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Ar0I ft Pj1t Itj 1~4 A I IAL 001V E 1o1urt II
WAIHIPIGITIN 0i C 2O4ws BIBLIOGRAPHIC INPUT SHEET
FOR AID USE ONLY
I SUBJECT A P IIARY
TEMPORARY CLASSI- FICATION 3FCONDARY
2 TITLE AND SUBTITLE
Inter-American Investigation of Mortality in Childhoodillustrative material
3 AUTHOR(SI(101) Pan AmHealth Organization
4 DOCUMENT DATE ISNUMBER OF PAGES I ARC NUMBER 1971 22p ARC
7 REFERENCE ORGANIZATION NAME AND ADDRESS PAHO
e SUPPLEMENTARY NOTES (Sponsoring Orfianlzatlon Publishers Availability)
9ABSTR iALTH R amp D)
OCONTPIN_31 PRICE OF DOCUMENT
12 DESCRIPTORS 13 PROJECT NUMBER
14 CONTRACT NUMBERCSD1~3l Resamp 1STYPE OF DOCUMENT
AIA 590- 474)
PAN AMERICAN HEALTH ORGANIZATION
Pan Americait Sanitaty Bureau Revional poundffice6of t
WORLD HEALTH ORGANIZATION
525 TWENTY-THIRD STREET NW WASHINGTON DC 20037 USA CABLE ADDRESS OFSANPAN
IN REPLY REFER TO TELEPHONE 223-4700
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Illustrative Material
A Questionnaire for Deaths
B Code Sheet
C Selected Material from Provisional Report for First Year
A
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Confidential Death - page 1
2 Serial no1 Name of child
3 Date of 14 Date of I5 Sex 16 Age at
birth death death -yrs -mos -dayshrs
Sector or division7 Address
HOUSING
8 Neighbor- 9 Type of IloNumber of Il1Water Piped water Other laoltFlush Othcr None
hood -P housing rooms- Inside0Outide 0 01 130dege 0 0
13HOUSEHOLD ROSTER
Relation Date of Marital Education Length of residence
Age Sex Total Last In Last 5yearsId Name to In~no head birth statics years Type Year Trunity Urban Rural
3
4
5
6
7
9
10 II 12
Enter date of birth for children under 6 years
14 OCCUPATION
Ind Name CurrentlyOccupation Kind of business Time in no employed occupation
15 DEATHS IN HOUSEHOLD IN PAST YEAR
Name of deceased Age Sex Date Home Hosp Name of hospital Other
16 PREGNANCY HISTORY OF MOTHER O Date Live births
Ord prenancy Abortion Stillbirth
enaed Name of child Sex Living now Age at death
2
3 4
5
6shy
8
9
_ _ __ _ __o_ __ _ __ _ _ __ _ _ __ _ _1 _ _ _ _ _ _ _ _10 ________
17 Pregnant now Yes [3 No 03 Unknown 03 18 Remarks
19LSource of Ind tGa
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Confidential Death - pag 2
Name of child Serial no -Dateof Dateof Sex Age at birth death death mox ayryaye hrs
20 DATA ON PARENTS Id Name Live Date of birth Age Marital status Education Employed Occupatiln Business no here now c
Father Mother
21 Was the mother of this child seen by physician or in a clinic or hospital during pregnancy Yep(Q No [3 Unknown [ If yes name of physician clinic or hospital Dats _
Reason Months pregnant at first visit Number of visits
22 Length of pregnancy months Unknown [0)
23 Were there complications during pregnancy No [ Yes 0 If yes check below Unknown 01 Edema [Q Convulsions 0 Threatened abortion 0 Hemorrhage 0 Trauma 0 Operation 0 Specify
Infectious disease 0 Specify 24 Where born Home [I Hospital L Name and address Other 0 25 Who attended birth Doctor 0 Midwife (j Other 0 Certificate no 26 Was the delivery spontaneous Nc [0 Yes [ Unknown [ Were instruments used No ] Yes 0 Unknown 0
Was anesthe3ia given NoQ 1es 0 Was sedation given No 0 Yes 0 Cesarian No 0 Yes 0 27 Was the general aspect of child good at birth No 0 Yes 0
If not good what did you notice
28 Birth weight Unknown 0 29 Did you breast feed the child Yes 0 When did you start weaning Age months Reason
When did you finish weaning Age months
No[ Why not Unknown 0 30 Was other milk used No [] Yes 0 At what age months or days Times per day
Composition Milk Water Was use of milk continued
31 Was other weaning food used Was weaning food continued 32 Give age in months when JUICES _ rus CEREALS emos PULSES _mos ROOTS TUBERS MOs
foods were added Times per week_ Times per week Times per week Times per week LEAFY VEGETABLES EGGS MOs POULTRY mos MEAT MOs FISH Mos
Times per Times per week Times per week Times per week Times per week mojns week
33 At what age (in months) did child do the followiag a) raise head b) seat self ) stand alone
d) walk alone a) control bladder f) control bowels_ g) feed self 34 Who cared for child most of day Mother 0 Grandmother 0 Sibling (15 yrs + ) 0 Sibling(-15 yrs ) 0
