BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

60 Pattern&'oJMortalityin Childhood
the relationship noted in several projects of
the Investigation.
It can be seen also that several of the
Latin American cities such as Recife, La
Paz, and Sio Paulo had death rates as high
or higher than some of the rural areas. At
the same time, all of the Latin American
cities had rates at least twice as high as
those in the projects in California and
Sherbrooke. Thus it becomes clear that
mortality could be reduced by at least one
half.
The three areas with the lowest death
rates under 5 years of age were those with
the lowest estimated birth rates and likewise
the lowest infant death rates. On the
other hand, those with the highest death
rates under 5 years had the highest birth
rates and highest infant death rates. One
explanation for part of the excessive mortality
is that high birth rates imply many
infants of high birth order, among whom
mortality is high. Other factors (such as
limited breast feeding, very little prenatal
care, and lack of water supplies) which will
be evaluated in this report also contribute
to these wide variations.
In order to show the age periods of excessive
mortality, Table 16 gives the numbers
of deaths and the rates in infancy in full
detail, as well as those in childhood for two
age groups (1 year and 2-4 years). For the
projects in San Juan and Chaco Provinces
and in Kingston-St. Andrew, data are given
for the projects as a whole as well as for
their subdivisions, since such data are useful
to the health officials for the direction of
programs. A brief, general description of
mortality by age group in children under 5
years of age is presented in the following
sections.
This overall view of mortality under 5
years reveals that differences are marked
not only among cities but also between cities
and the corresponding rural areas. These
differences between urban and rural populations
tend to disappear as mortality reaches
low levels.
INFANT MORTALITY
Of the 35,095 deaths under 5 years of age
studied in the Investigation, 78.6 per cent
(27,602) occurred in infancy, that is, in
children under one year of age; 12.4 per cent
occurred in children one year of age; and
the remaining 8.9 per cent in those aged
2-4 years (Table 17). Major attention,
therefore, must be given to mortality in
infancy,
The infant death rates for 24 areas are
ranked according to size in Table 18. In
Figure 33 the neonatal period (under 28
days) is divided into the first day of life
and the remainder, 1-27 days. The variation
in these infant death rates is greatfrom
17.2 per 1,000 live births in the suburban
counties of California to rates in
excess of 100 per 1,000 in two rural areas
(Viacha in Bolivia, and rural municipios in
El Salvador). Nearly all of this variation
occurs in the postneonatal rates (28 days­
11 months), which ranged from 4.5 in suburban
counties of California to 83.9 in the
rural municipios of El Salvador. This high
postneonatal mortality is due principally to
infectious diseases and nutritional deficiency,
and it indicates the impact of those
serious health problems. In Chapter V the