Knowledges of MDSR and challenges to reduce maternal death in Sierra Leone: Lessons learned from MDSR meetings review, Tonkolili health district.

Abstract

INTRODUCTION: Sierra Leone has one of the highest maternal and under-five mortality rates in the world. Maternal death reviews can reduce maternal mortality. In Sierra Leone, the national Maternal Death Surveillance, and responses (MDSR) was developed in 2015 and introduced (implementation) in 2016. This study exploring the knowledge and perceptions of MDSR, challenges to reduce the cause of maternal deaths in Tonkolili Health district, Sierra Leone. MATERIALS AND METHODS: It was a qualitative evaluation among MDSR review meeting members in Tonkolili health district. We used individual interviews and focus groups for audio recorded. We stopped to collect the data with the saturation. The audios records were transcript to word text and, systematic coding and thematic analysis done by using NVIVO software version 15. RESULTS: We conducted 30 interviews and 3 focus groups with 16 (40% female) participants of MDSR review meeting members in Tonkolili health district on July 2025. MDSR's start in Tonkolili lack consensus, with estimates from 2015, aligning with national rollout in 2015-2016. Participants understand MDSR as a continuous, collaborative system to identify, review, notify, and respond to maternal deaths (pregnancy to 42 days postpartum) to prevent future ones, addressing gaps, three delays, and accountability without blame. Viewed as well-designed, non-judgmental, and action oriented, MDSR fosters team collaboration, learning from mistakes, and clinical knowledge improvement. Postpartum Hemorrhage (PPH) was cited as top cause of maternal death, follow by, Hypertensive disorders, infections/sepsis, unsafe abortions, obstructed labor, non-obstetric issues and first delay (seeking care) from cultural barriers; referral/transport issues. As challenges, we noted, logistical (equipment/supply shortages, blood bank delays, poor referrals/vehicles); human resources (training gaps, low attendance, overburdened staff); community (awareness lacks, traditional birth attendance home deliveries) and systemic challenges (communication, documentation, politicization, blame culture). CONCLUSIONS: To enhance MDSR implementation, ensure comprehensive support through resource provision, capacity building, community engagement, timely processes, motivation, infrastructure, policy reforms, and a blame-free culture.