BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

Chapter V
Infant Mortality
The dynamic and complex process of
growth and development is the outstanding
characteristic of the early life of the infant
(as it is of the rest of childhood). This
process-a continuous one under normal
conditions-begins with a state of complete
dependency on the mother during intrauterine
life and progresses in a complex and
sometimes unfavorable enviromnent (luring
and after birth. Countless factors can interfere
with the normal evolution of this
process and hence with the health of the
child.
The interrelationships of factors affecting
the mother, the fetus, delivery, and postnatal
development constitute an extremely
important field for analysis in the study of
multiple causes and conditions responsible
for morbidity and mortality. For an understanding
of these interrelationships and associations,
it is necessary to take into
account also the chain of events leading to
death.
Closely related to these considerations is
the evidence that diseases and their effects
are not static. The impact that a morbid
condition may produce on health depends to
a great extent on the state of the host-that
is, stage of development, previous illnesses,
and existence of concomitant pathological
processes. In an age group in which growth
and development are biological necessities,
recurrent episodes of one or more diseases
have additive or compounded effects;
repetition of an apparently mild process can
lead to a critical state of health and even to
death. Typical examples are the very coinmon
problems of diarrheal diseases and
respiratory infections which, through 1'epeated
episodes, build susceptibility to a
point where one episode that would be
trivial for a healthy child becomes fatal.
Finally, it is known that morbid conditions
may have reciprocal and even synergistic
effects, and therefore effective measures directed
toward reducing mortality, besides
saving lives, undoubtedly have vital roles
in improving the future of survivors.
In this chapter, the multiple-cause approach
is described first, and data are then
presented on mortality for the entire infant
period by causes, underlying as well as
associated, and on mortality for the neonatal
and postneonatal periods. Neonatal
mortality is analyzed in further depth in
Chapter VI.
MULTIPLE CAUSES OF DEATH
In the Investigation the term "cause" is is involved either directly or indirectly in
used to designate whatever disease, syn- the process of death.
drome, morbid state, or pathologic condition Taking into account the serious diflicul­
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