Implementing Maternal Death Surveillance and Response (MDSR) in Sudan 2014-2017: Achievements and challenges

Objectives: To assess the results of implementing maternal death surveillance and response (MDSR) in Sudan, during 2014 -2017; and identify causes of maternal death (MD) and health system response for reducing maternal mortality (MM). Methodology: Hospital and community maternal death review (MDR) started in Sudan since 2009, where causes of maternal deaths MDs and areas of delays were identified after regular reporting and reviewing through focal persons’ networks; using a coordinated approach involving both notional and states’ stakeholders. MDs were discussed at state’ maternal death review committees (SMDRCs) and recommendations for reducing maternal mortality ratio (MMR) were generated for action. In 2014 MDSR was introduced using WHO guidance. Results: Over four years; a total of 4454 MDs were notified and reviewed, out of 3502540 Live births (LB), MMR was 127/ 100000 LB, with different variation between states. The MMR was declining from 209/ 100000 LB in 2010 to 115/100000 LB in 2017, with significant drop after implementing MDRS in 2014. Direct obstetric MDs were 72.9%, mainly from haemorrhage 32.6%, hypertensive disorders 15.7% and sepsis 12.7%, while indirect causes were 24.4%. National response included; improved coverage of midwives with recruitment in health system, availing of clean delivery requirements, management protocols, distribution of delivery and operating tables and ambulances for rural hospitals. Conclusion: - late presentation, home delivery, poor antenatal care (ANC) and referral system, non adherence to protocols, inadequate blood transfusion and lack of intensive care units (ICU) are related causes of MD. Strengthening the response requires commitment of various stakeholders, with clear accountability and budgets.