BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

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CMapter1 .. ... XI!. Chages. ia Aignments daes of Death 329 underlying or an associated cause on final assignment. Agreement was greater for the postneonatal deaths and those at 1-4 years of age (59.2 and 58.1, respectively) than for neonatal deaths (41.2 per cent). This was to be expected, since infectious diseases and external causes occurring after the neonatal period are more readily recognized and diagnosed than certain of the perinatal causes. The problems encountered in classifying the perinatal causes are discussed later in this chapter. The agreement of assignments, by age group, is shown in Figure 164. The first bar in each group is the critical one, measuring the amount of agreement that the final assignment of underlying cause on the basis of all available information would have with the underlying cause derived from the death ce:tificate after coding in accordance with international rules. The percentages for neonatal deaths (41.2) and those in the other two age groups combined (58.8) in- FiG. 164. Agreement of Underlying Causes Based on Death Certificates with the Final Assignments in Children Under 5 Years, by Age Group, in 14 Projects Combined. 60 50 ,0 Zunderlying U. 30 0 U UNDR 5YEARS NEONATAL POSTNEONATAL .4 YEARS AGREEMENTWIT,, UNDOEIYING CM ASSOCIATED E NO AGREEMENT CAUSE CAUSE 0 dicate that statistics on underlying causes of death are not satisfactory enough at the present time to give a true and realistic picture of causes as the basis for health planning. Actually, these data from death certificates are probably superior to those for a country as a whole, as tile quality of such information in rural areas is even poorer. For sound he"lth planning, it is essential to improve the quality of medical certification as well as the completeness of registration, or else to obtain data for planning from other sources, such as through sampling surveys or through specific research programs. In the individual projects (Table 195 and Figure 165) the general agreement of underlying cause on death certificate with that on final assignment for all the deaths under 5 years of age varied from 46.3 per cent in Chaco Province to 64.3 per cent in Sherbrooke. In eight projects 50.2 per cent or more of the underlying causes were in general agreement and in the remaining six projects less than half. In only eight projects was there as much as 40 per cent agreement for deaths in the neonatal period, while in the postneonatal and 1-4 year age group six projects had at least 60 per cent agreement (California, Sherbrooke, Bolivia, Chile, Kingston-St. Andrew, and Cali). These percentages indicate lack of understanding of the value of correctly stating cause on the death certificate. The agreement of underlying cause on the certificate with associated cause assigned in the Investigation indicated that many times one of the consequences (such as lneumonia) was given on the certificate instead of the underlying cause. Hospitals should set up clinical-pathological conferences and institute procedures for providing the certifying physicians with all available
330 Pattern of, Mortality in Childhood TamtLz 195. Agreement of Underlying Causes Based on Death Certificates with the Final Assignments in Children Under 5 Years, by Age Group, in 14 Projects. Under 5 years Neon.tal Potneonatal and 1-4 years _______ Project PoetTotal _______ Agreement Total _______ Agreement Total Agreement deaths death N deaths No. % No. % No. %h Total ........................... 27,082 14,222 52.5 9,714 4,003 41.2 17,368 10,219 58.8 ARGENTINA 460 195 42.6 1,030 494 48.0 Chaco Province ................ 1,490 690 46.3 Ban Juan Province ............. 1,898 961 50.6 732 267 36.5 1,166 694 59.5 BOLIVIA project ................ 3,180 2,010 63.2 729 326 44.7 2,451 1,684 68.7 BRAZIL Recife ......................... 3,310 1,642 49.0 943 370 39.2 2,367 1,272 53.7 Ribeirao Pr~to ................. 1,103 542 49.1 505 235 40.5 598 307 51.3 SitOPaulo. .................... 4,242 2,130 50.2 1,009 816 42.7 2.333 1,314 56.3 CANADA Sherbrooke .................... 314 202 64.3 188 101 53.7 126 101 80.2 CHILE project .................. 2,242 1,324 59.1 790 358 45.3 1,452 966 66.5 COLOMBIA Call .......................... 1,367 765 55.2 435 168 38.6 932 587 63.0 Cartagena ..................... 956 409 49.1 193 09 51.3 763 370 48.5 570 51.6 310 110 35.5 794 460 57.9 Medellin ...................... 1,104 JAMAICA Kingston-St. Andrew ........... 1,630 759 46.6 884 280 31.7 746 479 64.2 MEXICO Monterrey ..................... 3,348 1,635 48.8 1,066 407 38.2 2,282 1,228 53.8 UNITED STATES California project ............... 898 533 59.4 570 270 47.4 328 263 80.2 Flu. 165. Agreement of Underlying Causes Based on Death Certificates with the Final Amignments in Children Under 5 Years, by Age Group, in 14 Projects. PERCENT PER CENT PERCENT 0 20 40 60 70 0 20 Ae 60 0 20 40 60 80 90 UNDE 5 YEARS NEONATAL POSTNEONATAL AND 1.4 YEARS SHIRINUOOXI ,-, .- SOtlSlA PUOJIC! . CAWANUI1A PROJECT CNISII POJC IANJUAN PROVINCE SI0 PAULO NiSIlnnO CAnnTAItni A 11o "'° INOIIONt. i 01111 IN CHACOVINCEIE PRO data obtained in order to ensure that underlying causes are stated on death certificates. Here is a challenge for medical educators, who are ideally placed to contribute toward improvement in the quality of medical certification.
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A'.1 ii,', r" lWAH', T , .NA ON i I
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PATTEiNS OF MORTALITY IN CHILnnooll
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PrincipalCollaborators Dr. Adela Le
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vi Patternsof Mortality in Childhoo
