanzania

BackgroundTo reduce maternal mortality Tanzania introduced Maternal Death Surveillance and Response (MDSR) system in 2015 as recommended by World Health Organization (WHO). All health facilities are to notify and review all maternal deaths inorder to recommend quality improvement actions to reduce deaths in future. The system relies on consistent and correct categorization of causes of maternal deaths and three phases of delays. To assess its adequacy we compared the routine MDSR categorization of causes of death and three phases of delays to those assigned by an independent expert panel with additional information from Verbal Autopsy (VA).MethodsOur cross-sectional study included 109 reviewed maternal deaths from two regions in Tanzania for the year 2018. We abstracted the underlying medical causes of death and the three phases of delays from MDSR system records. We interviewed bereaved families using the standard WHO VA questionnaire. The obstetrician expert panel assigned underlying causes of death based on information from medical files and VA according to International Classification of Disease to Death in Pregnancy Childbirth and Puerperium (ICD-MM). They assigned causes to nine ICD-MM groups and identified the three phases of delays. We used Cohen’s K statistic to compare causes of deaths and delays categorization.ResultsComparison of underlying causes was done for 99 deaths. While 109 and 84 deaths for expert panel and MDSR respectively were analyzed for delays because of missing data in MDSR system. Expert panel and MDSR system assigned the same underlying causes in 64(64.6%) deaths (K statistic 0.60). Agreement increased in 80 (80.8%) when causes were assigned by ICD-MM groups (K statistic 0.76). The obstetrician expert panel identified phase one delays in 74 (67.9%), phase two in 24 (22.0%) and phase three delays in all 101 (100%) deaths that were assessed for this delay while MDSR system identified delays in 42 (50.0%), 10 (11.9%) and 78 (92.9%).The expert panel found human errors in management in 94 (93.1%) while MDSR system reported in 53 (67.9%) deaths.ConclusionsMDSR committees performed reasonably well in assigning underlying causes of death. The obstetrician expert panel found more delays than reported in MDSR system indicating difficulties within MDSR teams to critically review deaths.

Triangulating data sources for further learning from and about the MDSR in Ethiopia: a cross-sectional review of facility based maternal death data from EmONC assessment and MDSR system

BackgroundTriangulating findings from MDSR with other sources can better inform maternal health programs. A national Emergency Obstetric and Newborn Care (EmONC) assessment and the Maternal Death Surveillance and Response (MDSR) system provided data to determine the coverage of MDSR implementation in health facilities, the leading causes and contributing factors to death, and the extent to which life-saving interventions were provided to deceased women.MethodsThis paper is based on triangulation of findings from a descriptive analysis of secondary data extracted from the 2016 EmONC assessment and the MDSR system databases. EmONC assessment was conducted in 3804 health facilities. Data from interview of each facility leader on MDSR implementation, review of 1305 registered maternal deaths and 679 chart reviews of maternal deaths that happened form May 16, 2015 to December 15, 2016 were included from the EmONC assessment. Case summary reports of 601 reviewed maternal deaths were included from the MDSR system.ResultsA maternal death review committee was established in 64% of health facilities. 5.5% of facilities had submitted at least one maternal death summary report to the national MDSR database. Postpartum hemorrhage (10–27%) and severe preeclampsia/eclampsia (10–24.1%) were the leading primary causes of maternal death. In MDSR, delay-1 factors contributed to 7–33% of maternal deaths. Delay-2, related to reaching a facility, contributed to 32% & 40% of maternal deaths in the EmONC assessment and MDSR, respectively. Similarly, delay-3 factor due to delayed transfer of mothers to appropriate level of care contributed for 29 and 22% of maternal deaths. From the EmONC data, 72% of the women who died due to severe pre-eclampsia or eclampsia were given anticonvulsants while 48% of those dying of postpartum haemorrhage received uterotonics.ConclusionThe facility level implementation coverage of MDSR was sub-optimal. Obstetric hemorrhage and severe preeclampsia or eclampsia were the leading causes of maternal death. Delayed arrival to facility (Delay 2) was the predominant contributing factor to facility-based maternal deaths. The limited EmONC provision should be the focus of quality improvement in health facilities.

Maternal Death Surveillance System Evaluation at Addis Ababa City Administration, Ethiopia, 2018

