BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

Chapter IX. Nutritional Deficiency
163
cachectic, jr einapiated (with or without only 3.0 per cent of the deaths, while the
gradation by weight). Severe forms of nu- percentage for all causes was 6.8 (Table 5
tritional deficiency in infants under 6 in Chapter II). The findings, therefore,
months of age frequently fell in this eate- should be interpreted with care, as the l)robgory.
Category 269.9 (other nutritional de- lem may well be more serious in some areas
fieiency, unspecified) was used for all than can be measured at this ti:, This
deaths in which Grade II deficiency or confirms once again tile need to improve the
equivalent was found, in those for which quality of clinical data and to strengthen
data were not available for assigning a education in disciplines such ias pediatric
Grade III deficiency to a more specific type, pathology in many areas of Latin America.
and in those for which no type or grade was The group "Avitaminoses and Other Nuindicated
in the records.
tritional Deficiency" (260-2691 of the Ii-
In projects where high proportions of terimtiomtl (assification provides iatedeaths
occurred in hospitals (as in San Junan gories for specific avitamninoses (vitamin A
Province, Ribeirto PrCto, Silo Paulo, and deficiency 260, thiamine deficiency 261,
Chile) 90 per cent or more of the diagnoses etc.) and for the multiple deficiency synof
nutritional deficiency were sul))orted by dromes (protein malnutrition 267, nutriclinical
or autopsy evidence. In Cartagena, tional miarasmnus 268, and other nutritional
85.2 per cnt had such evidence. In several deficiency states 269). In the Investigation
project, (as in El Salvador), the medical only 15 deaths werv found to he (ile l, a
interviews conducted in the homes provided single vitamin deficiency within categories
the basic data for assignment of nutritional 260-266, and these categories are therefore
deficiency as underlying or associated cause grouped in this report under the general
in many deaths,
heading of vitamin deficiency within the
In areas where clinical data from hos- overall section 260-269, whih in this report
pital records were limited, special caution has been more properly named "nutritional
was exercised in assigning nutritional de- deficiency," because of the relative unimnficiency
as a cause, and thus the rates in portance of the avitaminoses. For future rethose
areas may be too low because of the visions of tile ('lassificationi the group
lack of supportive evidence. This appeared should he renamed "nutritional deficiency"
to be the case in the Bolivia project.
to give more weight to the multiple deficien-
Only low proportions of the deaths were cy syndromes, which are of major imporassigned
to nutritional deficiency without tance in many countries.
satisfactory evidence from autopsy, clinical As for categories 267-269, whenever direcords,
or medical interviews with families agnostic evidence was sufficient the assign­
-that is, on the basis of death certificate or ment was made to specific conditions (proother
record only (last column of Table 87). tein malnutrition, nutritional mnarasmus),
The percentages, in fact, were usually much thoughl in many areas high proportions of
lower than for other causes of death, be- the deaths had to be classified in the miscause
of the special caution exercised. In cellaneous group (269). The methods for
the 13 projects combined, the assignment to diagnosing nutritional deficiency syndromes
nutritional deficiency was based solely on have improved considerably since tile dethe
death certificate or other record for scription of kwashiorkor (in Spanish sin­