Other relative 0l Maid 0 Day care [ Other ] 35 Has your child been vaccinated Yes 0 No [] Unknown [] If yes which vaccinations
36 At what age in months did child have following a) German measles b) measles c) chickenpox
d) whooing cough e) mumps
37 Remarks
38 Source of informationi Mother Father 0 Other 0_1 Date Interviewer
INTER-AMERICAN iINVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 3Confidential
Serial noName o child
Date of IDate of Sex Age-at death _yrs _mos __days hrs
deathbirth
has this child been attended by a ph sician or in a clinic or hospital Yes No 0 Unknown 1339 During the past year
NumberDays in viO0tsName of physician clinic or hospital Type Dates hospital Reason
emergency E Indicate whether clinic (health center or hospital) C in-patient in hospital H practicing physician P
Yes r3 No J Unknown [40 Did the child receive medical attention before the past year
NumberReasonDays in visitsDates hospitalName of physician clinic or hospital Type
Indicate whether clinic (health center or hospital) C in-patient in hospital H practicing physician P emergency E
b) How did illness start41 Disease a) How long was the child ill
c) What disease do you think caused the childs death
42 Description of the disease by the mother
43 Home treatment
44 Prescriptions
45 Who prescribed
46 Did the mother see signs of malnutrition (edema loss of weight changes in hair or skin)
b) How many days after onset of illnessa) Was child taken to doctor No 0 Yes 0b c) What was condition of child Slightly ill [01 Moderately ill [ Very ill
47 To doctor
48 Where did child die Home 03 Hospital 0] Name Other 0
49 Death certificate number
50 Source of information Mother 0 Father 0 Other 03 InterviewerDate
INTER-AMEAdCAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Confidential Death - page 4
Serial noName of child
Date of 6 ate of Sei~g t birth 1 death death yrs -MoS days hr
DATA OBTAINED FROM HOSPITAL CLINIC OR PHYSICIAN
51 Abnormal None Edema Hyper- Albumi- Convul- Hyper- Anemia Threatened Placenta Other specify sions emeuis abortion previaconditions of tension nuria
pregnancy 0 03 0 0- 0] 0] 0 0 0
5 Conditions None German T b c Syphi- Operation reason findings Trauma specify Other specify
unrelated to measles puli lis
pregnancy n 0 03 0
Spontane-Q Forceps Sedation Length of 5553 Dlivery ous Manipu- Cesarian Azesthe- Other specify 54 Single orlation 0 03 0 sia 0 Q gestation multiple birth
DATA ON CHILD (age in completed months in first line)
56 Age At birth
57 Weight 58 Nutritional status
59 DATA ON NEWBORN FROM RECORD
General state Good 0 Fair 0 Poor 0 Genitals Normal [ Abnormal 0 Activity Normal 0 Abnormal 03 Extremities Normal n Abnormal 0
First cry_ min First breathing_ min Skin color
Movements Normal 0 Abnormal 0 Cyanosis General 0 Extremities [
Muscular tone Increased 0 Normal 0 Decreased 0 Jaundice Yes D3 No [ Time
Head - Size Increased 0 Normal 0 Decreased 0 Hemorrhagic signs Yes [ No C]
Shape Normal [ Abnormal 0) Infection signs
Cephalohematoma 0 Lacerations 0 Lacerations Yes 0 No 1
Eyes nose ears mouth Edema
Neck - Rigidity- Yes 0 No 0 Masses [ Breathing Normal 0 Irregular 0 Chest Secretion
First Voiding __hrs First bowel movement hrs Abdominal Masses 0 Hernia [
hrs Congenital anomalies
Acceptance 0 Rejection [ First feeding b- Type
Progrees
60 PRINCIPAL FINDINGS IN HOSPITAL AND CLINICS PRIOR TO ILLNESS LEADING TO DEATH
61 Sorce of o Private r information Hospital 03 Clinic 0 M D 0] Other 03I ae______ Interviewer
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 5Cosifidentlxl
Serial noName of child
Date of IDate of Sex Age at death yra ___oa days hrsdeuth
PRESENT ILLNESS - EVENTS THAT LED TO DEATH OF THE CHILD
birth
63 How disease started62 Date disease started
64 Main symptoms
65 Description of disease
PHYSICAL EXAMINATION (at aemission to hospital or first outpatient or house visit)
66 Date 67 Height 68 Weight and arm circumference Wt Arm circumference
69 Nutritional status
70 Relevant physical findings
71 Evolution and treatment
72 Source of i Private I information Hospital 3 Clinic 3 MDK t 0 Other [0 Date Interviewer
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD Confidential Death - page 6
Name of child Serial no Date of IDate of Sex Age at birth I death death yrs mon days hrs
DATA OBTAINED FROM HOSPITAL OUTPATIENT SERVICE OR PHYSICIAN 73 Relevant laboratory findings