Introduction: Public health surveillance is an ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health. Maternal Death Surveillance and Response (MDSR) is form of continuous surveillance linking the health information system to quality improvement processes from local to national levels. Ethiopia has been implementing Maternal Death Surveillance and Response for the last four years. The aim of evaluating Maternal Death Surveillance and Response system at Addis Ababa City Administration was to evaluate the performance and identify gaps of existing system in city administration 2018. Methods: A descriptive cross-sectional study design was used to evaluate Maternal Death Surveillance and Response system at Addis Ababa City Administration, which was conducted from March 12-23/2018. Purposive sampling technique was used to select 13 study units. Primary data was collected using structured questionnaire and crosschecked with available documents. Data was analyzed using Microsoft Office Excel, 2016. Result: Only 67% of study units had appropriate denominator and the denominator at city level was 1168157 (34.6% of total population). All study units had maternal death review committee and the action threshold used by all study units was one maternal death. A total 52 maternal death notifications received by the region from Sept/2016 to Aug/2017, giving case detection rate of 13% of national plan for the city. All notifications were true maternal deaths. Cause of death identified for 50 (96.15%) of deaths and only findings from 7 (14%) deaths used for action. No separate budget was allocated for Maternal Death Surveillance and Response system at all levels. MDSR system implementation at private health facilities was almost neglected and overall average attribute measurement for the system was 63%. Conclusion: Maternal Death Surveillance and Response system establishment objectives will not be achieved by current level of implementation and detection. Data utilization and attributes value was very low. Lack of separate budget affects the system implementation.

Training of health workers for Maternal Death Surveillance and Response program in India: knowledge assessment and analytical evaluation

Background & aim: Most maternal mortalities are preventable; however, there are significant regional and global disparities in this regard. Maternal Death Surveillance and Response (MDSR) launched in India is a continuous cycle of identification, notification, and review of maternal mortalities to improve the quality of care and prevent future deaths. The Ministry of Health and Family Welfare in India conducted five national capacity-building workshops for MDSR during October 2017 and February 2018 with the objective of training medical doctors as future trainers and developing competency-based skills for each component of the program. Methods: A training evaluation study was carried out on 144 workshop participants. Workshop outcomes in terms of trainees’ knowledge were assessed using a 20-item pre-post questionnaire and skill evaluations through group work. The data were analyzed using SPSS software (version 25). The difference in proportions was ascertained using the Chi-square test. Results: The mean score of the participants (n=144) increased from 13.2±2.3 in the pretest to 17±1.9 in the posttest (maximum score: 20). Themes generated during community and facility review sessions indicated the need for the capacity building of peripheral health facilities, sensitization for mandatory birth preparedness, complication readiness of all pregnant mothers by the frontline health workers, and regional-level MDSR training of all stakeholders involved in maternal mortality reporting. Conclusion: Training sessions were effective in the skill development of the participants in understanding the structure and function of the MDSR program.

Implementation assessment in confidential enquiry programmes: A scoping review.

BackgroundResponse should be a key part of maternal death surveillance and response (MDSR) programmes, which include confidential enquiries into maternal deaths. The programmes investigate avoidable factors in maternal deaths and make recommendations for improving maternity care. There is a gap in information on how these recommendations are transformed into practice.ObjectiveTo explore the methods used to assess the implementation status of recommendations made in confidential enquiries into maternal deaths and other health outcomes.Data sourcesWe searched PubMed, Web of Science, CINAHL, and Google Scholar databases and general web for grey literature using the “Arksey and O’Malley framework” in all major scientific databases and search engines.Study selection and data extractionAn initial screening was followed by extraction of information using a data chart. Variables in the chart were based on the response component of maternal death and surveillance systems.SynthesisInformation collected was summarised using content analysis method.ResultsWe reviewed 13 confidential enquiry systems into maternal deaths. Many confidential enquiries into maternal deaths published reports with their recommendations and dissemination often involved national‐level scientific presentations. Only five reports provided strategies for implementing the recommendations. Follow‐up of previous recommendations was routinely published in only two reports. However, impact assessment of recommendations on other health outcomes was found only in the UK.ConclusionThere is a gap in monitoring the response generated by confidential enquiries into maternal deaths. Actions to develop this are therefore needed.

Maternal death surveillance and response system in Northern Nigeria

Introduction: The maternal death surveillance and response (MDSR) responds to MDG 5 and Sustainable development goal 3. It was designed to achieve this goal by obtaining and strategically using information to guide public health actions and monitoring their impact. Objective: To determine the burden and avoidable causes of maternal mortality in midwives service scheme (MSS) communities in Northern Nigeria. Methodology: This was a cross-sectional study using baseline MDSR data on confidential enquiry into maternal deaths in all health facilities and their host communities under the MSS in Northern Nigeria from July 1st to December 31st, 2011. Results: The MMR was 181/100,000 live births. Most (80.9%) of the deaths were due to direct obstetric complications with obstetric hemorrhage and eclampsia accounting for 66.6% of the deaths. Most deaths occurred postpartum (93.6%) with the first 48 h accounting for 85.1% of cases. At presentation, 76.5% were in critical conditions. The TBAs conducted 50.0% of the deliveries. Delays in decision making contributed to 51 (63.8%), delay in arriving at the facility accounted for 48 (60.0%), financial constraints 28 (35.0%), unsafe traditional practice 27 (33.8%), and use of traditional medicines 22 (27.5%). The TBA failed to refer early in 42 (52.5%), failed to recognize dangers signs in 27 (33.8%). Stillbirths occurred in 22.2% of cases. Conclusion: Most maternal deaths in Northern Nigeria are preventable. Operational research using the MDSR is very useful in determining the causes and designing appropriate response to maternal deaths at the community level in Nigeria.