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

Objectives: Population-based information from Pakistan on maternal mor tality is inadequate to define the magnitude of the problem or to cont ribute information on the distribution of clinical causes and risk fac tors. 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 t o ascertain deaths of household members in the 5 years preceding the s urvey (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 se psis as the major causes of maternal deaths. Important risk factors id entified were maternal employment, paternal unemployment, and poor pri or pregnancy history. Women did seek health care but the assistance so ught was often inappropriate. Conclusion: Intervention programs for im proving timely referral and upgrading of hospitals are suggested.