BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

Chapter XVIII. Highlights and Recommendation8
351
MATERNAL AND CHILD HEALTH AND NUTRITION
The Investigation has provided the most
exact measurement possible of the magnitude
of problems underlying child mortality
in 15 projects in the Hemisphere. The evidence
presented indicates the urgent need
for action to find solutions for the main
problems uncovered. A multidisciplinary
and intersectoral al)proach should be introduced
to develop progranis that will
make optimum use of resources to deal with
the most serious of the multiple conditions
and factors found to be responsible for
mortality and morbidity. The degree of
risk at the level of community, family, and
individual must be taken into account in
setting the order of priorities.
A top priority is the promotion and attainment
of an ol)timum state of nutrition
for pregnant and nursing women and for
the products of conception. Prevention of
low weight at birth (immaturity) and Of
nutritional deficiency is considered a much
more effective and less expensive endeavor
than care of the immature infant and cxtended
treatment of the malnourished child.
These two conditions of high vulnerability
are main contributors to excessive mortality
and to permanent deficits in growth and developinent.
The highest priority, therefore,
is to assure the mother adequate medical
care and good nutrition so that she will
have healthy and intelligent children.
Parents should be provided with guidance
and assistance so that they may attain
optimal reproductive patterns in respect to
age of mother and intergestational intervals.
This must be considered a top priority
within programs of family health in order
to safeguard the physical condition and
intelligence of children and hence the wellbeing
of societies.
Breast feeding of sufficient duration and
the timely addition of adequate foods to the
diet of the weaning child should he encouraged
as essential life-giving measures
in developing areas. The use of these protective
measures to guard against iualnutrition
and gastrointestinal infections should
go hand in hand with other basic actions
to reduce the magnitude of what has been
shown to cause the most serious health
problems in developing areas: the complex
of nutritional deficiency-infection. Among
these measures, extension of immunization
programs, including vaccination against
measles in all countries, and provision of
piped water supplies appear to be mandatory.
All these basic activities should be carried
out as part of an integrated maternal
and child health program and within a general
plan of health and social progress. In
such a program the various phases of the
infant's development (intra- and extrauterine)
should be viewe(l as a continuum,
so as to take into account the interrelationships
of causes and factors that have been
discussed throughout this report.
Methods for increasing the efficiency of
each component of the program and for
recognizing and measuring high risk must
be developed, along with measures for extending
services to groups of population
that require them most. Certain basic principles
of health administvation recommended
by the l)rincipal collaborators
(PAHO, 1972-c)-such as regionalization
of health services, integration of preventive
and curative aspects on a functional and
programmed basis to provide continuous