74 X-rays Site Date Results
75 Other auxiliary examinations
76 Surgical procedures and findings
77 Cytology 78 Biopsy 79 CLINICAL DIAGNOSES
80 Autopsy No [ Yes 0 Date
81 Date ho- 82 Date dis- 83 Where Home I OutpatientD e IHospitalthan 48 hoursless IHospital 48 Otherservice hours or m O pitalized I charged died 0 0 0 0 o 0
84 Source of Hospital I Clinic 1Private Other Date Interviewer information 10 Cn IZ D t [] 111
DATA OBTAINED BY HOME VISIT OF MEDICAL INTERVIEWER 85 Date disease started 86 How disease started
87 Main symptoms 88 Description of disease
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 7Confidential
Serial noName of child
Date of IDate of Sex Age at
birIth - ideathdah- death yr _ MOS days hrs
__ DATA OBTAINED BY MEDICAL INTERVIEWER IN HOME
a) How long was the child ill b) How did illness startf
89 Disease
c) What do you think caused death d) Did someone else have same disease
a) Did the child have fever No [ Little 0 Moderate [ Very high 03 b) How long it9 ever c) Did you take the temperature No 0l Yes 0 d) What was
0 Normal 0 Rapid 01 Difficult 0a) How was the respiration Slow 91 Respiration b) Did the sides of nose move in breathing Yes 0 No 0 c) Noise
a) Did the child cough No 0 Little 0 Moderate 0 Heavy 0 No 03 Little 0 Moderate 0 Heavy shy
9Z Cough b) Expectoration c) Color of expectoration White 0 Yellow 0 Green 0 lth
a) Did the child vomit No [I Little 0 Moderate 0 Severe [
Solid [] Liquid [ Everything []93 Vomiting b) What did he vomit
c) How long did he vomit days d) Did he lose appetite
0 Loose 0 Liquid 0)a) How were the feces Very hard 0 Hard [3 Normal
94 Feces b) Color of the feces Yellow [ Brown [] Green 0 Red [ Black 0
c) How many times per day d) How many days__ e) Were worms seen
a) Difficulty in urination No 0 Yes 0-b) Retention of urineNo [] Yes 0
95 Urine c) Did urine diminish No 0 Yes Od) Eliminated calculiNo 0 Yes [
e) Color of urine Dark 0 Red 03 Dirty 0] a) Did the child lose weight No 0] A little 0 Moderate 0 Severe 0
No [ Yes []d) Face No[QYes[O96 Weight b) Did the arms get thinner No [ Yes []c) Legs
e) Could ribs be seen under skin No [ Yes ]
a) Did the child have swollen legs No 0 Yes [Ob) Swollen abdomen No 0 Yes [] c) Face No [] Yes []
a) Did you see anything on skin No 0 Yes [
98 Skin b) Appearance Yellow 0 Rash [ Pustule [ Cyanotic 03 Pale 0] Blemishes [ Depigmentation 03 Dryness (3
a) Did the child have much hair No 0 Yes 0 b) Pull out easily No 0) Yes 03 99 Hair 0c) Change of color No 0 Yes [ d) Glossy No 03 Yes
a) Did the child move actively No 0 Yes [b)All parts of body No 1 Yes 03 10Neuromuscular
100 activity c) Delay in movement No [ Yes [ d) Since when
___ _ e) Convulsions No 0 Yes 0 No [ Yes Ob) How longa) Did the child have pain No n Yei [d) Associated with whatc) Continuous
a) Did the child have a fall No [0 Yes Qb) Injury
102 Accident c) Other accident No 03 Yes [d) Explain
103 Other What other symptoms
Provide data regarding these items before final illness
104 Observation
a) Did you take child to doctor No [ Yes 0 b) How soon after onset of illness 105 To doctor
c) What was condition of child Slightly ill 03 Moderately ill 0 Very ill 0
106 Source of Mother 0 Father b Other Date Interviewer
information
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 8Confidential
Name of child Serial no
Date of Sex lAge at
birth death death _yrs mo_ day hr
AUTOPSY REPORT
Date of
107 Autopsy number 108 Interval from death to initiation of autopsy
109 Weight 110 Arm circumference
Ill Other anthropometric measurements
112 Description of cadaver (note all positive findings especially on nutrition)
113 Macroscopic examination of cavities and segments (positive findings of head thorax abdomen pelvis neck limbs)
114 Macroscopic examination of organs (positive findings of appearance surfaceweight color consistency etc)
115 Microscopic examination of organs and tissues (positive findings of organs macroscopically abnormal and of those
requested)
116 Positive laboratory findings from autopsy_
117 Final diagnoses from autopsy Direct cause of death
Principal diagnosis (underlying cause)
Secondary diagnoses (associated causes)
cause118 Associated diagnoses not related with underlying
119 Type of Hospital Verification of death Medico-legal Complete Partial Incomplete
0 n biautopsy
