Public Health Burden and Statistical Determinants of Maternal and Child Mortality in Blue Nile State, Sudan: A Secondary Data Analysis, 2010-2023

Background: Blue Nile State is one of the most health-fragile regions in Sudan, characterised by recurrent conflict, population displacement, poverty, weak health infrastructure, and a high burden of preventable communicable diseases. Despite its public health importance, state-level statistical evidence on disease burden and determinants of maternal and child health outcomes remains limited. Objective: This study aimed to describe the public health burden in Blue Nile State during 2010-2023 and to identify key statistical determinants associated with maternal and child mortality using available secondary data. Methods: A secondary data analysis was conducted using publicly available reports and published studies from WHO, UNICEF, OCHA, the Sudan Central Bureau of Statistics, the Federal and State Ministries of Health, and peer-reviewed literature. Descriptive statistics, comparative analysis against national averages and SDG targets, chi-square tests, t-tests, time-trend analysis, and multiple linear regression were applied. Regression assumptions were evaluated using residual diagnostics, variance inflation factors (VIF), Durbin-Watson statistics, and influence diagnostics. Results: Blue Nile State showed substantially poorer health indicators than national averages. The maternal mortality ratio (MMR) was estimated at 412 per 100,000 live births compared with 295 nationally, while the under-five mortality rate (U5MR) reached 89.3 per 1,000 live births compared with 56.0 nationally. Malaria represented the dominant communicable disease burden (68 cases per 1,000 population). The multiple linear regression model identified poverty rate, distance to health facility, maternal education, vaccination coverage, and malaria prevalence as statistically significant determinants (R 2 = 0.784; F = 68.32; p < 0.001). Conclusion: Poor health outcomes in Blue Nile State are associated with structural deprivation, geographic barriers, infectious disease burden, limited vaccination coverage, and conflict-related disruption of health services. A comprehensive multi-sector strategy is urgently needed.