BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

ChapterV. Infant Mortality
81
Diseases of the respiratory system (460-
519)-which include those of the upper
respiratory tract, influenza, bronchitis,
bronchopneumonia, pneumonia, and other
conditions-were underlying causes of 45.9
infant deaths per 1,000 live births in
Viacha, 27.1 per 1,000 in La Paz, and 22.2
in the rural departments of San Juan Province.
With the exception of the rural departments
of Chaco Province and both
areas in the Bolivia project, all the Latin
American areas had higher death rates
from respiratory diseases as associated
causes than as underlyihg causes. In Sherbrooke
and San Francisco the rates for these
diseases as underlying and as associated
causes differed only slightly; the rates were
low (below 3 per 1,000 live births) for both
types of causes in these two areas as well
as in the suburban California counties.
Congenital anomalies (740-759) were underlying
causes of a high proportion of
infant deaths in Sherbrooke-98 deaths, or
31.6 per cent. The rate of 5.8 per 1,000 live
births was higher than in the other projects.
However, relatively high rates were noted
in the suburban departments of San Juan
(4.7), in the rural municipios of El Salvador
(4.4), and in Monterrey (4.3). In three
areas (Sherbrooke, rural municipios of El
Salvador, and Monterrey) the death rates
were high from congenital anomalies of the
central nervous system. In the California
project more anomalies were reported as
associated causes than as underlying causes,
several anomalies having been diagnosed in
the same infant. In all other projects the
reverse was usually noted, with higher
rates as underlying causes. Mortality from
specific types of congenital anomalies is discussed
in Chapter X.
Nutritional deficiency (260-269), which
includes the various forms of protein-calorie
malnutrition, constitutes another important
group of causes. The role of nutritional
deficiency and immaturity in mortality has
in the past been masked by adherence to
the principle of underlying cause, both conditions
usually being assigned as associated
causes. As is illustrated in Figure 37, these
two conditions have high death rates as
associated causes in many of the Latin
American projects, especially in those with
high infant death rates.
ROLE OF IMMATURITY AND NUTRITIONAL DEFICIENCY
Immaturity and nutritional deficiency
constitute deficits in growth and development
during intrauterine and early life. The
data on these causes have been processed so
as to make only one assignment for each,
immaturity (777) or nutritional deficiency
(260-269). It is thus possible to obtain the
number of infant deaths in which one of
these causes is present (Table 33).
As was revealed by the data in Chapter
III, the frequency of deaths of neonates
with low birth weights (2,500 grains or less)
was relatively high in many of the projects.
Of the 24 areas, there were six in which
immaturity was reported as underlying or
associated cause for at least 20 deaths per
1,000 live births in infancy; in contrast, the
two areas in California had rates of only
10.1 and 10.2.
Low-birth-weight infants surviving the
first month of life often develop a superimposed
nutritional deficiency state. Likewise,
nutritional deficiency develops in
many infants weighing 2,501 grams or more
as a result of repeated attacks of diarrheal
disease or other morbid conditions, usually
associated with inadequate intake of proteins
and calories. In the Latin American