Reduction Of Maternal Mortality Research Articles

MENGATASI OVERDISPERSI DENGAN REGRESI BINOMIAL NEGATIF PADA ANGKA KEMATIAN IBU DI KOTA BANDUNG

The maternal mortality rate in the city of Bandung is still a concern for the government, even though various health programs have been held to handle it. The very slight reduction in maternal mortality is a reason for further research to look for factors that have a significant effect. The data on maternal mortality cases usually contain a lot of zeros and follow the Poisson distribution so that they are solved with a Poisson regression model, however the model formed cannot be used because the model shows overdispersion with a deviation value of more than one. Therefore, to overcome this problem, negative binomial regression is used as a solution. This negative binomial regression model produces three predictor variables out of seven variables that have a significant effect on maternal mortality in the city of Bandung including pregnant women receiving FE1 (30 tablets), deliveries assisted by health personnel and postpartum service coverage. Then tested the goodness of the model from the negative binomial regression model by looking at the AIC value. The true negative binomial regression model is better because the AIC value is 109.4 which is smaller than 121.65 which is the AIC value of the Poisson regression model.

Involvement of community pharmacy professionals in maternal health service provision in Ethiopia: a multi-centre cross-sectional survey

Abstract Objectives In countries with high maternal mortality and a shortage of healthcare professionals, community pharmacy professionals can provide important maternal healthcare services within their scope of practice. Evidence of community pharmacy professionals’ level of involvement in maternal health service provision in Ethiopia is limited. This study aimed to assess the level of involvement of community pharmacy professionals in providing maternal health services in Ethiopia. Methods A multi-centre cross-sectional survey of 238 community pharmacy professionals was conducted from March to July 2020 in 6 cities of Amhara regional state in Ethiopia. Independent samples t-test and one-way analysis of variance (ANOVA) were used to test the mean difference. Key findings Most community pharmacy professionals were either ‘involved’ in advising about vitamins (53.4%), provision of contraceptives (52.9%), advising about lifestyle changes (46.2%), responding to minor symptoms (47.5%), nutritional advice during pregnancy (45.0%) and breastfeeding guidance or ‘very involved’ in advising about screening for chronic disease (41.6%). However, the level of involvement of community pharmacy professionals differed according to study participants’ educational qualification/s, years of experience, licensure level, setting type, responsibility in the facility and previous training exposure about maternal health services. Conclusions Community pharmacy professionals in Ethiopia are involved in providing various maternal health services highlighting the importance that pharmacists can play in improving access and care within this context. However, government attention is needed to enhance their role through policy support and capacity building to improve the quality of service provided which could contribute to the reduction of maternal mortality.

Design and Build of Posyandu Service Application at Posyandu Yanita

Posyandu Yanita is a form of Community-Based Health Efforts (UKBM) which is managed and organized, by the village, for and with the community in implementing health development, in order to empower the community and provide convenience to the community in obtaining basic health services to accelerate the reduction of maternal mortality and baby. Posyandu Yanita experienced input errors and data changes because the work was still manual so it would require a lot of paper to replace new ones, and Posyandu Yanita had difficulty finding the information needed in a short time. Based on these problems, the Android-based Yanita Posyandu information system was designed using the analysis and design method using the Unfield Modeling Language (UML). The Yanita Posyandu information system uses the Dephi and HeidiSql programming languages ??as its database. With the Yanita Posyandu information system, related processes become easier to use, accurate and integrated.

