Dissertation (MSc Midwifery)Maternal and Perinatal Deaths Review and Surveillance (MPDSR) is a technical system which was issued by the World Health Organization in 2013 to help developing countries improve maternal health. The major purpose of the system was to reduce the ongoing high numbers of maternal deaths and perinatal deaths from avertable causes. Tanzania adopted MPDSR system in 2015. The system was intended to generate useful information by ensuring that all pregnancy related deaths of women and newborns are notified and are reviewed by experts in the field. The study was done to determine the influence of knowledge and attitude of health workers on implementation of MPDSR system among health facilities in Morogoro region. This analytical cross sectional study was conducted in three districts of Morogoro region from April 27, 2020 to May 29, 2020 involving 360 health workers from 38 health facilities. Health workers were asked to fill questionnaires, at the same time their respective facilities were assessed for status of MPDSR implementation by using document review checklist. SPSS was used to analyze the obtained data by using chi square tests and binary logistic regression analysis. 29.2% of the respondents had adequate knowledge of MPDSR system while 70.8% of respondents had positive attitude towards MPDSR system. On the other hand, 52.6% health facilities had satisfactory status of MPDSR implementation. The status MPDSR implementation among health facilities was significantly associated with attitude of health workers, level of health facility and ownership of the facility Both knowledge and attitude of health workers are important factors in MPDSR implementation. More efforts are needed to impact health workers with necessary knowledge on the system.