Regional inequalities and temporal trends in maternal disorders across sub-Saharan Africa, 1990–2023: a systematic analysis of the global burden of disease 2023 data

Background Maternal disorders remain a critical public health challenge in sub-Saharan Africa, accounting for disproportionate maternal mortality despite global progress. This study examined regional inequalities and temporal trends in maternal disorders across sub-Saharan Africa from 1990 to 2023 using the Global Burden of Disease 2023 data. Methods Age-standardized disability-adjusted life years and death rates per 100,000 population were extracted for 11 maternal disorder causes across 46 sub-Saharan African countries classified into four subregions (Western, Eastern, Central, and Southern Africa). Cause of Death Ensemble modeling and DisMod-MR 2.1 were used to generate mortality and morbidity estimates. Temporal trends were assessed using percentage change calculations, and geographic distributions were mapped using choropleth visualizations. Subregional inequalities were quantified by comparative analyses of absolute and relative disparities. Results In 2023, maternal disorders accounted for 1,601.9 disability-adjusted life years and 25.8 deaths per 100,000 population region-wide, with substantial subregional variation. Central Africa exhibited the highest burden (2,592.6 disability-adjusted life years; 42.7 deaths per 100,000), followed by Western Africa (1,889.6; 30.9), Eastern Africa (1,204.4; 18.7), and Southern Africa (586.3; 9.4). Maternal hemorrhage, sepsis, and hypertensive disorders were the leading causes. From 1990 to 2023, the overall burden declined by 60%, driven primarily by Eastern Africa’s 76.6% reduction in disability-adjusted life years. Central and Western Africa achieved moderate declines (42.8% and 50.2%, respectively), whereas Southern Africa experienced increases in specific causes, including hypertensive disorders (33.5%) and HIV-aggravated maternal deaths (241.5%). Conclusion Despite remarkable progress, profound regional inequalities persist in the burden of maternal disorders across sub-Saharan Africa. Achieving Sustainable Development Goal 3.1 requires strengthened health systems, universal access to quality obstetric care, expanded reproductive health services, and targeted interventions that address subregion-specific maternal health challenges.