Capacity Building to Achieve Sustainable Development Goals (SDGS) in Reduce Maternal and Infant Mortality Rate (Study in the Organizational Scope of Regional Development of Timor Tengah Selatan)

The Regional Government of South Central Timor Regency is fully aware of and knows what the SDGs are. Some OPD leaders and officials know the SDGs are only an extension of the MDGs, but do not know the substance of the agenda. The method used in this study is a descriptive method with a qualitative approach, then the primary data and secondary data collected are analyzed using data analysis techniques from Creswell (2016). Capacity building in order to achieve sustainable development goals (SDGs) in reducing maternal and infant mortality within the scope of the South Central Timor Regency Regional Apparatus Organization uses the opinion of Thompson (2003: 60) which develops the concept created by Parsons (1960 with research results namely on ;( a) at the technical level it was found that the Regional Apparatus Organization (OPD) in TTS Regency did not yet have a comprehensive understanding of the SDGs with indicators of maternal and infant mortality so that they were still limited to the problem of stunting alone and still had problems integrating databases in each agency.(b) level managerially it was found that there was no synchronization of personnel allocation for each unit and function in carrying out SDG's goals (c) at the institutional level it was known that local governments had not developed effective policies regarding the implementation of SDGs in regional development plans.

“Safer Births Bundle of Care” Implementation and Perinatal Impact at 30 Hospitals in Tanzania—Halfway Evaluation

Safer Births Bundle of Care (SBBC) consists of innovative clinical and training tools for improved labour care and newborn resuscitation, integrated with new strategies for continuous quality improvement. After implementation, we hypothesised a reduction in 24-h newborn deaths, fresh stillbirths, and maternal deaths by 50%, 20%, and 10%, respectively. This is a 3-year stepped-wedged cluster randomised implementation study, including 30 facilities within five regions in Tanzania. Data collectors at each facility enter labour and newborn care indicators, patient characteristics and outcomes. This halfway evaluation reports data from March 2021 through July 2022. In total, 138,357 deliveries were recorded; 67,690 pre- and 70,667 post-implementations of SBBC. There were steady trends of increased 24-h newborn and maternal survival in four regions after SBBC initiation. In the first region, with 13 months of implementation (n = 15,658 deliveries), an estimated additional 100 newborns and 20 women were saved. Reported fresh stillbirths seemed to fluctuate across time, and increased in three regions after the start of SBBC. Uptake of the bundle varied between regions. This SBBC halfway evaluation indicates steady reductions in 24-h newborn and maternal mortality, in line with our hypotheses, in four of five regions. Enhanced focus on uptake of the bundle and the quality improvement component is necessary to fully reach the SBBC impact potential as we move forward.

Factors influencing midwives’ professional belongingness in northwest Ethiopia: Multicenter study

BackgroundProfessional belonging is an individual's engagement in their profession and where they see themselves in that profession. Midwives who have strong sense of belonging can provide compassionate care to pregnant women, newborns and families throughout their lives. The generation of evidence on sense of midwives professional belongingness is a critical step for maternal and neonatal mortality reduction. However, there is a lack of evidence about professional belongingness and influencing factures among midwives in Ethiopia particularly the study area. ObjectiveTo determine factors influencing midwives’ professional belongingness in public hospitals in Amhara regional state, northwest Ethiopia, 2022. MethodsInstitution-based cross-sectional study was conducted from February 21 to April 1, 2022. A cluster sampling technique was used to select 636 midwives. Data were collected using a self-administered and structured questionnaire, entered into Epi-Data version 4.6.software and exported to SPSS version 23 for analysis. A binary logistic regression analysis was fitted to identify factors associated with professional belongingness and p-value <0.05 at 95% confidence interval was used to declare statistical significance. ResultsThe proportion of belongingness was 52.7% (95% CI = 48.7, 56.6).Midwives who satisfied with their jobs [AOR = 3.50, CI= (2.48, 4.93)], had co-worker support [AOR = 1.54 CI= (1.08, 2.19)], had BEmONC training [AOR = 1.53 CI= (1.01, 2.30)], and experienced workplace violence [AOR = 0.55, CI= (0.39, 0.77)], had significant association with professional belongingness. ConclusionThe proportion of professional belongingness was low. Increasing job satisfaction, providing professional training, strengthening co-worker support, and developing workplace violence prevention strategies are all important steps toward increasing midwives’ professional belongingness.

