Evaluation of Maternal Death Surveillance and Response Implementation at Secondary Health Facilities in Ondo State, South West Nigeria

Maternal death surveillance and response is a WHO-endorsed accountability mechanism for identifying avoidable causes of maternal mortality and translating findings into actionable quality improvements. This study evaluates the implementation fidelity and outcomes of the maternal death surveillance and response system across secondary health facilities in Ondo State, South West Nigeria. A mixed-methods cross-sectional evaluation is conducted across 20 secondary health facilities selected through stratified random sampling from five local government areas. Document reviews of maternal death review reports, verbal autopsy forms, and action plan registers assess completeness, timeliness, and response tracking. Structured interviews with 40 facility in-charges and state obstetric quality coordinators explore implementation barriers. Quantitative data are analysed in SPSS, and qualitative data undergo thematic analysis. Available maternal audit literature from South West Nigeria identifies incomplete verbal autopsy documentation, absence of multidisciplinary review committees at secondary level, and failure to complete and disseminate corrective action plans as the most prevalent implementation gaps. The WHO MDSR Framework and the Nigerian National MDSR Operational Guidelines provide the normative evaluation reference. Findings will inform Ondo State's Family Health Division on structuring a targeted capacity-building programme for secondary facility MDSR implementation. Keywords: maternal death surveillance, MDSR, maternal mortality, Ondo State, South West Nigeria.