Date____________ Interviewer_________
OF MORTALITY IN CHILDHOODINTER-AMERICAN INVESTIGATION
Confidential Death - page 9
Name of child_ Serial no
DDate of Sex [Age at
birth [death death yr mos day hr
120 Medicalcertification of cause of death (ekact copy) Duration Classification
I a _ _ _ _ _ _ _ _
Sb
121 SUMMARY OF INVESTIGATION
Medical interviewer
Basis for diagnosis Classifishycationcation
Underlying cause
1Associated causes
3
-Evaluation of nuitrition
Principal collaborator
122 ASSIGNMENT BY REFEREE Basis Special code Underling cause Iorntrishy
_________ated__auses___tional status
Clinical questionableBasis fordiagnosis 1 Autopsy 4 Hospital 5 Interview only
6 Death certificate only3 Clinical definite
--
___________
B
copyIU1Cl-AInRICAN INVES1I6AIZONCARODabitAMi Of 1ICOALITY I CRILiSUOSSerialla
Fi thas colm pY Cost Snail ro DATIS LO TOall cardi
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C
Selected Materialfrom Provisional Report for First Year
I QUALITY OF VITAL STATISTICS
a) Deficiency in registration and in hospital records and procedures
Figure 2
DEATHS UNDER 5 YEARS WITHOUT REGISTRATION IN 9 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 5 10 15 20 25
CARTAGENA
LA PAZ AREA
SAN JUAN PROVINCE
KINGSTON AREA
CilACO PROVINCE
MEDELLIN
NONTERREY
SAN SALVADOR AREA
RECIFE
Figure 3
NEONATAL DEATHS WITHOUT REGISTRATION FOR TWO AGE GROUPS IN 9 PROJECTS
FIRST YEAR OF INVESTIGATION
Per cenL Per cent
0 10 20 30 40 50 60 70 0 10 20 30 40 50
Under I day 1-27 days
CARTAGENA
LA PAZ AREA Jmimmiil mf
SAN JUAN PROVINCE
CIIACO PROVINCE t
HONTERREY
MEDEI LN IsN KINGSTON AREA 1
SAN SALVADOR AREA
R)CCEil
b) Incomplete and puzzling data by birth weight
Figure 21
PERCENTAGE DISTRIBUTION OF NEONATAL DEATHS BY BIRTH WEICHT IN 13 PROJECTS FIRST YEAR OF INVESTIGATION AND UNITED STATES 1950
KINGSTON MEDELLIN CARTAGENA SAN SALVADOR CHACO30 AREA AREA PROVINCE
20
RIBEIREO PRETO RECIFE SO PAULO CALU ITA ATEPD10
u 20
oti
NRE0 Y SAN JUAN SANTIAGO MNERY PROVINCE AREA UNITED STATES
10-
Birth weight in grams
Excluding those with weight not stated
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
PAN AMERICAN HEALTH ORGANIZATION
Pan Americait Sanitaty Bureau Revional poundffice6of t
WORLD HEALTH ORGANIZATION
525 TWENTY-THIRD STREET NW WASHINGTON DC 20037 USA CABLE ADDRESS OFSANPAN
IN REPLY REFER TO TELEPHONE 223-4700
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Illustrative Material
A Questionnaire for Deaths
B Code Sheet
C Selected Material from Provisional Report for First Year
A
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Confidential Death - page 1
2 Serial no1 Name of child
3 Date of 14 Date of I5 Sex 16 Age at
birth death death -yrs -mos -dayshrs
Sector or division7 Address
HOUSING
8 Neighbor- 9 Type of IloNumber of Il1Water Piped water Other laoltFlush Othcr None
hood -P housing rooms- Inside0Outide 0 01 130dege 0 0
13HOUSEHOLD ROSTER
Relation Date of Marital Education Length of residence
Age Sex Total Last In Last 5yearsId Name to In~no head birth statics years Type Year Trunity Urban Rural
3
4
5
6
7
9
10 II 12
Enter date of birth for children under 6 years
14 OCCUPATION
Ind Name CurrentlyOccupation Kind of business Time in no employed occupation
15 DEATHS IN HOUSEHOLD IN PAST YEAR
Name of deceased Age Sex Date Home Hosp Name of hospital Other
16 PREGNANCY HISTORY OF MOTHER O Date Live births
Ord prenancy Abortion Stillbirth
enaed Name of child Sex Living now Age at death
2
3 4
5
6shy
8
9
_ _ __ _ __o_ __ _ __ _ _ __ _ _ __ _ _1 _ _ _ _ _ _ _ _10 ________
17 Pregnant now Yes [3 No 03 Unknown 03 18 Remarks
19LSource of Ind tGa
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Confidential Death - pag 2
Name of child Serial no -Dateof Dateof Sex Age at birth death death mox ayryaye hrs
20 DATA ON PARENTS Id Name Live Date of birth Age Marital status Education Employed Occupatiln Business no here now c
Father Mother
21 Was the mother of this child seen by physician or in a clinic or hospital during pregnancy Yep(Q No [3 Unknown [ If yes name of physician clinic or hospital Dats _
Reason Months pregnant at first visit Number of visits
22 Length of pregnancy months Unknown [0)
23 Were there complications during pregnancy No [ Yes 0 If yes check below Unknown 01 Edema [Q Convulsions 0 Threatened abortion 0 Hemorrhage 0 Trauma 0 Operation 0 Specify
