Assessment of Maternal Mortality and Sociodemographic Determinants in Enugu State

Maternal mortality reduction is a core development target, and understanding its sociodemographic distribution in Enugu State provides evidence for addressing the persistent South East Nigeria maternal health challenge. This study assessed maternal mortality ratios and associated sociodemographic determinants using facility records and community verbal autopsy data from three tertiary hospitals and 30 PHCs in Enugu North, Enugu East, and Nkanu East Local Government Areas, Enugu State. Records covering 2019 to 2022 documented 214 maternal deaths and 41,320 live births. The estimated maternal mortality ratio was 518 per 100,000 live births. Direct obstetric causes accounted for 78.5 percent of deaths, with postpartum haemorrhage (31.2 percent), eclampsia (24.8 percent), and sepsis (22.5 percent) as the leading causes. Most deaths occurred in PHC facilities (48.1 percent) or at home (26.2 percent). Women in the lowest wealth quintile were 4.8 times more likely to experience maternal death. Referral delays from PHC to tertiary facilities contributed to a significant proportion of preventable deaths. Recommendations include strengthening PHC obstetric emergency capacity, expanding skilled birth attendance, deploying maternal waiting homes near tertiary facilities, and implementing community-based maternal death surveillance in Enugu State to track and respond to preventable deaths systematically.

Keywords: maternal mortality, Enugu State, obstetric causes, verbal autopsy, sociodemographic determinants