BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

30 Patterns 01Aortalil inChildhood
utilization of the WHO definition of live
birth. For the analysis of infant mortality
another standard based on past experience
in developed countries was used: if the
infant death rate was in excess of 50 per
1,000 live births, the neonatal rate could be
expected to be at least 30 per 1,000 live
births (usually postneonatal mortality declines
before neonatal mortality),
Also, tabulations from the completed
household sampling units were used for
evaluating local birth and death rates. This
use of samples for calculating rates requires
sufficient population (number of households),
births, and likewise deaths. In several
projects (such as those in Monterrey,
Recife, and Silo Paulo) current analysis of
the samples proved valuable in various
ways. In view of the problems uncovered
in this Investigation, greater use of such
sampling is being recommended (PAHO,
1971-a) as a means of improving the vital
statistics so urgently needed for health
planning,
In nearly all projects the registered fetal
deaths were investigated routinely to distinguish
those with evidence of life after
birth. In La Paz deaths in the first day of
life were termed mortinatos (stillbirths),
for legally they were not considered live
births; each of these was investigated. In
Sio Paulo registered fetal deaths were used
as the source of infant deaths, which were
investigated in accordance with the sampling
ratio of 1 in 4.25 fetal deaths.
Even though intensive efforts were exerted
to secure information on all deaths in
early life, provisional analyses indicated
the incoml)leteness of the data in many
projects. Additional searches were made to
discover deaths that had escaped the registration
process. The clinical records for
women admitted to obstetrics wards of hospitals
and the "delivery books" proved to
be excellent sources for discovering deaths
that occurred soon after birth. Unfortunately,
local registration practices were lax
in several places. The term "abortion" was
being misused in many areas; at times a
diagnosis of abortion was given even though
the product had lived a few hours. Moreover,
certain hospitals buried unclaimed
bodies without official death certificates
being filed. In at least two areas, hospitals
would complete the death certificates but
sometimes these were not filed in the civil
registry office. At times it was difficult to
ascertain whether the death certificate was
official or not.
The local teams of the Investigation were
alert to these p:'oblems, and as a result of
their efforts mothers knew in advance that
nurses would be visiting homes to obtain
and chilinformation
on deceased infants
dren under 5 years. In one project, for
example, two mothers commented to the
public health nurse that she had failed to
visit them-that they too had suffered the
loss of a baby recently and thus should
have visits by the nurse. These as well as
all other known unregistered deaths were
included.
The analysis of neonatal mortality on
the basis of birth weight provided another
method of evaluating the comparability of
results. It was expected that the proportion
of deaths in the lowest weight group
(1,000 grams or less) would be at least 10
per cent. Thus the findings on birth weight
furnished additional clues for discovering
deatl.s that had not been included. A detailed
discussion of birth weight is presented
in Chapter III.
A systematic search was conducted to
uncover information on all products of multiple
pregnancies. Often it was found that
when both twins died within a short interval
only one death certificate was filed. The