Infectious disease 0 Specify 24 Where born Home [I Hospital L Name and address Other 0 25 Who attended birth Doctor 0 Midwife (j Other 0 Certificate no 26 Was the delivery spontaneous Nc [0 Yes [ Unknown [ Were instruments used No ] Yes 0 Unknown 0
Was anesthe3ia given NoQ 1es 0 Was sedation given No 0 Yes 0 Cesarian No 0 Yes 0 27 Was the general aspect of child good at birth No 0 Yes 0
If not good what did you notice
28 Birth weight Unknown 0 29 Did you breast feed the child Yes 0 When did you start weaning Age months Reason
When did you finish weaning Age months
No[ Why not Unknown 0 30 Was other milk used No [] Yes 0 At what age months or days Times per day
Composition Milk Water Was use of milk continued
31 Was other weaning food used Was weaning food continued 32 Give age in months when JUICES _ rus CEREALS emos PULSES _mos ROOTS TUBERS MOs
foods were added Times per week_ Times per week Times per week Times per week LEAFY VEGETABLES EGGS MOs POULTRY mos MEAT MOs FISH Mos
Times per Times per week Times per week Times per week Times per week mojns week
33 At what age (in months) did child do the followiag a) raise head b) seat self ) stand alone
d) walk alone a) control bladder f) control bowels_ g) feed self 34 Who cared for child most of day Mother 0 Grandmother 0 Sibling (15 yrs + ) 0 Sibling(-15 yrs ) 0
Other relative 0l Maid 0 Day care [ Other ] 35 Has your child been vaccinated Yes 0 No [] Unknown [] If yes which vaccinations
36 At what age in months did child have following a) German measles b) measles c) chickenpox
d) whooing cough e) mumps
37 Remarks
38 Source of informationi Mother Father 0 Other 0_1 Date Interviewer
INTER-AMERICAN iINVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 3Confidential
Serial noName o child
Date of IDate of Sex Age-at death _yrs _mos __days hrs
deathbirth
has this child been attended by a ph sician or in a clinic or hospital Yes No 0 Unknown 1339 During the past year
NumberDays in viO0tsName of physician clinic or hospital Type Dates hospital Reason
emergency E Indicate whether clinic (health center or hospital) C in-patient in hospital H practicing physician P
Yes r3 No J Unknown [40 Did the child receive medical attention before the past year
NumberReasonDays in visitsDates hospitalName of physician clinic or hospital Type
Indicate whether clinic (health center or hospital) C in-patient in hospital H practicing physician P emergency E
b) How did illness start41 Disease a) How long was the child ill
c) What disease do you think caused the childs death
42 Description of the disease by the mother
43 Home treatment
44 Prescriptions
45 Who prescribed
46 Did the mother see signs of malnutrition (edema loss of weight changes in hair or skin)
b) How many days after onset of illnessa) Was child taken to doctor No 0 Yes 0b c) What was condition of child Slightly ill [01 Moderately ill [ Very ill
47 To doctor
48 Where did child die Home 03 Hospital 0] Name Other 0
49 Death certificate number
50 Source of information Mother 0 Father 0 Other 03 InterviewerDate
INTER-AMEAdCAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Confidential Death - page 4
Serial noName of child
Date of 6 ate of Sei~g t birth 1 death death yrs -MoS days hr
DATA OBTAINED FROM HOSPITAL CLINIC OR PHYSICIAN
51 Abnormal None Edema Hyper- Albumi- Convul- Hyper- Anemia Threatened Placenta Other specify sions emeuis abortion previaconditions of tension nuria
pregnancy 0 03 0 0- 0] 0] 0 0 0
5 Conditions None German T b c Syphi- Operation reason findings Trauma specify Other specify
unrelated to measles puli lis
pregnancy n 0 03 0
Spontane-Q Forceps Sedation Length of 5553 Dlivery ous Manipu- Cesarian Azesthe- Other specify 54 Single orlation 0 03 0 sia 0 Q gestation multiple birth
DATA ON CHILD (age in completed months in first line)
56 Age At birth
57 Weight 58 Nutritional status
59 DATA ON NEWBORN FROM RECORD
General state Good 0 Fair 0 Poor 0 Genitals Normal [ Abnormal 0 Activity Normal 0 Abnormal 03 Extremities Normal n Abnormal 0
First cry_ min First breathing_ min Skin color
Movements Normal 0 Abnormal 0 Cyanosis General 0 Extremities [
Muscular tone Increased 0 Normal 0 Decreased 0 Jaundice Yes D3 No [ Time
Head - Size Increased 0 Normal 0 Decreased 0 Hemorrhagic signs Yes [ No C]
