BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

64 Patternsof Mortality,in Childhbod
Annual Vital Statistics of WHO. In Figure
34 the infant death rates for these countries
are shaded in the same way as those for the
24 areas of this Investigation shown in
Figure 33. Mortality in the irst day of life
was less than 10 per 1,000 liv births in all
but three of these countries, and actually
was less than 5 in seven of them. Even
countries such as Norway and Sweden, with
a long history of vital statistics, had rates
of only 5.6 and 4.4 per 1,000, and likewise
England and Wales had a rate of 6.3. As
these figures suggest, it is likely that the
WHO definition of a live birth has not been
applied consistently throughout these coun-
tries. Actually, variations in registration
practices are known for several of themn
(Chase, 1967). Probably the infant death
rates in many of thcse countries would be
higher if the WHO defniticr, was followed
consistently.
On the other hand, the possibility that
some of the deaths in the first day of life
are being prevented in highly developed
areas deserves consideration also. The frequency
of low-birth-weight babies may be
less in some of these countries. Explanations
of the reasons for the differences
should aid in the formulation of preventive
programs and the reduction of unnecessary
biological wastage.
Obviously efforts must be directed to recording
the outcome of pregnancies following
the accepted definition of WHO. The
English (Butler ind Bonham, !963) have
studied perinatal mortality by combining
late fetal deaths (over 28 weeks of gestation)
and deaths in the first week of life,
and WHO (1972-b) is planning a study of
factors determining perinatal mortality in
seven countries, based on official statistics.
Although in these studies length of gestation
is one of the measures, in most countries of
the world this factor is not sufficiently well
known and recorded. The distinction be­
t,veen live births and fetal deaths is useful
for many purposes, in health as well as
social fields. Calculation of life expectancy
at birth-a measure of evaluation of progress
often used-necessitates knowledge of
live births and of deaths of those born alive.
Until standard definitions are followed consistently,
there will not be comparability in
the data on mortality or on life expectancy
at birth.
In addition to these advantages of adhering
to standard definitions, there are immediate
needs in terms of evaluation of the
outcome of products of conception. As technohogy
advances, measures to prevent premature
deliveries become more effective and
the probability of survival and the prognosis
for infants born with low weights are
improved. While such improvements are
being achieved in specialized centers, large
areas (states and countries) are undergoing
important changes in policies in programs
such as those of family planning and
legalized abortion. It is evident that ac­
curate and comparable data are essential
for measuring the contributions of programs
of maternal and child health in reducing
morbidity and mortality among infants and
young children.
MORTALITY
IN EARLY CHILDHOOD
The variations in death 'ates in early
childhood (1-4 years of age) were great in
the 25 areas in the Investigation. They
ranged from over 20 per 1,000 population in
rural El Salvador and Viacha in Bolivia, to
as low as 0.8 and 0.7 in Sherbrooke and