BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

348 Patterna,Oe4MortalityinChildhood,
involved. , Since some deaths from spina
bifida and other anomalies of the nervous
systemi occurbefore birth and thus are fetal
deaths, only a limited part of this problem
may have been uncovered in the Investigation.
In these projects the principal coland
their staffs made certain
laborators
that deaths of all such products with evi-
dence of life were included in the Investi-
gation. Moreover, damage other than that
causing death (fetal deaths and infant
deaths) should be explored in the surviving
children.
In the Sherbrooke project in Canada
anencephalus was found to have excessive
frequency, and the causes should be sought.
Although the frequency of spina bifida also
was high in Sherbrooke, this was due in
part to the fact that this condition was
found at times in combination with anencephalus.
Eighth. Marked variations in patterns
of mortality were noted for certain other
causes and groups of causes such as diseases
of the nervous and respiratory systems,
malignant neoplasms, external causes, and
the sudden death syndrome. Mortality from
malignant neoplasms in childhood was
greater than that revealed by mo 'tality
statistics of the respective counti',s :'d
thus the groundwork is being laid for studies
on causation of these conditions. Sudden
death was found more frequently among infants
of young mothers (less than 20 years
of age) than among those of older mothers.
In this way, the study of patterns of such
diseases by geographic area provides bases
for planning health programs aL well as
clues for further research.
Ninth. Child mortality in rural areas of
the. projects included in the Investigation
was much higher than in the neighboring
cities, thereby reflecting the seriousness of
health problems in those sectors. These
rural areas studied in the Investigation,
because of their closeness to the urban
medical centers, cannot be considered
typical of the large rural populations of
Latin America where mortality in childhood
is probably at least twice as high as
in the cities.
The variation in mortality was greatest
for children in the second year of life, the
highest rate (in a rural area) being more
tlin 50 times the lowest (in suburban
California). To reduce mortaiity in childhood,
major attention must be given to
rural areas in Latin American coantries.
Because of lack of registration of deaths, as
well as the deficient quality of certification,
the extent and L-:riousness of health problems
in most rural areas in Latin America
remains obscure.
Tenth. Excessive reproductive wastage
has been revealed through the study of
mortality in products of previous pregnancies
of the mothers of deceased children
included in the Investigation. In two projects
with high death rates, Recife and El
Salvador, more than 30 per cent of the
products of previous pregnancies were found
to have died.
In projects with high birth rates, high
proportions of the deceased infants studied
in the Investigation were of fifth or higher
birth orders (e.g., 50.7 per cent in Recife
and 48.6 per cent in Monterrey). Death
rates were found to be excessive in infants
of fifth or higher birth orders ill the two
Latin American projects that had data
available on live births; those rates were
90.0 and 90.6 deaths per 1,000 live births
in the Monterrey and Chile projects, in confor
first births. trast to 40.5 and 39.4
In