Shape Normal [ Abnormal 0) Infection signs
Cephalohematoma 0 Lacerations 0 Lacerations Yes 0 No 1
Eyes nose ears mouth Edema
Neck - Rigidity- Yes 0 No 0 Masses [ Breathing Normal 0 Irregular 0 Chest Secretion
First Voiding __hrs First bowel movement hrs Abdominal Masses 0 Hernia [
hrs Congenital anomalies
Acceptance 0 Rejection [ First feeding b- Type
Progrees
60 PRINCIPAL FINDINGS IN HOSPITAL AND CLINICS PRIOR TO ILLNESS LEADING TO DEATH
61 Sorce of o Private r information Hospital 03 Clinic 0 M D 0] Other 03I ae______ Interviewer
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 5Cosifidentlxl
Serial noName of child
Date of IDate of Sex Age at death yra ___oa days hrsdeuth
PRESENT ILLNESS - EVENTS THAT LED TO DEATH OF THE CHILD
birth
63 How disease started62 Date disease started
64 Main symptoms
65 Description of disease
PHYSICAL EXAMINATION (at aemission to hospital or first outpatient or house visit)
66 Date 67 Height 68 Weight and arm circumference Wt Arm circumference
69 Nutritional status
70 Relevant physical findings
71 Evolution and treatment
72 Source of i Private I information Hospital 3 Clinic 3 MDK t 0 Other [0 Date Interviewer
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD Confidential Death - page 6
Name of child Serial no Date of IDate of Sex Age at birth I death death yrs mon days hrs
DATA OBTAINED FROM HOSPITAL OUTPATIENT SERVICE OR PHYSICIAN 73 Relevant laboratory findings
74 X-rays Site Date Results
75 Other auxiliary examinations
76 Surgical procedures and findings
77 Cytology 78 Biopsy 79 CLINICAL DIAGNOSES
80 Autopsy No [ Yes 0 Date
81 Date ho- 82 Date dis- 83 Where Home I OutpatientD e IHospitalthan 48 hoursless IHospital 48 Otherservice hours or m O pitalized I charged died 0 0 0 0 o 0
84 Source of Hospital I Clinic 1Private Other Date Interviewer information 10 Cn IZ D t [] 111
DATA OBTAINED BY HOME VISIT OF MEDICAL INTERVIEWER 85 Date disease started 86 How disease started
87 Main symptoms 88 Description of disease
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 7Confidential
Serial noName of child
Date of IDate of Sex Age at
birIth - ideathdah- death yr _ MOS days hrs
__ DATA OBTAINED BY MEDICAL INTERVIEWER IN HOME
a) How long was the child ill b) How did illness startf
89 Disease
c) What do you think caused death d) Did someone else have same disease
a) Did the child have fever No [ Little 0 Moderate [ Very high 03 b) How long it9 ever c) Did you take the temperature No 0l Yes 0 d) What was
0 Normal 0 Rapid 01 Difficult 0a) How was the respiration Slow 91 Respiration b) Did the sides of nose move in breathing Yes 0 No 0 c) Noise
a) Did the child cough No 0 Little 0 Moderate 0 Heavy 0 No 03 Little 0 Moderate 0 Heavy shy
9Z Cough b) Expectoration c) Color of expectoration White 0 Yellow 0 Green 0 lth
a) Did the child vomit No [I Little 0 Moderate 0 Severe [
Solid [] Liquid [ Everything []93 Vomiting b) What did he vomit
c) How long did he vomit days d) Did he lose appetite
0 Loose 0 Liquid 0)a) How were the feces Very hard 0 Hard [3 Normal
94 Feces b) Color of the feces Yellow [ Brown [] Green 0 Red [ Black 0
c) How many times per day d) How many days__ e) Were worms seen
a) Difficulty in urination No 0 Yes 0-b) Retention of urineNo [] Yes 0
95 Urine c) Did urine diminish No 0 Yes Od) Eliminated calculiNo 0 Yes [
e) Color of urine Dark 0 Red 03 Dirty 0] a) Did the child lose weight No 0] A little 0 Moderate 0 Severe 0
No [ Yes []d) Face No[QYes[O96 Weight b) Did the arms get thinner No [ Yes []c) Legs
e) Could ribs be seen under skin No [ Yes ]
a) Did the child have swollen legs No 0 Yes [Ob) Swollen abdomen No 0 Yes [] c) Face No [] Yes []
a) Did you see anything on skin No 0 Yes [
98 Skin b) Appearance Yellow 0 Rash [ Pustule [ Cyanotic 03 Pale 0] Blemishes [ Depigmentation 03 Dryness (3
a) Did the child have much hair No 0 Yes 0 b) Pull out easily No 0) Yes 03 99 Hair 0c) Change of color No 0 Yes [ d) Glossy No 03 Yes
a) Did the child move actively No 0 Yes [b)All parts of body No 1 Yes 03 10Neuromuscular
100 activity c) Delay in movement No [ Yes [ d) Since when
___ _ e) Convulsions No 0 Yes 0 No [ Yes Ob) How longa) Did the child have pain No n Yei [d) Associated with whatc) Continuous
a) Did the child have a fall No [0 Yes Qb) Injury
102 Accident c) Other accident No 03 Yes [d) Explain