Socio-economic disadvantage and quality Antenatal Care (ANC) in Sierra Leone: Evidence from Demographic and Health Survey.

Reduction of maternal mortality remains a global priority as highlighted by the third Sustainable Development Goal (SDG). This is critical in the case of Sierra Leone as the country is one of three (3) countries with the highest maternal mortality ratio globally, thus 1,120 per 100,000 live births. The approximate lifetime risk of maternal mortality in the country is 1 in 17, relative to 1 in 3,300 in high-income countries. These raise doubt about the quality of the continuum of maternal healthcare in the country, particularly antenatal care and as a result, the objective of the present study is to investigate the association between socio-economic disadvantage and quality antenatal care service utilisation as well as associated correlates in Sierra Leone. The study used data from the most recent Demographic and Health Survey (DHS) of Sierra Leone. Only women who had given birth in the five years preceding the survey were included, which is 6,028. Quality antenatal care was defined as receipt of recommended ANC services including uptake of recommended pregnancy drugs (e.g. Fansidar and iron supplement); injections (e.g. tetanus injection) and having some samples (e.g. blood and urine sample) and health status indicators (e.g. blood pressure) taken. An index was created from these indicators with scores ranging from 0 to 6. The scores 0 to 5 were labelled as "incomplete" and 6 was labelled as "complete" and this was used to create a dummy variable. In analysing the data, descriptive analysis was done using chi-square test as well as an inferential analysis using bivariate and multivariate models. Socio-economic disadvantaged [1.46 (1.09, 1.95), place of residence [2.29 (1.43, 3.67)], frequency of listening to radio [1.58 (1.20, 2.09)], health insurance coverage [3.48 (1.40, 8.64)], getting medical help for self: permission to go [0.53(0.42, 0.69) were seen to have significant relationship with quality of ANC utilized by women during pregnancy. Also, women Mende ethnicity are more likely to utilise quality ANC compared to women from the Temne ethnicity [2.58 (1.79, 3.72)]. Policy makers could consider measures to boost patronage of quality ANC in Sierra Leone by targeting the socio-economically disadvantaged women. Targeting these sub-groups with pro- maternal and child health (MCH) interventions would help Sierra Leone achieve Goal 3 of the SDGs.

Documenting activism and advocacy around medication abortion in Central, East, and West Africa.

Medication abortion, a safe and effective method for terminating pregnancy in the first and second trimester, can reduce overall maternal mortality. However, little is known about how advocates for abortion view medication abortion in their communities, particularly where abortion is legally restricted. We conducted in-depth interviews (2018-2019; N=24) with health workers and community leaders in the Democratic Republic of the Congo, Kenya, Nigeria, Malawi, and Tanzania identified from the Mobilizing Activists Around Medication Abortion (MAMA) network. Interviews focused on the role of advocacy in medication abortion provision. Participants identified benefits of medication abortion to women, including privacy, accessibility, and safety, and community benefits, including perceived reduction in maternal mortality. Participants described challenges to providing support for medication abortion, including difficulties operating in legally restrictive environments and stigma. Findings highlight the role of grassroots advocacy to overcome challenges and provide an alternative model of abortion access and care to women.

Assessment of mother and child protection card utility in a rural block of Odisha

