Ff. Fikree et al., MATERNAL MORTALITY IN DIFFERENT PAKISTANI SITES - RATIOS, CLINICAL CAUSES AND DETERMINANTS, Acta obstetricia et gynecologica Scandinavica, 76(7), 1997, pp. 637-645
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.