A retrospective study to understand the differences in maternal mortality among women admitted in critical and stable conditions in Malawi.

Introduction: Addressing the burden of preventable maternal deaths remains a critical focus of global health efforts in countries like Malawi which still has a high maternal mortality ratio of 381 deaths per 100 000 live births. We investigated the differences in case characteristics, survival and causes of death between pregnant and recently pregnant women who died, following their admission in stable or critical conditions to healthcare facilities in Malawi. Methods: We conducted a retrospective analysis of maternal deaths of women from all district and central hospitals of Malawi between August 2020 and August 2022. Data were sourced from the national maternal and newborn health surveillance platform. We performed descriptive analyses, stratified by condition on admission, to identify differences in case characteristics between the two groups, and an exploratory survival analysis, to understand the differences in time to death since admission. Lastly, we performed a principal component analysis to reduce dimensionality to identify the main factors leading to deaths. Results: Obstetric haemorrhage was the predominant cause of death among women admitted in stable condition, while those admitted in critical condition primarily died of hypertensive disorders. Most deaths in both categories occurred on the day of admission, corresponding to their primary causes of death. The key factors leading to deaths were mostly healthcare worker factors followed by administrative factors. Conclusion: Understanding and responding to the different underlying causes of maternal mortality and contributing factors in the stable and critical cohorts are vital to designing well-targeted and impactful interventions to prevent maternal deaths.