103 Other What other symptoms
Provide data regarding these items before final illness
104 Observation
a) Did you take child to doctor No [ Yes 0 b) How soon after onset of illness 105 To doctor
c) What was condition of child Slightly ill 03 Moderately ill 0 Very ill 0
106 Source of Mother 0 Father b Other Date Interviewer
information
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 8Confidential
Name of child Serial no
Date of Sex lAge at
birth death death _yrs mo_ day hr
AUTOPSY REPORT
Date of
107 Autopsy number 108 Interval from death to initiation of autopsy
109 Weight 110 Arm circumference
Ill Other anthropometric measurements
112 Description of cadaver (note all positive findings especially on nutrition)
113 Macroscopic examination of cavities and segments (positive findings of head thorax abdomen pelvis neck limbs)
114 Macroscopic examination of organs (positive findings of appearance surfaceweight color consistency etc)
115 Microscopic examination of organs and tissues (positive findings of organs macroscopically abnormal and of those
requested)
116 Positive laboratory findings from autopsy_
117 Final diagnoses from autopsy Direct cause of death
Principal diagnosis (underlying cause)
Secondary diagnoses (associated causes)
cause118 Associated diagnoses not related with underlying
119 Type of Hospital Verification of death Medico-legal Complete Partial Incomplete
0 n biautopsy
Date____________ Interviewer_________
OF MORTALITY IN CHILDHOODINTER-AMERICAN INVESTIGATION
Confidential Death - page 9
Name of child_ Serial no
DDate of Sex [Age at
birth [death death yr mos day hr
120 Medicalcertification of cause of death (ekact copy) Duration Classification
I a _ _ _ _ _ _ _ _
Sb
121 SUMMARY OF INVESTIGATION
Medical interviewer
Basis for diagnosis Classifishycationcation
Underlying cause
1Associated causes
3
-Evaluation of nuitrition
Principal collaborator
122 ASSIGNMENT BY REFEREE Basis Special code Underling cause Iorntrishy
_________ated__auses___tional status
Clinical questionableBasis fordiagnosis 1 Autopsy 4 Hospital 5 Interview only
6 Death certificate only3 Clinical definite
--
___________
B
copyIU1Cl-AInRICAN INVES1I6AIZONCARODabitAMi Of 1ICOALITY I CRILiSUOSSerialla
Fi thas colm pY Cost Snail ro DATIS LO TOall cardi
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C
Selected Materialfrom Provisional Report for First Year
I QUALITY OF VITAL STATISTICS
a) Deficiency in registration and in hospital records and procedures
Figure 2
DEATHS UNDER 5 YEARS WITHOUT REGISTRATION IN 9 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 5 10 15 20 25
CARTAGENA
LA PAZ AREA
SAN JUAN PROVINCE
KINGSTON AREA
CilACO PROVINCE
MEDELLIN
NONTERREY
SAN SALVADOR AREA
RECIFE
Figure 3
NEONATAL DEATHS WITHOUT REGISTRATION FOR TWO AGE GROUPS IN 9 PROJECTS
FIRST YEAR OF INVESTIGATION
Per cenL Per cent
0 10 20 30 40 50 60 70 0 10 20 30 40 50
Under I day 1-27 days
CARTAGENA
LA PAZ AREA Jmimmiil mf
SAN JUAN PROVINCE
CIIACO PROVINCE t
HONTERREY
MEDEI LN IsN KINGSTON AREA 1
SAN SALVADOR AREA
R)CCEil
b) Incomplete and puzzling data by birth weight
Figure 21
PERCENTAGE DISTRIBUTION OF NEONATAL DEATHS BY BIRTH WEICHT IN 13 PROJECTS FIRST YEAR OF INVESTIGATION AND UNITED STATES 1950
KINGSTON MEDELLIN CARTAGENA SAN SALVADOR CHACO30 AREA AREA PROVINCE
20
RIBEIREO PRETO RECIFE SO PAULO CALU ITA ATEPD10
u 20
oti
NRE0 Y SAN JUAN SANTIAGO MNERY PROVINCE AREA UNITED STATES
10-
Birth weight in grams
Excluding those with weight not stated
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
A
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Confidential Death - page 1
2 Serial no1 Name of child
3 Date of 14 Date of I5 Sex 16 Age at
birth death death -yrs -mos -dayshrs
Sector or division7 Address
HOUSING
8 Neighbor- 9 Type of IloNumber of Il1Water Piped water Other laoltFlush Othcr None
hood -P housing rooms- Inside0Outide 0 01 130dege 0 0
13HOUSEHOLD ROSTER
Relation Date of Marital Education Length of residence
Age Sex Total Last In Last 5yearsId Name to In~no head birth statics years Type Year Trunity Urban Rural
3
4
5
6
7
9
10 II 12
Enter date of birth for children under 6 years
14 OCCUPATION
Ind Name CurrentlyOccupation Kind of business Time in no employed occupation
15 DEATHS IN HOUSEHOLD IN PAST YEAR
