BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

224 Patternsof Mortalityin Childhood
has been reported (di Sant'Agnese and
Talamo, 1967). From 2 to 4 per cent of autopsies
carried out in various pediatric hospitals
in the United States and abroad revealed
cystic fibrosis of pancreas (di Sant'-
Agnese, 1969). The small number of deaths
from this disease found in several of the
projects may be due principally to lack of
awareness and unavailability of required diagnostic
procedures. Of the 18 deaths
caused by cystic fibrosis, nine occurred in
the neonatal period and had as principal
manifestation a meconium ileus syndrome.
Congenital anomalies were found in three
of the deaths from cystic fibrosis. Two of
them occurred in Sherbrooke, one in a 5­
month-old child with anomaly of the traclical
cartilages (category 748.3) and the
other in a newborn infant with three minor
anomalies, namely, hypoplasia of the mandiblc
(524.1) and deformities of lower and
tipper limbs (755). The third death was
found in the California project in a 23­
ionth-old child with Down's disease.
DEFICIENCY ANEMIAS AND OTHER DISEASES OF BLOOD
BLOOD-FORMING ORGANS
AND
This important group of conditions includes
the anemias due to deficiency of iron,
vitamins and other nutrients, the hereditary
and acquired hemolytic anemias (except
anemia of newborn), aplastic anemias, coagulation
defects, purpuras, and other diseases
of blood-forming organs.
Deficiency anemias (categories 280, 281)
were assigned only exceptionally as underlying
causes (in one death in each of three
projects), as can be observed in Table 133.
As associated causes, they were assigned in
158 deaths in 14 projects, with rates of from
0.8 to 21.8 per 100,000 population. The reasons
for this relatively small involvement
are, first, that nutritional anemias arcrarely
diagaiosel with specificity and, second,
whenever the presence of anemia was stated
or confirmed by laboratory evidence in a
child with moderate to severe malnutrition
the anemia was considered a component of
the general deficiency state.
The other diseases of blood and bloodforming
organs (282-289) were mainly unspecified
anemias, usually assigned as associated
causes. Possibly many of these anemias
may have resulted from deficiency of
one or more nutrients, but no clarification
was found in the records. In the many instances
in which a bleeding tendency (purpuric
episode) was present as one of the
manifestations of conditions such as septicemia,
no assignment was made to the hemorrhagic
syndrome as an associated cause,
but rather it was considered a component
of the main disease. The number of deaths
from all these conditions as associated
causes, compared with those as underlying
causes (636 as associated and 55 as underlying),
reveals once more the importane of
the study of mortality using the multiplecause
approach.