{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:50:41Z","timestamp":1791384641687,"version":"4.3.3"},"reference-count":144,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite global efforts, sub\u2010Saharan Africa continues to account for 70% of maternal deaths, yet systematic cause\u2010specific analyses across African regions remain limited. We examined 33\u2010year trends in maternal mortality to identify epidemiologic divergence and guide differentiated intervention strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the 2023 Global Burden of Disease Study, maternal mortality ratios (MMR), cause\u2010specific deaths, and age\u2010specific patterns were analysed across five African regions (Central, Eastern, Northern, Southern, and Western Africa) from 1990 to 2023. Absolute and relative changes, average annual rates of change, cause\u2010specific mortality proportions, and progress against Sustainable Development Goal targets were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>MMR reduction varied dramatically across regions. Northern Africa achieved the greatest decline (65.0%; 241.2 to 84.4 per 100,000 live births), while Central Africa achieved only 16.7% reduction (818.1 to 681.3). Cause\u2010specific patterns diverged strikingly: HIV\u2010related causes accounted for 87.3% of maternal deaths in Southern Africa versus 34.2% in Central Africa, while direct obstetric causes showed inverse patterns (6.3% vs. 39.9%). HIV\u2010related maternal deaths increased 76%\u2013454% across most regions despite antiretroviral therapy (ART) scale\u2010up. Age\u2010extreme populations faced 1.3\u2010 to 7.2\u2010fold elevated risks; adolescents in Central Africa had an MMR of 852.3, and women aged 45\u201349\u2009years reached 2233.0. Central Africa's MMR remained 3.6 times the global average, with sepsis burden (15.3%) more than double other regions (4%\u20137%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>African regions demonstrate distinct epidemiologic profiles requiring tailored intervention strategies. Universal maternal health approaches inadequately address HIV\u2010dominant versus obstetric\u2010dominant regional burdens or age\u2010extreme vulnerability. Central Africa's minimal progress signals that standard interventions fail under protracted humanitarian crises. Post\u20102025 strategies must integrate linked HIV\u2010maternal care, emergency obstetric services, crisis\u2010adapted approaches, and age\u2010targeted programming while recognizing within\u2010region heterogeneity to achieve equitable maternal health outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tmi.70197","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T04:06:55Z","timestamp":1782878815000},"page":"1465-1482","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Divergent Epidemiology of Maternal Mortality in Sub\u2010Saharan Africa: The Case for Differentiated Regional Strategies to Achieve 2030\n                    <scp>SDG<\/scp>\n                    Targets"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6006-9355","authenticated-orcid":false,"given":"Amadou","family":"Barrow","sequence":"first","affiliation":[{"name":"Department of Public &amp; Environmental Health, School of Medicine &amp; Allied Health Sciences University of the Gambia  Faraba The Gambia"},{"name":"Department of Epidemiology, College of Public Health and Health Professions University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friday E.","family":"Okonofua","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Reproductive Health Innovation (CERHI) University of Benin  Benin City Nigeria"},{"name":"Department of Obstetrics and Gynecology University of Benin  Benin City Nigeria"},{"name":"Women's Health and Action Research Centre  Benin City Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5867-0160","authenticated-orcid":false,"given":"Anne Baber","family":"Wallis","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health, School of Public Health and Information Sciences University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"Trends in Maternal Mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division","author":"Cresswell J.","year":"2023"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-025-08456-5"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00838-7"},{"key":"e_1_2_12_5_1","volume-title":"The Millennium Development Goals Report 2015","author":"UNDP","year":"2017"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.14.138131"},{"key":"e_1_2_12_7_1","volume-title":"World Health Statistics 2023: Monitoring Health for the SDGs, Sustainable Development Goals","author":"World Health Organization","year":"2023"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(21)00079-6"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13457"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30104-1"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_2_12_12_1","unstructured":"United Nations \u201cWorld Population Prospects 2024: Summary of Results | DESA Publications \u201d 2024 accessed January 23 2026 https:\/\/desapublications.un.org\/publications\/world-population-prospects-2024-summary-results?_gl=1*13n0xd5*_ga*MTI3NDk5ODg3NS4xNzY0NTM0ODI5*_ga_TK9BQL5X7Z*czE3NjkyMTk2MTQkbzMkZzEkdDE3NjkyMTk2NjMkajExJGwwJGgw."},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31470-2"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-14-216"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31533-1"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30386-3"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31525-2"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00837-5"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60792-3"},{"key":"e_1_2_12_20_1","volume-title":"WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience","author":"World Health Organization","year":"2016"},{"key":"e_1_2_12_21_1","unstructured":"World Health Organization \u201cEssential Interventions Commodities and Guidelines for Reproductive Maternal Newborn and Child Health \u201d 2011 accessed January 23 2026 https:\/\/www.who.int\/publications\/i\/item\/essential-interventions-commodities-and-guidelines-for-reproductive-maternal-newborn-and-child-health."},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-015-0449-8"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2015.08.031"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12630"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2010.07.006"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.15171\/ijhpm.2014.120"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62379-X"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30925-9"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)01330-3"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)02724-0"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/1478-7954-10-1"},{"key":"e_1_2_12_32_1","volume-title":"An Integrative Metaregression Framework for Descriptive Epidemiology","author":"Flaxman A. 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