BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

346 Patternsof Mortalityin Childhood
death. In several areas two-thirds of the
deceased children had such evidence of increased
susceptibility to disease.
Immaturity indicates a deficit in growth
and development of the infant at birth, and
low birth weights are believed to be attributable
at least in part to the poor nutritional
state of the mothers. Breaking this
vicious cycle is mandatory. Mothers must
be provided with sufficient food of good
quality so that they will be able to produce
healthy children.
Immaturity and nutritional deficiency
were found to be even more serious in rural
areas thnn in the neighboring cities, the
magnitude of these problems in the rural
sector of Latin America having been uncovered
for the first time in the Investigation.
The impact of nutritional deficiency and
low birth weight at a stage when the infant
normally undergoes rapid growth and developmcnt
should be considered not only
in terms of mortality but also and principally
in terms of the effects on the future
health of the survivors,
Second. For the first time mortality from
nutritional deficiency has been analyzed by
age at death and by type of deficiency, and
a geographic description has been provided
for urban and rural populations in 13 projects
in widely separated areas of Latin
America.
The peak of mortality from nutritional
deficiency was in infancy, as early as the
third and fourth months of life, but the
patterns differed markedly in the 13 projects.
In six projects mortality was excessive
early in life, in the first few months; in six
others high rates extended into the second
year; and in the rural areas of the El Salvador
project mortality from this cause
continued during the first five years of life.
Mortality from protein malnutrition increased
to its peak in children 12-17 months
of age, while nutritional marasmus caused
high rates in infants from 2-6 months old.
Third. Only through the study of multiple
causes was it possible to measure the
magnitude of health problems in infancy
and childhood. Analyses of associated as
well as underlying causes of death were
necessary in order to uncover important
interrelationships such as the synergistic
action of infectious diseases and nutritional
deficiency, and the effects of complications
of pregnancy and childbirth on products of
gestation as measured by weight and condition
of the newborn.
To implement the recommendation made
after the first Inter-American Investigation
of Mortality in adults (1962-1964), this
Investigation has sought to study the epidemiology
of diseases, not by isolated entities
but by analyzing combinations of
pathological states. Modern data processing
methods, including tabulation by computer,
have proved valuable in carrying out these
analyses of multiple causes. Use of such
tabulations and analyses should be extended
widely for the study of vital statistics in
cities and other selected areas where satisfactory
data can be obtained in developing
countries, as well as in highly developed
countries of the world.
Fourth. Official mortality statistics fail
to reveal the real magnitude of health
problems. in the Investigation registration
of neonatal deaths was found to be so incomplete
that it is certain that mortality
in this period of life has not been sufficiently
known. For the 15 projects combined, 13.2
per cent of the neonatal deaths had not
been registered; in one project half had not
been registered, and in two others more than
one-fourth. The outcome of each pregnancy