Determinants of cause-specific maternal mortality at Murtala Muhammad Specialist Hospital, Kano State, Nigeria: a six-year multinomial logistic regression analysis (2011–2016)

Maternal mortality remains a major public health challenge in Nigeria, particularly in northern regions. Evidence on cause-specific maternal mortality is essential for guiding targeted interventions. To identify the leading causes of maternal mortality at Murtala Muhammad Specialist Hospital in Kano State, Nigeria, and determine socio-demographic and obstetric factors associated with cause-specific maternal deaths among women who died. We conducted a retrospective hospital-based study using records of all maternal deaths at Murtala Muhammad Specialist Hospital, Kano State, from 2011 to 2016. Causes of death were categorised as haemorrhage, infectious diseases, abortions, non-infectious diseases, and miscellaneous causes. Multinomial logistic regression was used to identify determinants of cause-specific maternal mortality among the deceased women. Among 1,197 maternal deaths, haemorrhage was the leading cause (33.1%), followed by infectious diseases (24.5%). Among women who died, higher parity was associated with lower odds of the death being attributed to non-infectious diseases (adjusted OR 0.91, 95% CI 0.84–0.98, p = 0.019). Among women who died, those residing in urban areas had higher odds of the death being attributed to haemorrhage (adjusted OR 2.40, 95% CI 1.69–3.42, p < 0.001) and infectious diseases (adjusted OR 2.04, 95% CI 1.41–2.96, p < 0.001), possibly reflecting referral patterns. Deaths of women aged < 20 had lower odds of being attributed to abortion-related causes (adjusted OR 0.28, 95% CI 0.11–0.68, p = 0.005), while deaths of women aged ≥ 35 had higher odds of being attributed to infectious and non-infectious diseases. Model fit indicated statistical significance but low explanatory power (pseudo-R² = 0.024). Haemorrhage and infectious diseases together accounted for more than half (57.6%) of maternal deaths at this tertiary hospital. Expanding antenatal care coverage must be coupled with functional emergency obstetric referral systems, as antenatal care alone was not independently associated with cause-specific mortality among women who died. Strengthening emergency obstetric services and improving referral systems remain essential.