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DEDICATED TO ROBERT GOODWIN FIELD A
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CONTENTS (cont.) Page Comparisons w
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CONTENTS (cont.) Distribution of Li
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xvi Patternsof Mortality in Childho
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xviii Patternsof Mortalityin Childh
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8 Patterns ol Mortality in Childhoo
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12 Pattermn of Mortalityin Childhoo
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20 PatternsofMortality in Childhood
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22 Patternsof Mrtalityin (i'=LWWoo
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26 Pattern8of Mortalityin Childhood
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28: Patterhs ol Mortality in Childh
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30 Patterns 01Aortalil inChildhood
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32, Pattern8ofMortality in Childhoo
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34 Patterms of Mortality in Childho
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36 Pattermsof Mortality in Childhoo
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'42 Patterns of Mortality inChildho
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46 Pattesof Mortality in Childhood
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54,, Pattyern of Mortality in:Child
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*56 Patterniof Mortality in Childho
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Chapter IV Mortality in Childhood T
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60 Pattern&'oJMortalityin Childhood
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64 Patternsof Mortality,in Childhbo
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66 Patternsof Mortalitv in Childhoo
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70 Patterns of Mortality in Childho
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72 Pattern oflMortality in Childhoo
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74' Patternsof Mortality in Childho
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!78 Patterisof Mortality.in Childho
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78 Pdttern of Mortality in Childhoo
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86 Patterns of Mortality in Childho
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-88 .. . i atten8oiMortait~i 'Child
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96 Patters.of Mortality in Childhoo
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98. PatternsofMorti6ity in Childhoo
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100 Patternsof Mortality in Childho
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-.102 Patternsof Mortalityin Childh
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108" .. Patternsof Mortality in Chi
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110 ,Patternsof Mortality in Childh
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112: Pattern. of Mortality in Child
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116 , patterniof. Mortality in Chil
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118 Patterns of Mortality in Childh
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12. Patternsof Mortality in Childho
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124* Patternsof Mortality in Childh
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128 Patternsof Mortalityin'Childhoo
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132 Pattenisof Mortality in Childho
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134i Patternsof Mortality in Childh
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4130 -Patternm of Mortality.in Chil
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140. Patterisof Mortality in Childh
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S142 :Patternsof.Mortality in Child
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144 ,Patterna of Mortality in:Child
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.146. Patternsof Mortalityin Childh
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148, PalternaoJMortalityin Childhoo
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'150 Patternsof Mortalityin Childho
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1 64 Patternsof Mortalityin Uhlzdh
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156.. Patterhei o[Mortality'inChild
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-158. Patternsof Mortality in Child
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162 Pattern8of Mortalityin Childhoo
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164 Patternsof Mortalityin Childhoo
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188 Patter w8 Motalityin Childhood
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168 Patternaof Mortalityin Childhoo
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,170 Patternsof Mortalityin Childho
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174, Pat*ernof-Mortalityin Childhoo
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,180 Patternsof Mortality in Childh
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Chapter X Congenital Anomalies Know
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192 Patternlof Mortality in Childho
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194 Pattern of Mortality in Childho
