BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

Chapter XVI1.
Changes in Assignments of Causes of Death
333
in this case infectious diseases. All projects
except those in Chile and Sherbrooke had
some net understatement of infectious diseases.
The ratios of final assignment to death
certificate assignment are shown in Figure
166 for five infectious diseases and two
groups of the remaining infectious diseases.
The largest increase was noted for measles
(81 per cent). The increase for whooping
cough of 52 per cent indicated that this
communicable disease of childhood was understated
as well. Increases were noted
also for diarrheal disease and other intestinal
infectious diseases. Of the 573
deaths assigned to septicemia from death
certificates, a reduction was made to 322 on
the basis of additional information on a
more specific underlying cause.
Fio. 166. Ratio of Final Assignments to Death
Certificate Assignments for Infective and Parasitic
Diseases as Underlying Causes in Children Under
5 Yc.nrs of Age in 14 Projects Combined.
RATIO
o ,15 .o 1.5 2.0
the additional information; the ratios of
number on final assignment to that on
death certificate were 2.78 in Chaco Province,
2.66 in Recife, 2.25 in Cartagena, 2.89
in Medellin, and 2.77 in Monterrey. For
these five projects the number of deaths that
could have been classified as measles on the
basis of death certificate was 337, while the
additional information revealed 899. Therefore,
the Investigation has uncovered the
size of this serious problem, against which
action has already been recommended by
the Ministers of Health of the Americas
(Pan American Health Organization, 1969).
However, if the effects of the actions taken
are to be properly evaluated, death certificates
should in the future include this important
underlying cause whenever known.
Figure 167 shows the numbers of deaths
from measles derived from death certificates
on final assignment for 11 of the 14 projects.
Data for Kingston-St. Andrew and the
two Northern American projects are not
shown because of the small numbers of
deaths involved.
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EQUALITY OF
ASSIGNMENTS
With respect to measles, the assignments
increased from 984 deaths on the basis of
death certificates to 1,777 on final assignmhent.
Using the death certificates alone,
only 55.4 per cent of these deaths found due
to measles could have been classified as
measles. This indicates a serious lack of information
regarding this preventable disease.
In several projects the number of
measles deaths was more than doubled by
Fin. 167. Measles as Underlying Cause Based on
Death Certificates and on Final Assignments in
Children Under 5 Years of Age in 11 Latin
American Projects.
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