Background: Despite the worldwide commitment to improving maternal health, measuring, monitoring and comparing mortality estimates remain a challenge. Objectives: Implementing maternal death review (MDR) in Sudan, during 2010 -2015, to determine maternal mortality ratio (MMR), identify underlying causes and health system response for reducing maternal mortality. Methodology: Hospital and community- based MDR was conducted during 2010-2015. National and states’ maternal death review committees (NMDRC, SMDRC) were established, a focal person was nominated in each state, hospital and locality. Every maternal death was notified by the focal person using a telephone and notified deaths were reviewed using a structured format, discussed by SMDRC, generate recommendations and submitted to NMDRC. Data was collected by trained registrars, analyzed using microcomputer, SSPS, version 20.0. Results: Out of 3686762 Live births (LB) reported over six years, 6055 maternal deaths were notified and reviewed, MMR was 164/ 100000 LB, with different variation between states. Hospital deaths were 5207 (86.0%), while community deaths were 848 (14.0%). Direct obstetric deaths were 3791 (62.6%), mainly from haemorrhage 1881(31.1%), hypertensive disorders 784 (12.9%) and sepsis 694 (11.5%), while indirect causes were 1699 (28.0%), mainly from hepatitis, complicated malaria & severe anemia. Most of hospital deaths 4401 (72.7%) were admitted late, 3051 (50.4%) died within first 24 hours from admission. Conclusion: Poor antenatal care (ANC) and referral system, home delivery, late presentation and unavailability of blood are the main factors behind MD. Moving to maternal death surveillance and response (MDSR) requires strong commitment of the various stakeholders and responsive health system.
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