title: Emergency obstetric care in Punjab, Pakistan: improvement needed.
abstract: BACKGROUND
  This paper describes an approach to maternal mortality reduction in Pakistan that uses UN emergency obstetric care (EmOC) process indicators to examine if public health care centres in Pakistan's Punjab province comply with minimum recommendations for basic and comprehensive services.
  
  
  METHODS
  In a cross sectional study in September 2003, through random sampling at area and health-facility levels from 30% of districts in Punjab province (n = 11/34 districts), all public health facilities providing EmOC were included (n = 120). Facility data were used for analysis.
  
  
  RESULTS
  No district in Punjab met the minimum standards laid down by the UN for providing EmOC services. The number of facilities providing basic and comprehensive EmOC services fell far short of recommended levels. Only 4.7% of women with complications attended hospitals. Caesarean section was carried out in only 0.4% of births. The case fatality rate was hard to accurately calculate due to poor record keeping and data quality.
  
  
  CONCLUSIONS
  The study may be taken as a baseline for developing and improving the standards of services in Punjab province. It is vital to upgrade existing basic EmOC facilities and to ensure that staff skills be improved, facilities be better equipped in critical areas, and record keeping be improved. Hence to reduce maternal mortality, facilities for EmOC must exist, be accessible, offer quality services, and be utilized by patients with complications.
authors.affiliation: Department of Health Policy and Planning, Institute of International Health, Graduate School of Medicine, The University of Tokyo, Japan. denube5@yahoo.com
authors.forename: Moazzam
authors.initials: M
authors.lastname: Ali
authors.forename: Khawaja Masuood
authors.initials: KM
authors.lastname: Ahmed
authors.forename: Chushi
authors.initials: C
authors.lastname: Kuroiwa
mesh_terms: D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006301:Health Services Needs and Demand; D006779:Hospitals, Public; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration / Q000600:supply & distribution*; D008428:Maternal Mortality; D020380:Needs Assessment; D010154:Pakistan / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D011787:Quality of Health Care