Background: Mother and Child Protection card was introduced for accelerating reduction in maternal, neonatal, and infant mortality and child under-nutrition & meant to be used by both beneficiaries and health care providers. It is a folding pictorial tool designed to assist mothers' understanding and monitor individual progress of maternal and child health and also enable the large networks of ASHAs, AWWs, and ANMs to converge their efforts and utilize the critical contact opportunities more effectively. Objective: To assess the completeness of information in MCP card filled by the AWW, ANM, and Beneficiary. Material and Methods: Twelve villages in mendhasal block of Khurdha district were selected for this study by multistage stratified random sampling method. MCP cards of Pregnant women from the second trimester onwards and Mothers of children 0-2 years of age were assessed for completeness using a Checklist. Results: A total of 34 and 46 items were checked for completeness in the MCP cards of Antenatal and post-natal women. The median entries found to be complete in Antenatal and Post-natal women were 34 and 26. Recording information on demographic details and antenatal care details was high but there was poor maintenance of other records like post-natal care, immunization, and growth chart. It was also found that beneficiaries are not marking the circles in the tablets consumption part. Conclusion: The study reported a gap in the maintenance of records in the Mother & Child Protection Card. Training for both the health care providers and mothers is needed for adequate use of the MCP card.

Determinants of Maternal Near Miss among Women in Northeast Iran: A Facility-Based Case-Control Study.

The investigation of Maternal Near-Miss (MNM) risk factors is important for the global reduction of maternal mortality. This study aimed to identify the determinants of MNM among pregnant women in northeastern Iran. A prospective case-control study was conducted on 250 women referred to the maternity ward of Nohom-e-Dey hospital in Torbat-e Heydarieh, Iran, from June 2018 to May 2020. Applying the criteria of the World Health Organization tool, near-miss mothers were taken as cases, and mothers with normal obstetric outcomes were selected as controls with convenience sampling. Logistic regression models using Stata version 14.0 and odds ratios (95% confidence intervals) were reported. A total of 123 MNM cases and 127 controls were included in the study. The multiple logistic regression represented that having had previous abortion, living in rural or urban areas, whether the mother went through C/S or vaginal delivery and level of prenatal education were associated with MNM. Besides, having experienced chronic medical diseases during pregnancy had the strongest association with MNM, and next were complications during childbirth and neonatal outcomes which were associated with MNM, although in terms of statistical association, only the first two mentioned factors were statistically significant. Determinants of MNM could be experiencing chronic medical disorders during maternal complications. Health providers need to carefully manage past medical history and adverse perinatal outcomes, especially in pregnant women who live in rural areas. Encouraging mothers to attend pregnancy training classes is effective in reducing MNM.

Sepsis

Maternal sepsis is "a life-threatening condition defined as an organ dysfunction caused by an infection during pregnancy, delivery, puerperium, or after an abortion," with the potential to save millions of lives if a proper approximation is made. Undetected or poorly managed maternal infections can lead to sepsis, death, or disability for the mother, and an increased likelihood of early neonatal infection and other adverse outcomes. Physiological, immunologic, and mechanical changes that occur in pregnancy make pregnant women more susceptible to infections than nonpregnant women and may obscure signs and symptoms of infection and sepsis, resulting in a delay in the recognition and treatment of sepsis. Prioritization of the creation and validation of tools that allow the development of clear and standardized diagnostic criteria of maternal sepsis and septic shock, according to the changes inherent to pregnancy, correspond to highly effective strategies to reduce the impact of these conditions on maternal health worldwide. After an adequate diagnostic approach, the next goal is achieving stabilization, trying to stop the progression from sepsis to septic shock, and improving tissue perfusion to limit cell dysfunction. Management protocol implementation during the first hour of treatment will be the most important determinant for the reduction of maternal mortality associated with sepsis and septic shock.

Improving access to maternities: a key challenge in low-resource settings

In low- and middle-income countries, pregnant women face considerable challenges in accessing emergency obstetric and neonatal care services. Several factors contribute to this, such as insufficient availability of services, their inadequate geographical distribution, and a lack of qualified staff and infrastructure. The United Nations Population Fund, in collaboration with the University of Geneva, has deployed an innovative approach in 14 countries to optimise service quality and geographical accessibility. This approach has formed the basis for a new global indicator contributing to the reduction of maternal mortality. Calculating this indicator requires various types of data, going beyond traditional indicators, but allowing for a more comprehensive consideration of the different facets of access to services.

Women’s Voices, Women’s Realities; Experiences of Respectful Maternity Care During Childbirth in Jos, Nigeria

Introduction: Maternal health has gradually shifted over the years from emphasizing maternal mortality reduction to encouraging respectful maternity care (RMC). Although respectful maternity care is advocated, widespread instances of disrespectful childbirth treatment in maternity facilities have been reported. Nigeria continues to have one of the highest levels of disrespectful care in the world, which calls for a contextual understanding of the experiences of women during childbirth. the study therefore aimed to understand the experiences of respectful care among women who delivered in two hospitals in Jos, Nigeria. Methods: This research was performed using a qualitative, phenomenological approach involving in-depth interviews conducted on purposefully selected 13 mothers who delivered in the labor ward of two selected hospitals. The thematic analysis procedure was used to create the findings of the study are summarized in three major thematic areas: women associated respectful care with labor pain management; women linked respect to having their needs met; and women want to be respected. Descriptive accounts of the study information were analyzed using Nvivo software. Results: The findings of the study are summarized in three major thematic areas: women associated respectful care with labor pain management, women linked respect to having their needs met, and women want to be respected. Discussion: Given that their expectations were not satisfied, the women in this study expressed a tone of discontent with the realities of childbirth. The results point to the necessity of reorganizing labor ward settings to permit companionship and midwives' training on respectful maternity care, stressing the need to meet the expectations and needs of women during childbirth.

Study to analyse prescription pattern of antihypertensive drugs used in preeclampsia patients at a secondary care hospital: A Prospective observational study

Hypertension is one of the common medical complications of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Once the hypertension is diagnosed starting with antihypertensive therapy help to manage the outcomes of pregnancy, for both mother and baby. The main objective of the study is to assess prescribing patterns of antihypertensive drugs in pregnant women. It was a prospective observational study that was conducted for 4 months from November 2021 to February 2022. A total of 120 prescriptions were analyzed. Through the current study, we could assess the utilization of antihypertensive drugs in pregnant women. The study reveals that most of the patients having PIH were from Primi gravida in the age group 25-28 years old. The study also shows that Labetalol an alpha-beta blocker is mostly prescribed as monotherapy followed by Nifedipine a calcium channel blocker, or a combination of Labetalol with Nifedipine. Also according to the study, 12% of patients showed co-morbidities and the other 88% were without co-morbidities. Other than antihypertensive prescribed to maximum patients were a combination of several supplements that are protein powders, iron-calcium supplements (Protex powder, Anaport powder, LG-9 sachet, bio folate, calcium supplements, Hbcare, cc250, RG-9 sachet). The current study assessed that most of the patients showed mild to moderate preeclampsia that is blood pressure between 140-160 mmHg. It will help the prescriber to pay more attention to the outcomes of B.P. during pregnancy. If PIH can be treated rationally the complication of pregnancy that affect the mother and baby can be overcome and there would be a significant reduction in maternal and perinatal morbidity and mortality.

ACHIEVING THE SDGs TARGETS: WOMEN’S AUTONOMY AND THE CONTINUUM OF MATERNAL AND CHILD HEALTH SERVICES UTILIZATION IN INDONESIA USING IDHS 2017

A reduction of child and maternal mortality is among the targets of the Sustainable Development Goals (SDGs), namely the third goal. An important determinant of child and maternal mortality risk is the utilization of maternal and child health (MCH). This study aims to analyze the relationship between women's autonomy and the continuum of MCH services utilization in Indonesia using IDHS 2017. The unit of analysis was women of childbearing age who were married or living together, gave birth to at least one child in the five years before the survey, and had the last child aged 1 to 3 years, totalling as many as 6,575 samples. The analytical method used is multinomial logistic regression. The dependent variable in this study is the continuity of MCH services utilization and is divided into three categories, namely not a continuum, partial continuum, and whole continuum. The primary independent variable used in this study is women's autonomy with the demographic and socioeconomic factors as control variables. The results show that the proportion of mothers who used all MCH services continuously in Indonesia was 22.14 percent. Utilization of PNC and K4 became the most dominant services from disconnection of every mother from utilizing all MCH services continuously. Mothers with higher autonomy had a higher probability of taking advantage of some and all stages of the continuum of MCH services utilization. Therefore, the government must continue to increase women's autonomy to increase the continuum of MCH services utilization and achieve the SDGs targets.