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0819 Patternsof Mortality in Childh
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:202 ,Pattern8of Mortality in Child
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204 Patternaof Mortalityin Childhoo
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Chapter:XI Other Diseases and Exter
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226 Patterns of Mortalityin Childho
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228i Patterniof Mirtalityin Childho
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.234 i:Patternsof MortalityiwChildh
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238 Patternh of Mortalityin Childho
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242 Pattern of Mortality in Childho
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244. Patternaof Mortality in Childh
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260 Paiterns of Mortality in Childh
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262 Pattern,of Mortalityin Childhoo
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.2,4 Pattensof Mortality in Childho
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270 patternsofMortality in Childhoo
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Chater XI.v Socioeconomic and Relat
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276 PatternsofMortality.inChildhood
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Page 377 and 378: APPENDICES
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Page 390 and 391: APPENDIX 2 UNDERLYING AND ASSOCIATE
Page 392 and 393: Appendix 2 373 DEATH RATES Chaco Pr
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DEATH RATES San Juan Province-ARGEN
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Appendii 2 381 DEATH RATES City of
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4ppendiz2 383 DEATH RATES Suburban
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Appendiz 2 385 DEATH RATES Rural De
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ppendix 2 087 DEATH-RATES La Paz-BO
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Appendix 8 389 DEATH RATES Viacha-B
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Appendix 2 391 DEATH RATES Recife-B
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Appendix 9 393 DEATH RATES City of
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dppendix 8 395 DEATH RATES Franca,
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Appendix'$ :397 DEATH RATES Ribeiri
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Appendix B 399 Cause DEATH RATES S
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Appendix . 401 DEATH RATES Sherbroo
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Appendiz 8 403 DEATH RATES Santiago
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Appendix 9 405 nfective and parasit
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Appendiz 2 407 DEATH RATES Cali-COL
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Appendix 2 409 DEATH RATES Cartagen
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Appendiz, 411 DEATH RATES MedellIn-
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Appendix 2 413 DEATH RATES San Salv
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Appendix 2 415 DEATH RATES Rural
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Appendix 9 417 DEATH RATES Kingston
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1pPendix2 419 Cause 5 years Total D
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Appendix 8 421 DEATH RATES Rural St
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Appendirs 423 DEATH RATES Monterrey
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AppendixlB 425 DEATH RATES San Fran
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Appmdx 427 DEATH RATES Suburban Cou
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APPENDIX 4 HOME INTERVIEWS OF FAMIL
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Appenam a Sol APPENDIX 5 (cont.) NU
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-Appendix 6 433 Miguel A. Garcia Ce
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Appenae uO Denise Bernier Cleuza Ma
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REFERENCES-' American Society of Cl
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References, 439 rof,Differing Socio
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References 441 Pan American Health
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References 4 Verhoestuaete, L.J. an
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Index Accidents, 234-238 Age of mo
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447 Bolivia project, La Paz (cont.)
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Index 449 California project, Unite
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Index 451 Chaco Province project, A
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Index 453 'bile, City of Santiago (
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El Salvador project (cont.) Nutrit
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Inter American Investigation (cont.
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Index 459 Maternal infection, 99-10
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ItidI 481 Monterrey project, mexico
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irurcx 463 Recife project, Brazil (
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Index 465 Ribeirfo Pr~to, communiti
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Index 467 San Juan Provin,e project
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Index- 469 Sheehy, T. W., 149, 442
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