BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

Chapter XVIII. Highlights and Recommendations
353
plexity makes clear the need to introduce
the multiple-cause approach in the study of
factors involved in morbidity and mortality,
The adoption of such methods in teaching
will encourage team effort in the task of
defining and solving health problems.
Integration, or as a minimum, close coordination
of obstetrics and pediatrics, with
a strong component of preventive aspects,
should be established in teaching and training
programs so as to provide basic knowledge
of all the multiple factors affecting the
health of mother and child.
Concerted efforts to attain high quality
in delivery of health services should be the
aim of teaching and training, just as they
should be also of clinical and community-
centered research. The relationship is reciprocal
in the sense that good training and
tcrchin thel ase et rai and
teaching as well as current research are
necessary for improving the quality of
health services.
Continuing education in maternal and
child health disciplines, using the facilities
of health services as well as university
resources, is essential. Problems such as
those revealed by this Investigation should
have precedence in the program of instruction,
and efforts should be made to reach
every member of the health team, including
midwives as well as such empirical personnel
as lay midwives or lay birth attendants,
who must learn to comply with at
least the minimum standards in the care of
women at childbirth and of the newborn.
Such personnel should be supervised, assisted,
and taught the essentials of care of
uncomplicated cases and the procedures for
prompt referral of patients in whom a coinplication
is found or suspected.
The efforts undertaken by the teams, participating
in this Investigation should be
continued and carried forward, by setting up
teaching programs and centers in the different
schools to disseminate and encourage
wide application and further develo)ment of
community-centered research. All the experiences
in this Investigation, including
the difficulties, are useful for gaining knowledge
of and working out solutions for the
many problems uncovered.
DEVELOPMENT AND IMPROVEMENT OF
BASIC HEALTH DATA AND STATISTICS
For geographic studies of diseases it is
necessary to have available or develop basic
data from different areas. There is a wealth
of such data to be found in the Americas, as
the areas have varied characteristics and
these must be taken into account in order to
obtain complete and comparable information
on the epidemiology and, in particular,
the causation of disease. Through the research
that has been completed, this Investigation
has pointed out the steps which
are advisable for recording and collecting
such data as well as for tabulation and
analysis of the multiple causes and factors
involved.
The first and most important recommendation
is that the outcome of each pregnancy
be recorded with as much information
as possible. This should include condition
of the newborn, birth weight, signs of life
(Ruch as recommended by Chase et al.,
1972), and if death occurs, all possible in­