{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:32:33Z","timestamp":1792024353303,"version":"4.4.0"},"reference-count":27,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T00:00:00Z","timestamp":1705017600000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,12,18]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Sierra Leone is among the top countries with the highest maternal mortality rates. Although progress has been made in reducing maternal mortality, challenges remain, including limited access to skilled care and regional disparities in accessing quality care. This paper presents the first comprehensive analysis of the burden of different causes of maternal deaths reported in the Maternal Death Surveillance and Response (MDSR) system at the district level from 2016 to 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The MDSR data are accessed from the Ministry of Health and Sanitation, and the secondary data analysis was done to determine the causes of maternal death in Sierra Leone. The proportions of each leading cause of maternal deaths were estimated by districts. A subgroup analysis of the selected causes of death was also performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, obstetric haemorrhage was the leading cause of maternal death (39.4%), followed by hypertensive disorders (15.8%) and pregnancy-related infections (10.1%). Within obstetric haemorrhage, postpartum haemorrhage was the leading cause in each district. The burden of death due to obstetric haemorrhage slightly increased over the study period, while hypertensive disorders showed a slightly decreasing trend. Disparities were found among districts for all causes of maternal death, but no clear geographical pattern emerged. Non-obstetric complications were reported in 11.5% of cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The MDSR database provides an opportunity for shared learning and can be used to improve the quality of maternal health services. To improve the accuracy and availability of data, under-reporting must be addressed, and frontline community staff must be trained to accurately capture and report death events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-076256","type":"journal-article","created":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T12:36:23Z","timestamp":1705062983000},"page":"e076256","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Causes of maternal deaths in Sierra Leone from 2016 to 2019: analysis of districts\u2019 maternal death surveillance and response data"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1576-724X","authenticated-orcid":false,"given":"Yasir","family":"Shafiq","sequence":"first","affiliation":[{"name":"Department of Translational Medicine and Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universit\u00e0 degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Piemonte, Italy"},{"name":"Center of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4164-4756","authenticated-orcid":false,"given":"Marta","family":"Caviglia","sequence":"additional","affiliation":[{"name":"Universit\u00e0 degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab","family":"Juheh Bah","sequence":"additional","affiliation":[{"name":"Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6649-1525","authenticated-orcid":false,"given":"Francesca","family":"Tognon","sequence":"additional","affiliation":[{"name":"Doctors with Africa CUAMM, Padova, Veneto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Orsi","sequence":"additional","affiliation":[{"name":"Doctors with Africa CUAMM, Padova, Veneto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abibatu","family":"K. 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World population prospects 2022: the 2022 revision; 2022."},{"key":"2025121402571679000_14.1.e076256.2","unstructured":"World Health Organization . Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, world bank group and UNDESA\/population division. 2023."},{"key":"2025121402571679000_14.1.e076256.3","unstructured":"Leone SS , International ICF . Sierra Leone demographic and health survey 2019. In: Freet Sierra Leone Rockv Md USA Stats SL ICF 2019."},{"key":"2025121402571679000_14.1.e076256.4","unstructured":"Sanitation M of H and national health sector strategic plan 2017\u20132021. 2017 Available: https:\/\/extranet.who.int\/countryplanningcycles\/sites\/default\/files\/planning_cycle_repository\/sierra_leone\/sierra_leone_nhssp_2017-21_final_sept2017.pdf"},{"key":"2025121402571679000_14.1.e076256.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0276102","article-title":"Inequalities in maternal Healthcare use in Sierra Leone: evidence from the 2008\u20132019 demographic and health surveys","volume":"17","author":"Tsawe","year":"2022","journal-title":"PLoS One"},{"key":"2025121402571679000_14.1.e076256.6","doi-asserted-by":"crossref","DOI":"10.1186\/s13690-022-00946-8","article-title":"Continuum of maternal and newborn health in Sierra Leone: a 2019 national survey","volume":"80","author":"Sserwanja","year":"2022","journal-title":"Arch Public Health"},{"key":"2025121402571679000_14.1.e076256.7","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.2484"},{"key":"2025121402571679000_14.1.e076256.8","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2019-001605","article-title":"The rate and perioperative mortality of caesarean section in Sierra Leone","volume":"4","author":"Holmer","year":"2019","journal-title":"BMJ Glob Health"},{"key":"2025121402571679000_14.1.e076256.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-019-4181-3","article-title":"Impact of the free healthcare initiative on wealth-related inequity in the utilization of maternal & child health services in Sierra Leone","volume":"19","author":"Jalloh","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"2025121402571679000_14.1.e076256.10","unstructured":"Maternal death surveillance and response. 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