Community-Based Health Management Information System (CBHMIS): causes and distribution of maternal deaths in a high community death setting of Northern Nigeria

Nigeria accounts for 28.5% of global maternal deaths. Achieving the maternal health-related Sustainable Development Goals (SDGs) requires a clear understanding of the causes of maternal death, particularly in Northern Nigeria, where routine reporting systems are lacking.  This study aimed to identify the causes and distribution of maternal deaths in Katsina State, Nigeria. The study was conducted in five Local Government Areas (LGAs), with an estimated population of 1,600,000. Maternal deaths were identified through the CBHMIS, which engaged trained community informants. A total of 1,151 verbal autopsies were conducted for maternal deaths reported between December 2023 and November 2024 using the WHO 2022 Verbal Autopsy tools and causes of death assigned to ICD-11 using the WHO DORIS tool by trained physicians. All data was analyzed using ANACOD-3. Descriptive statistics were used to determine the Maternal Mortality Ratio (MMR), and distribution of deaths. Ethical clearance was obtained from the Katsina State Ministry of Health. The mean maternal age was 31.4 ± 6.9 years, with 62.2% of deaths occurring outside health facilities. A total of    83, 855 live births were reported, giving an MMR of 1,373 per 100,000 live births-more than double the national average of 512 per 100,000 live births. The leading causes of maternal deaths were obstetric hemorrhage (40.7%), hypertensive disorders of pregnancy (17.2%), maternal sepsis (10.1%), malaria in pregnancy (5.8%), prolonged or obstructed labor (5.6%), and abortion-related complications (4.6%). Collectively, the five leading causes accounted for about 80% of all maternal deaths. Given the high proportion of community-based births and deaths, relying solely on hospital-based interventions may not significantly reduce maternal mortality. Strengthening community-based interventions and addressing obstetric delays are critical for improving maternal survival. The study underscores the urgent need for grassroots maternal health policies prioritizing timely maternal interventions and community-level care strategies in Nigeria.