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The research staff needs to thank the editors and the reviewers for their in-depth critiques and very helpful suggestions. This has helped us to revise the paper, which now focuses on the root-cause analysis, highlighting causes of poor quality of care resulting in maternal deaths. The modifications are described in detail within the ‘response to reviewers’ document. The modifications close to journal’s requirement are described within the cowl letter.

In the case of a minimum of 5 women, it appeared that the protocols for managing deterioration have been either not obtainable or not used effectively. For example, a girl kept receiving the identical ineffective medication for so much of days. For one other woman, it appeared that the frontline hospital didn’t have an agreed protocol for managing pulmonary oedema and pulmonary embolism. In another case, the protocols for inverted uterus, heavy bleeding and severe anaemia and hypovolemia have been both not available or not applied. The root-cause analysis was carried out on 30 deaths which occurred at the peak referral hospital in 2017 out of the whole of 70 deaths in that location.

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