A situation analysis on malnutrition by food-intake practices: link to maternal and child mortality in India

Inadequate food and nutrition security affect malnutrition among women and children. This significant global public health issue increases the proportion especially towards maternal and child mortality. Malnutrition poses a grave danger to India’s socio-economic progress and maternal and child health improvement. The aim of the study was to understand the linkages between inadequate food-intake practices and their contribution to maternal and child mortality in India. A situation analysis was done using relevant secondary data from National Family Health Survey reports for assessing nutritional status, sample registration system compendium for evaluating mortality reduction, and National sample survey report was used for assessing per-capita consumption of calories intake. Published and unpublished literature, documents were used to identify linkages of food-intake practices, which increase the proportion of malnutrition and mortality. Findings depict a scarce improvement i. e.; only 109 reductions in maternal mortality (SRS 2007-09 to 2017-19), 5.8 per cent and 8.1 per cent reduction in infant and under-five mortality (NFHS-4 and NFHS-5). They are also increasing consumption of low-nutritive-value food items both in rural and urban India pulling into micronutrient deficiencies, resulting in maximising maternal and child mortality. Policies to intervene in the nutrition issues, agri-organic growth, food accessibility and quality utility, and gender equality would play a vital role in changing the food-intake behaviour among women with a significant impact on maternal and child health in India.

The role of multidisciplinary care for a pregnant woman with a positive cardiological history in everyday medical practice

Reducing maternal mortality is a global health goal of the World Health Organization. While the number of perinatal deaths from hemorrhage and infection is declining, the number of deaths related to heart disease is on the rise and is now the most important cause in Western countries. The aim of expert societies is to define contemporary, diagnostic-specific outcomes in pregnant women with heart disease. Knowing about your cardiovascular risk during pregnancy is crucial for pre-contraceptive counseling. In the process of organizing care for a pregnant woman with cardiovascular diseases, a multidimensional approach to the problem is important, involving close cooperation between the cardiological and gynecological teams. Despite numerous publications, more studies are still needed to broaden the knowledge of cardiological care in pregnant women. The data obtained from the registers created on the initiative of the European Society of Cardiology, headed by the ROPAC register, seem promising.

Number of antenatal care visits and associated factors among reproductive age women in Sub-Saharan Africa using recent demographic and health survey data from 2008-2019: A multilevel negative binomial regression model.

Antenatal care is one of the best strategies for maternal and neonatal mortality reduction. There is a paucity of evidence on the mean number of ANC visits and associated factors in Sub-Saharan Africa (SSA). This study aimed to investigate the mean number of ANC visits and associated factors among reproductive-age women in Sub-Saharan Africa using the Demographic and Health Survey conducted from 2008 to 2019. A total of 256,425 weighted numbers of women who gave birth five years before the survey were included. We used STATA version 14 for data management and analysis. A multilevel negative binomial regression model was fitted. Finally, the Adjusted Incident Rate Ratio (AIRR) with its 95% CI confidence interval was reported. Statistical significance was declared at P-value < 0.05. The mean number of ANC visits among women who gave birth five years before the survey in SSA was 3.83 (95% CI = 3.82, 3.84) Individual-level factors such as being aged 36-49 years (AIRR = 1.20, 95% CI = 1.18,1.21), having secondary education &above (AIRR = 1.44, 95% CI = 1.42, 1.45), having rich wealth status (AIRR = 1.08, 95% CI = 1.07, 1.09), media exposure (AIRR = 1.10, 95% CI = 1.09,1.11), and grand multiparity (AIRR = 0.90, 95% CI = 0.89, 0.91) were significantly associated with the number of ANC visits. Furthermore, rural residence (AIRR = 0.90, 95% CI = 0.89, 0.91), Western SSA region (AIRR = 1.19, 95% CI = 1.18, 1.20) and being from a middle-income country (AIRR = 1.09, 95% CI = 1.08, 1.10) were community-level factors that had a significant association with the number of ANC visits. The mean number of ANC visits in SSA approximates the minimum recommended number of ANC visits by the World Health Organization. Women's educational status, women's age, media exposure, parity, planned pregnancy, wealth status, residence, country's income, and region of SSA had a significant association with the frequency of ANC visits. This study suggests that addressing geographical disparities and socio-economic inequalities will help to alleviate the reduced utilization of ANC services.

