Addisie, Mesfin(PhD)Seifu, AbiyTesfaye, Tseyon2018-07-242023-11-052018-07-242023-11-052015http://etd.aau.edu.et/handle/123456789/9966Background: Reducing maternal deaths is one of the key goals of Millennium Development Goals (NDGs). Programs and policies aiming to reduce maternal deaths need reliable and valid information. Maternal Death Surveillance and Response (MDSR) system is a method of collecting information on the level and causes of maternal death in order to provide accurate information to improve quality of maternal health care. Objective: The study aims to assess causes of maternal deaths and factors affecting MDSR system in public health facilities in Dire Dawa Methods: A cross sectional facility based study design including quantitative and qualitative methods was conducted in nine health facilities of Dire Dawa where an MDSR system was introduced. The quantitative method assessed maternal deaths and complications for causes and avoidable factors before the introduction of MDSR from 8 June 2013 to 7 June 2014 and after the introduction of MDSR from 8 June 2014 to 9 March 2015 by reviewing patient and facility records and interviewing with health care providers. Factors which affect the implementation of MDSR assessed qualitatively through in-depth interview with 24 purposively selected health care providers working in the nine public health facilities. Results: A total of 45 maternal deaths, 247 maternal complications and 8,857 deliveries were recorded during the two study periods. Maternal mortality ratios for the two periods were 511 and 505 per 100,000 live births in the baseline and implementation period respectively. Of the total maternal deaths 33 (73.3%) were avoidable. The direct obstetric causes were responsible for 41 (91%) of the deaths, of which hemorrhage 27%, hypertension during pregnancy 22% and obstructed labour 18% are the leading causes. MDSR is implementing in the nine public health facilities. Knowledge, attitude, support and supervision, training, staff turnover, and community participation are the main factors which affect the program implementation. Conclusions and recommendations: The identified maternal death is very high and most of them are avoidable and caused by direct obstetric causes of maternal death. MDSR system is implementing and accepted by most of the care providers. Improving care, capacity building, support and supervision and community awareness is crucial to reduce the number of maternal death and to strengthen and sustain the program implementationsenReducing maternal deathsThesis