MATERNAL MORTALITY IN DIFFERENT PAKISTANI SITES - RATIOS, CLINICAL CAUSES AND DETERMINANTS

Background. Population-based estimates of maternal mortality from Paki stan are inadequate to define the magnitude of the problem or provide information on clinical causes and determinants. Methods. Surveys were conducted in selected clusters in Karachi, Balochistan and North West Frontier Province from 1989-1992. Pre-coded questionnaires were admin istered to 38,563 households to ascertain household characteristics, c omplete pregnancy histories and deaths of household members in the fiv e years preceding the survey. Verbal autopsy questionnaires were then conducted to establish cause of death to women in the reproductive age group. Descriptive, bivariate and multivariable analyses were carried out to determine the association between the background variables, bi ological and women's status indicators and maternal mortality using a nested case-control design. Results. Overall, the estimated maternal m ortality ratio combining the data from the different sites was 433 per 100,000 livebirths. The estimated maternal mortality ratios per 100,0 00 livebirths ranged from a low of 281 in Karachi to a high of 673 in Khuzdar [Balochistan]. Hemorrhage (52.9%), puerperal sepsis (16.3%) an d eclampsia (14.4%) were the leading causes for direct maternal deaths . Logistic regression identified the important risk factors as poor ho using construction material (OR = 2.1; 95% CI = 1.3,3.2), distance of 40 or more miles from nearest hospital (OR = 1.3; 95% CI = 0.9,1.8), g randmultigravidity (OR = 1.6; 95% CI = 1.1,2.4) and prior fetal losses (OR = 5.3; 95% CI = 3.8,7.4).Conclusion. Focusing on special groups o f pregnant women with targeted programs such as training, monitoring a nd supervision of birth attendants for the provision of oxytocics, wil l go a long way in decreasing the proportion of maternal deaths attrib uted to direct, avoidable causes.