{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:15:22Z","timestamp":1789172122753,"version":"build-2803163510"},"reference-count":54,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100014220","name":"Innovative Genomics Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014220","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the variability in causes of maternal deaths in African countries using the World Health Organization (WHO) International Classification of Diseases Maternal Mortality (ICD\u2010MM) framework and the contributing factors using the three delays framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary data analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>African countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Sample<\/jats:title>\n                    <jats:p>National maternal death review reports.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A framework analysis of data extracted from maternal death review reports utilising the ICD\u2010MM and three delays analytical frameworks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Proportions of the causes of maternal death and contributing factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010two reports published between 2009 and 2022 were included, comprising 18,321 maternal deaths. The mean proportions were: 73% direct, 20% indirect, 8% unspecified, and 1% coincidental. The causes of death consisted of: 6% abortion\u2010related; 16% hypertensive disorders; 33% obstetric haemorrhage; 9% infection; 10% other direct complications; 3% complications of management; 20% non\u2010obstetric complications; 8% unknown; and 1% coincidental. All three delays contributed to maternal deaths. The third delay: receiving adequate care, was the most common in all countries except Ethiopia, where the first delay: deciding to seek care, dominated. On average, the first, second, and third delays contributed to 26%, 15%, and 61% of deaths, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A renewed focus on the quality of care within health facilities, alongside addressing pre\u2010facility contributing factors, could re\u2010ignite progress in reducing the burden of preventable maternal deaths.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.18342","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:39:27Z","timestamp":1756370367000},"page":"106-115","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Variability in the Causes and Delay Factors Contributing to Maternal Mortality: Evidence From Maternal Death Surveillance Reports of 22 African Countries"],"prefix":"10.1111","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2314-5611","authenticated-orcid":false,"given":"Francis G.","family":"Muriithi","sequence":"first","affiliation":[{"name":"Department of Metabolism and Systems Science, School of Medical Sciences, College of Medicine and Health University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles A.","family":"Ameh","sequence":"additional","affiliation":[{"name":"Department of International Public Health, Emergency Obstetric and Quality of Care Unit Liverpool School of Tropical Medicine  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth W.","family":"Gakuo","sequence":"additional","affiliation":[{"name":"Department of Nursing, Queen's Medical Centre Nottingham University Hospitals NHS Trust, Lenton  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin 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