BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

334 Patterna of Moitalityin Childhood
Although the Bolivia project appears to
have the largest number of measles deaths
known by death certificate, a-,tually the
term escarlatina(equivalent to scarlet fever
in English) was freqiently used by physicians
and witnesses to signify measles. In
the early months of the Investigation this
misuse of the term was detected and so
the deaths stated to be due to sarampi6n
(measles) and escarlatina were combined
to give the total on death certificates as
shown in Table 197. It can thus be seen
that, because of this terminology difficulty,
the seriousness of the measles problem had
not been known in Bolivia. Even in Chile,
where a preventive prcgram against measles
had been successfully conducted, an increase
was noted from 11 to 21 deaths on the
basis of the additional information,
For the 1,777 deaths due to measles on
final assignment, the underlying causes derived
from death certificates are given in
Table 198 and Figure 168. Another infectious
disease was stated for 365 deaths
120.5 per cent), including 288 in which
diarrheal disease was the reported cause.
Pneumonia or influenza was the cause given
for 287 or 16.2 per cent. In Chapter VIII it
was shown that pneumonia and diarrheal
disease were frequently found to be intermediate
or terminal complications (consequences)
of measles. Confusion of underlying
cause with terminal condition, often
called the direct cause of death by the
certifying physician, is common. The percentage
distribution of these other underlying
causes stated on death certificates for
the 1,777 deaths due to measles, in which
at least one additional source of information
was used for the final assignment, is shown
in Figure 168. While significant numbers
of these deaths were assigned to complications
such as pneumonia or influenza (16.2
per cent) very few (4.4 per cent) were assigned
to nutritional deficiency, a common
contributory cause also responsible for those
complications.
The second communicable disease with a
marked increase on final assignnent-52
per cent-was whooping cough. Though
Final assignment
Death certificate cause
Measles Diarrheal disease
(055) (009)
.
Total deaths ................................................
Same as final assignment .......................................
Other infective and parasitic diseases ............. Rest of 000-136
Nutritional deficiency ................................. 260-269
Pneumonia and influenza .............................. 470-486
Other diseases of respiratory system ............. 460-466, 490-519
Immaturity .............................................. 777
Symptoms, ill-defined conditions ................ 780-792, 795, 796
All other causes ...............................................
No.
1,777
915
365 b
79
287
52
1
29
49
% No. %
100.0 7,455 100.0
51.5 4,557 61.1
20.5 374 5.0
4.4 570 7.6
16.2 824 11.1
2.9 147 2.0
0.1 135 1.8
1.6 348 4.7
2.8 500 6.7
TABLE 188. Final Assignments of Deaths cf Children Under 5 Years of Age from Measles and Diarrheal
Disease. Compared with Underlying Causes Stated on Death Certificates in 14 Projects Com­
bined.
a Includes only deaths with information available from death certificates and from other
b Incluaes 288 deaths (16.2%) assigned to diarrheal disease by death certificate.
sources.