Factors Associated with Maternal Deaths in the Donga Department, Benin, from 2020 to 2024

Introduction: maternal deaths remain a major public health issue in Benin, particularly in the Donga department despite notable efforts. The study aimed to identify factors associated with maternal deaths in order to improve decision-making. Methods: A case-control study was conducted in the Djougou-Copargo-Ouaké and Bassila health zones from January 2020 to December 2024. A total of 143 cases (maternal deaths) and 286 controls (women who gave birth without a fatal outcome) were included. Data were collected from birth registers, medical records, referral forms, and maternal death surveillance forms. Statistical analysis was performed using Epi Info software. Multivariate logistic regression was used to identify factors significantly associated with maternal deaths. Results: The maternal mortality ratio was 95.01 deaths per 100,000 live births. Factors significantly associated with the increase of maternal deaths were marital status (OR = 2.23; p = 0.007), history of cesarean section (OR = 1.65; p = 0.027), high multigravidity (OR = 2.01; p = 0.014), and high multiparity (OR = 2.23; p = 0.021). Managemenst-related factors, such as a consultation delay of more than 3 days (OR = 4.06; p = 0.048), absence of a referral form (OR = 2.72; p = 0.001), absence of venous access upon arrival (OR = 2.23; p = 0.023), and late referral to a specialized service (OR = 3.32; p = 0.001) were also identified as major determinants. Conclusion: Reducing maternal deaths in the Donga department requires strengthening the referral system, improving obstetric care, better preparedness of peripheral health facilities, and addressing community awareness, transport, road conditions, and other structural barriers to minimize preventable delays.