title: A community-based nested case-control study of maternal mortality.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Intervention programs for improving timely referral and upgrading of hospitals are suggested.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
authors.forename: F F
authors.initials: FF
authors.lastname: Fikree
authors.forename: R H
authors.initials: RH
authors.lastname: Gray
authors.forename: H W
authors.initials: HW
authors.lastname: Berendes
authors.forename: M S
authors.initials: MS
authors.lastname: Karim
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002423:Cause of Death; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008428:Maternal Mortality; D010154:Pakistan / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires