This study assessed to what extent an enforcement campaign influenced seat-belt and helmet wearing on a Pakistani highway. The study setting was the Karachi-Hala highway where a traffic enforcement campaign was conducted from Dec 2009 to Feb 2010. Seat-belt and helmet wearing were observed in Nov 2009 and Apr 2010 at Karachi toll plaza. Differences in wearing rates as a function of occupants' age, sex, and vehicle type were compared between the two periods. On average, 9 119 (Standard deviation=1 896) traffic citations were issued per month from Aug 2009 to Feb 2010; 4.2% of which were for not wearing helmet. A 22.5% increase in citations was observed for Dec 2009 to Feb 2010 periods compared with Aug 2009 to Oct 2009 periods. Nearly six thousand four-wheeled and four hundred two-wheeled motorized vehicle occupants were observed in Nov 2009 and Apr 2010. Overall, two of the five drivers and one of the five front seat occupants wore seat belts. This proportion was significantly higher in drivers and front-seat occupants of cars than those of heavier vehicles. Similarly, one of two motorcyclists used a helmet but this proportion was 5.8% for pillion riders in Nov 2009. The increased enforcement had a limited influence on belt wearing in drivers (+4.0%; 95% Confidence Interval [95%CI]=1.8-6.1) and occupants (+6.2%; 95%CI=4.2-8.2). A higher increase was observed for motorcyclists (+9.8%; 95%CI=2.6-16.8) and pillion riders (+12.8%; 95%CI=5.4, 20.5). These results suggested that serious efforts are required to increase seat-belt and helmet use on Pakistani highways. Improving enforcement resources, increased fines, not allowing such vehicles on roads, and awareness campaigns targeting drivers of heavy vehicles might increase wearing rates in Pakistan.