Maternal Mortality Surveillance in Kano State, Nigeria: Findings from the Kano State Surveillance for Evidence and Policy (KASSEP) Sample Registration System

Background: Maternal mortality remains a major public health challenge, particularly in low- and middle-income countries (LMICs). Nigeria accounts for a substantial proportion of global maternal deaths, with Kano State having one of the highest maternal mortality ratios (MMR). This study provides retrospective maternal mortality ratios and main causes of maternal deaths from data generated by the Kano State Surveillance for Evidence and Policy (KASSEP) project using a sample registration system approach. <div> <br> </div> <div> Methods: We conducted a quantitative analysis within a mixed-methods design. Retrospective maternal mortality data were collected across all 44 local government areas in Kano State from August 1, 2023, to July 31, 2024, using a sample registration system. Household surveys and verbal autopsies were conducted using the WHO verbal autopsy tool 2022, and InterVA-5 software was used for cause-of-death assignment. Descriptive statistics were applied, 95% confidence intervals were generated, and Poisson regression models were used to estimate maternal mortality ratios.&nbsp;&nbsp; </div> <div> <br> </div> <div> Findings: A total of 11,106 deliveries and 93 maternal deaths were recorded. The crude maternal mortality ratio was 937 per 100,000 live births, and the population-weighted maternal mortality ratio was 1,143 per 100,000. Leading causes included hypertensive disorders (20.4%), obstetric hemorrhage (19.4%), and sepsis (17.2%). Emergency-related causes accounted for the largest share of maternal deaths (46%), followed by health system-related causes (39%). Secondary or higher education was associated with lower maternal mortality ratios compared with no education or lower levels of education, and this difference was statistically significant. Cultural factors accounted for a small proportion of maternal deaths.It is feasible to implement sample registration systems to obtain reliable state-level MMR in Kano State. Kano State exhibits high maternal mortality.&nbsp; Key drivers of high MMR include none to primary or Islamic education, low income and poor emergency obstetric care. Strengthening data collection mechanisms for decision making and emergency obstetric care are critical to reducing maternal deaths.&nbsp; </div> <div> <br> </div> <div> Interpretation: It is feasible to implement sample registration systems to obtain reliable state-level maternal mortality ratios in Kano State. Maternal mortality remains high, with key drivers including low educational attainment, low income, and poor emergency obstetric care. Strengthening data collection systems and emergency obstetric services is critical to reducing maternal deaths.&nbsp; </div>