BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

354 . patteens of Mortality*in Childhood
formation regarding underlying and associated
causes, in both mother and newborn,
that may have contributed to the fatal outcome,
as well as exact age at death. Search
for congenital anomalies is an esential part
of this first examination of the niwborn.
An expert committee of the World Health
Organization (WHO, 1970-b) has recommended
a complete and uniform system for
the registration of all live births and perinatal
deaths. In such a system it is essential
to distinguish clearly between those
born alive and fetal deaths, in accordance
with the WHO definitions. It is advisable
to use a form for recording the out-ome,
with statement of the evidence of sf,:ns of
life, and basic information such as length
of gestation, age and parity of mother, infant's
weight at birth, congenital anomalies,
etc. Specific principles governing clinical
records in the hospital as well as responsibilities
for registration of vital events were
formulated by the principal collaborators
(PAHO, 1972-c).
These recommendations can be carried
out readily in hospitals and health centers.
Midwives and nurses as well as obstetricians
and pediatricians can contribute to the conplete
recording of such vital data. To evaluate
the completeness of recording of these
events, analyses of series of births and
deaths are advisable at many levels, first in
the hospital, and then in local areas such
as a community, city or county, province or
state, and finally in the country. The standard
of 10 deaths in the first day of life per
1,000 live births is a useful indicator for a
hospital to use in evaluating the completeness
of recording.
Until the coverage of the vital stafistics
system is complete, analyses at the levels
where it is complete are advisable-for example,
first for a district within a state, and
later for the entire state and for the country
as a whole. To increase the value of basic
data, completeness of the information and
quality in certification must be stressed.
For calculation of death rates in a given
area, essential data on infant's birth weight
and on age and parity of mother must be
provided for both the numerator (infant or
neonatal deaths) and the denominator (live
births) ; and the proper distinction must be
made between mothers who are residents of
the area and those who are non-residents.
The leadership if the medical profession in
establishing procedures in hospitals, health
centers, and vital statistics systems is irportant
so that the data needed for health
programs and for research will become
available.
As an important step to achieve comparability
as well as compliance with recommendations
of the World Health Organization
to Member Governments, the definitions
of a live birth and of a fetal death
should be introduced and followed by all
those with responsibilities in relation to
vital events: obstetricians, pediatricians,
nurses and midwives, as well as personnel
employed in hospital records rooms, civil
registries, and vital statistics offices.
In the section on medical certification
and rules for classification in the International
Classification of Diseases (WHO,
1967) the following statements are made:
"From the standpoint of prevention of
deaths, it is important to cut the chain of
events or institute the cure at some point.
The most effective public health objective
is to prevent the precipitating cause from
operating.... It is assumed, and rightly so,
that the certifying medical practitioner is
in a better position than any other individual
to decide which of the morbid conditions
led directly to death and to state
the antecedent conditions, if any, which
gave rise to this cause."