BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

ChapterX. CongenitalAnomalies
187
secutive births occurring in 24 hospitals in
16 countiies in the years 1961-1964. Tile
report on the frequency of congenital realformations
found in the outcomes of 421,781
consecutive pregnancies (live births and
fetal deaths) was publised by WHO (Stevenson
et al., 1966). Fortunately seven hospitals
in six cities in Latin America were ineluded
in that research program, thereby
providing data on the occurrence of an.-mialies
diagnosed at birth in four of the countries
in which the present Investigation was
carried out. Since the Stevenson study was
a prospective one in which obstetricians and
pediatricians larticilpated in recording the
findings, the results (an be expected to differ
from those obtained retrospectively in
the Investigation covering deceased children.
The frequency of congenital anomalies
among the 35,095 deceased children under 5
years of age included in the Investigation
was obtained from hospital and autopsy reeords
or from interviews in the children's
homes. This clmal)ter presents first the numbers
of infants and chihldren 1-4 years of age
with congenital anomalies, and then an
analysis of the specific types diagnosed. The
data on these anomalieS among the 35,095
deceased children relate to: 27,602 infants
from aibase of 474,050 live births in the 15
projects, and 7,493 children 1-4 years of age
from a base of 1,653,540 population in that
age group.
CONGENITAL ANOMALIES
IN DECEASED CHILDREN
Presentation of the data on congenital
anomalies is complicated because of the frequency
with which several anomalies are
found in different organie systems in a child
and even within the same system. The
anomalies diagnosed ts associated and as
underlying causes are given for each area of
the Investigation in the Appendix tables,
In order to arrive at clear comparisons of
the findings in the valrious projects and with
other studies that have been made, the data
have been classified according to whether
the anomaly was an underlying or an associated
cause of death or a minor anonmaly
only. In this way, duplication in the data
has been eliminated.
Of the 27,602 decease(d infants, 2,873 or
10.4 per cent were found to have had at least
one anomaly, which gave a rate of 606.1 per
100,000 live births (Table 101). Considering
only those with anomalies as underlying or
associated causes of death, the number was
2,286, or a rate of 482.2 per 100,000 live
births. Only 587 or 20.4 per cent of the 2,873
infants were (lassed as having minor anomalies,
that is, conditions that were present
but did not contribute to the sequence of
events leading to death. Although such
minor anomalies were not involved in the
fatal outcome, knowledge of their frequeney
in a population is important, as they
may handicap a surviving child physically
and mentally. Also, the finding of minor
anomalies indicates the need for a search for
serious hidden anomalies. For this reason,
elpidemniologic studies of causation should
include time minor as well as the serious and
fatal anomalies.
The variation in mortality in these infants
with anomalies was much less than