Background: Maternal mortality remains a major public health challenge globally, particularly in Sub-Saharan Africa and Zambia, despite the availability of interventions aimed at reducing preventable deaths. In Mazabuka District, maternal deaths continue to occur, reflecting gaps in access to timely and quality maternal healthcare services. Achieving the Sustainable Development Goal target of reducing maternal mortality to fewer than 70 deaths per 100,000 live births by 2030 remains a significant challenge. Objective: This study aimed to determine the prevalence and identify the determinants of maternal mortality in Mazabuka District, Zambia. Materials and Methods: A retrospective analytical cross-sectional study design using a quantitative approach was employed. Data were extracted from 13,519 maternal records at Mazabuka General Hospital covering the period January 2018 to December 2022. Purposive sampling was used to select maternal death cases, while systematic random sampling was used for non-mortality cases. Data were analysed using descriptive statistics, Chi-square tests, and Pearson’s correlation analysis at a 95% confidence level. Results: The prevalence of maternal mortality during the study period was 0.274% (37/13,519). Maternal mortality was significantly associated with maternal age (p<0.01), referral status (p<0.001), duration of referral (p<0.001), and mode of delivery (p<0.001). Patient-related factors including cause of death, pregnancy interval (p=0.002), parity (p=0.001), period of death (p<0.001), and complications during pregnancy (p=0.003) were also significantly associated with maternal mortality. Postpartum haemorrhage was identified as the leading cause of death. Socio-demographic factors such as education, marital status, occupation, and residence were not significantly associated with maternal mortality. Conclusion: Maternal mortality in Mazabuka District is primarily driven by delays in referral, obstetric complications, and high-risk c