A COMMUNITY-BASED NESTED CASE-CONTROL STUDY OF MATERNAL MORTALITY

Objectives: Population-based information from Pakistan on maternal mortality is inadequate to define the magnitude of the problem or to contribute information on the distribution of clinical causes and risk factors. A population-based survey was conducted in eight urban squatter settlements of Karachi Pakistan, to address these key issues. Methods: Pre-coded questionnaires were administered to the 10 135 households to ascertain deaths of household members in the 5 years preceding the survey (1984-1989). A verbal autopsy questionnaire was administered to the 121 households where a female death between 15 and 49 years of age was reported. Results: The maternal mortality ratio was estimated as 281 per 100 000 livebirths with hemorrhage, eclampsia and puerperal sepsis as the major causes of maternal deaths. Important risk factors identified were maternal employment, paternal unemployment, and poor prior pregnancy history. Women did seek health care but the assistance sought was often inappropriate. Conclusion: Intervention programs for improving timely referral and upgrading of hospitals are suggested.