Barriers to reporting postpartum hemorrhage at different levels of healthcare facilities in Nigeria: A qualitative study.

Maternal mortality reduction remains a world health priority. One of the causes of maternal death is bleeding after childbirth. However, little is known regarding barriers to reporting for postpartum hemorrhage care among postnatal women in Nigeria. This research aimed to understand the perceived barriers to reporting postpartum hemorrhage care experienced by women and healthcare workers in Birnin Kebbi, North west-Nigeria. Qualitative case research was employed in this study with face-to-face interviews among ten postnatal women who experienced bleeding and six healthcare workers. Data were collected from September to November 2021. The interviews were all audio-taped, transcribed verbatim, and analyzed using thematic analysis. NVivo Pro Version 12 was applied to organize further and manage the data. Six themes were developed: (1) knowledge deficit, (2) poor attitudes, behaviors, and performances, (3) low socioeconomic status, (4) lack of healthcare personnel, (5) cultural norms, and (6) lack of access to healthcare facilities. The study findings might serve as input for healthcare policymakers and healthcare workers to improve health and reduce maternal mortality. Enhancing knowledge and awareness about reporting process is necessary to improve reporting for postpartum hemorrhage care among women. Training and continuous professional development of health care workers are also highly suggested to enhance the quality of care.

Reducing maternal and neonatal mortality through integrated and sustainability-focused programming in Zambia.

Reducing maternal and neonatal mortality is a critical health priority within Zambia and globally. Although evidence-based clinical interventions can prevent a majority of these deaths, scalable and sustainable delivery of interventions across low-resource settings remains uneven, particularly across rural and marginalized communities. The Zambian Ministry of Health and the Clinton Health Access Initiative implemented an integrated sexual, reproductive, maternal, and newborn health (SRMNH) program in Northern Province aimed at dramatically reducing mortality over four years. Interventions were implemented between 2018 and 2021 across 141 government-owned health facilities covering all 12 districts of Northern Province, the poorest performing province nationwide and home to over 1.4 million people, around six pillars of an integrated health system. Data on institutional delivery and antenatal and postnatal care were collected through the national Health Management Information System (HMIS). A community-based system for capturing birth outcomes was established using existing government tools and community volunteers since HMIS did not include community-based mortality. Baseline and endline population-based mortality rates were compared for program-supported areas. From the earliest period of population-based mortality reporting in 2019 to program end in 2021, there were statistically significant decreases of 41%, 45%, and 43% in maternal, neonatal, and perinatal mortality rates respectively. Between 2017 to 2021, institutional maternal, neonatal, and perinatal mortality rates across entirety of Northern Province reduced by 12%, 40%, and 41%, respectively. Service readiness and coverage for SRMNH services improved dramatically, supporting increased numbers of patients. Significant mortality reductions were achieved over a relatively short period, reinforced through an emphasis on sustainability and strengthening existing government systems. These results were attained through a consciously cost-efficient approach backed by substantially lower levels of external investment relative to prior programs, allowing many of the interventions to be successfully adopted by government within public sector budgets.