BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

4: Patternsof Mortality in Childhood
PILOT TESTING AND PLANNING CONFERENCES
An important feature of the Investigation
was the planning phase, which included
pilot testing of questionnaires and procedures
in several areas, rural as well as
urban, and meetings with local collaborators.
The original proposal stipulated
an 18-month period for this phase, funding
for which was awarded by the U.S. Agency
for International Development in July 1966.
After a search was made for possible
pilot testing sites and local collaborators,
the first working group waa convened in
Washington, D.C., on 19 and 20 October
1966, to review a draft questionnaire and
discuss testing procedures. Twelve participants
from Brazil, Colombia, Guatemala,
Jamaica, the United States of America, and
Venezuela agreed on the trial questionnaire
and procedures to be followed in five areas:
Recife and Ribeirfio Prato in Brazil, an
urban area in Jamaica, and rural and urban
areas in Colombia and Guatemala. Field
work for the testing commenced in January
1967. Also in 1967 interviewers of the U.S.
National Morbidity Survey tested the questions
in North Carolina.
The first 700 completed questionnaires
from the five Latin American pilot projects
were analyzed in 1967. The analysis revealed
incompleteness of registration of
deaths in the first day of life in two areas,
thus indicating the need for introduction
of the World Health Organization's definition
of a live birth. In several areas relatively
high proportions of the deaths and
also of the births of the deceased children
had occurred in hospitals, where clinical
data could be expected to be available.-
However, deficiencies in the completeness
of these data pointed to the need for improving
the records systems of hospitals in
areas where the Investigation was to be
carried out, and also for providing short
courses for personnel in charge of such
records.
Difficulties were encountered in regard
to quality of the field work in two rural
areas, principally due to the lack of diagnostic
evidence and medical attention. The
findings indicated that, with the staff
planned, the inclusion of rural areas in
which medical attention was lacking was
not advisable. Medical interviewers would
be needed to make a thorough investigation
of the causes leading to death. Even if
physicians could be employed for such
work, they would not be able to obtain any
laboratory and pathological evidence to
support their diagnoses. It was clear that
the plan of the Investigation necessitated
selection of rural areas that had local
health services and were in close proximity
to medical centers so that satisfactory clinical
data would be available for a high proportion
of the deaths. Areas at great distances
from cities could not he included and
thus the rural sites selected could not be
truly representative of the rural population
in the corresponding countries. Nevertheless,
even though the areas selected near
cities had greater health facilities, the data
they provided served to show the nature of
differences in mortality patterns between
rural and urban populations.
On the whole the interviewers obtained
complete histories of pregnancies of the
mother, a fact indicating the competency
of public health nurses and social workers
in this phase of the Investigation. Birth
weights were obtained for more than threefourths
of births of the deceased children in
Recife and Ribeirdo Prato but were not
available for a sufficient number in the
other areas. Therefore, efforts had to be