Understanding household maternal and child health predictors: a periodic assessment across three states in Sudan

BackgroundWhile Sudan's essential health care package historically aimed to support maternal and child health services, limited empirical evidence exists on patterns of service utilization, health-seeking behaviors, and maternal, infant, and young child nutrition practices under the current crisis conditions. This study set out to examine maternal and child health service use, health-seeking behaviors, and nutrition practices in three Sudan states in 2021 through 2024.MethodsAnnual repeated cross-sectional household surveys were conducted from 2021 to 2024 across three Sudanese states: Blue Nile, South Darfur, and East Darfur. Each year, approximately 906 households were sampled using probability-proportional-to-size (PPS) cluster sampling. Data collection occurred during the post-harvest season using a standardized questionnaire covering household demographics, infant and young child feeding (IYCF) practices, health service utilization (antenatal care, delivery, immunization), and key nutrition indicators. The tools were translated into local languages, pretested, and administered electronically using KoboCollect. Descriptive statistics and trend analyses were performed in SPSS version 25, with results presented as frequencies, means, and logistic regression analyses were 95% confidence interval was determined.ResultsAlthough any ANC attendance remained high (87.3% on average), facility delivery was low (mean 23.1%) and home births predominated (mean 76.9%), suggesting sustained barriers to safe childbirth access. Nutritional risks widened: ever breastfeeding declined (91.8% to 82.7%), continued breastfeeding fell sharply (99.1% to 70.4%), and pre-lacteal feeding increased to 64.5% in 2024, patterns consistent with documented IYCF vulnerabilities during crises. Bivariate and multivariate logistic regression analyses were done where Female caregivers demonstrated higher odds of achieving minimum dietary diversity compared with male caregivers (OR ≈ 2.4, p < 0.001). Female caregivers had higher adjusted odds of practicing appropriate newborn care (aOR≈3.4, p < 0.001).ConclusionThe collapse of Sudan's health systems compounded by recurrent shocks has significantly eroded MIYCN and maternal health service uptake, with gains in 2022 largely reversed by 2024. These reductions in maternal new-born and child health survive means that Sudan might not be able to meet its targets as stipulated in every Woman, every child loba framework. Further Sudan might not be able to substantially to meet the Sustainable development goals 2 (Zero Hunger), 3(Good Health and wellbeing) and 5 (Gender Equality).