BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

140. Patterisof Mortality in Childhood
children under 5 years of age. No other
single category had as many deaths.
Prior to the 1965 Revision of the Classification,
deaths stated to be due to diarrheal
disease were assigned to several different
categories. In countries where Spanish and
Portuguese are spoken, the term toxicosis
(Spanish) and toxicose (Portuguese) are
often used to signify a specific clinical syndroine
that is in essence the result of severe
and rapid dehydration from diarrheal discase.
In the 1948 and 1955 Revisions of the
Classification, when toxicosis was stated as
the cause of death signifying infant (liarrheal
disease it was classed as 764.0 (diarrhea
of newborn) for deaths under 4 weeks
of age, in the section on diseases leculiar
to early infancy. The inclusion of deaths
due to toxicosis in this category of early
infancy contributed to high death rates for
that group and likewise to low rates for
diarrheal disease (at that time classed as
543, 571, and 572). In 1955 in Chile the
group of diseases of early infancy was reported
to be the leading cause of death because
of the inclusion of these diarrheal
disease deaths; but in Venezuela toxicosis
was coded to 571 and the group gastritisenteritis
(543, 571, and 572) was the leading
cause. There were difliculties also in the assignment
of toxicosis for deaths in other age
groups (Verhoestraete and Puffer, 1958-h).
An analysis of mortality from cardiovascular
diseases and in particular arteriosclerotic
heart disease in different countries
of the world was prepared for the WHO
Study Group on the Classification of Atheroselerotic
Lesions (WHO, 1958). The
marked geographic differences in death
rates from these causes which were pointed
out in a working document (Puffer and
Verhoestracte, 1958) led to the adoption of
recommendations for the improvement of
mortality statistics on cardiovascular discase.
The Study Group suggested that comparative
studies be made of death certificates
in different countries in order to review
the terminology in use and promote
the utilization of comparable procedures.
The Inter-American Investigation of Martality
in adults was designed to ascertain
whether the death rates for coronary heart
disease were lower in the Latin American
countries or whether the differences were
due to the terminology in use and the Classifieation
of sutch causes. or to a combination
of these factors. Thus noso!ogical and
classification problemns let{ to the first large
research project and sulsequently to this
Investigation.
In the 15 projects whenever the diagnostic
evidence and laboratory findings indieated
amebiasis (006) or another specific
intestinal disease (000-008), such categories
were used, though the numbers of such
deaths were small (303 and 291, respeetively
in comparison with the 10,052 from
diarrheal disease.
For analysis of the role of diarrheal disease
as underlying and as associated cause,
the numbers and rates are given in Table 72
for deaths in infancy and in children one
year and 2-4 years of age in the 15 projects.
The mortality was much more serious in
infancy than in the two other age groups.
As can be seen in Figure 70, rates for diarrheal
disease of infants were much higher
as an underlying cause than as an associated
cause, while in the second year of life this
difference narrowed and even was reversed
(as in Recife).
Aside from differences due to terminology,
other difficulties are encountered in classifying
diarrheal disease as a cause of death.
For example, in many children there is a
history of repeated diarrheal disease episodes
which combined with inadequate food
intake result in nutritional deficiency. These