Name of deceased Age Sex Date Home Hosp Name of hospital Other
16 PREGNANCY HISTORY OF MOTHER O Date Live births
Ord prenancy Abortion Stillbirth
enaed Name of child Sex Living now Age at death
2
3 4
5
6shy
8
9
_ _ __ _ __o_ __ _ __ _ _ __ _ _ __ _ _1 _ _ _ _ _ _ _ _10 ________
17 Pregnant now Yes [3 No 03 Unknown 03 18 Remarks
19LSource of Ind tGa
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Confidential Death - pag 2
Name of child Serial no -Dateof Dateof Sex Age at birth death death mox ayryaye hrs
20 DATA ON PARENTS Id Name Live Date of birth Age Marital status Education Employed Occupatiln Business no here now c
Father Mother
21 Was the mother of this child seen by physician or in a clinic or hospital during pregnancy Yep(Q No [3 Unknown [ If yes name of physician clinic or hospital Dats _
Reason Months pregnant at first visit Number of visits
22 Length of pregnancy months Unknown [0)
23 Were there complications during pregnancy No [ Yes 0 If yes check below Unknown 01 Edema [Q Convulsions 0 Threatened abortion 0 Hemorrhage 0 Trauma 0 Operation 0 Specify
Infectious disease 0 Specify 24 Where born Home [I Hospital L Name and address Other 0 25 Who attended birth Doctor 0 Midwife (j Other 0 Certificate no 26 Was the delivery spontaneous Nc [0 Yes [ Unknown [ Were instruments used No ] Yes 0 Unknown 0
Was anesthe3ia given NoQ 1es 0 Was sedation given No 0 Yes 0 Cesarian No 0 Yes 0 27 Was the general aspect of child good at birth No 0 Yes 0
If not good what did you notice
28 Birth weight Unknown 0 29 Did you breast feed the child Yes 0 When did you start weaning Age months Reason
When did you finish weaning Age months
No[ Why not Unknown 0 30 Was other milk used No [] Yes 0 At what age months or days Times per day
Composition Milk Water Was use of milk continued
31 Was other weaning food used Was weaning food continued 32 Give age in months when JUICES _ rus CEREALS emos PULSES _mos ROOTS TUBERS MOs
foods were added Times per week_ Times per week Times per week Times per week LEAFY VEGETABLES EGGS MOs POULTRY mos MEAT MOs FISH Mos
Times per Times per week Times per week Times per week Times per week mojns week
33 At what age (in months) did child do the followiag a) raise head b) seat self ) stand alone
d) walk alone a) control bladder f) control bowels_ g) feed self 34 Who cared for child most of day Mother 0 Grandmother 0 Sibling (15 yrs + ) 0 Sibling(-15 yrs ) 0
Other relative 0l Maid 0 Day care [ Other ] 35 Has your child been vaccinated Yes 0 No [] Unknown [] If yes which vaccinations
36 At what age in months did child have following a) German measles b) measles c) chickenpox
d) whooing cough e) mumps
37 Remarks
38 Source of informationi Mother Father 0 Other 0_1 Date Interviewer
INTER-AMERICAN iINVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 3Confidential
Serial noName o child
Date of IDate of Sex Age-at death _yrs _mos __days hrs
deathbirth
has this child been attended by a ph sician or in a clinic or hospital Yes No 0 Unknown 1339 During the past year
NumberDays in viO0tsName of physician clinic or hospital Type Dates hospital Reason
emergency E Indicate whether clinic (health center or hospital) C in-patient in hospital H practicing physician P
Yes r3 No J Unknown [40 Did the child receive medical attention before the past year
NumberReasonDays in visitsDates hospitalName of physician clinic or hospital Type
Indicate whether clinic (health center or hospital) C in-patient in hospital H practicing physician P emergency E
b) How did illness start41 Disease a) How long was the child ill
c) What disease do you think caused the childs death
42 Description of the disease by the mother
43 Home treatment
44 Prescriptions
45 Who prescribed
46 Did the mother see signs of malnutrition (edema loss of weight changes in hair or skin)
b) How many days after onset of illnessa) Was child taken to doctor No 0 Yes 0b c) What was condition of child Slightly ill [01 Moderately ill [ Very ill
47 To doctor
48 Where did child die Home 03 Hospital 0] Name Other 0
49 Death certificate number
50 Source of information Mother 0 Father 0 Other 03 InterviewerDate
INTER-AMEAdCAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Confidential Death - page 4
Serial noName of child
Date of 6 ate of Sei~g t birth 1 death death yrs -MoS days hr
DATA OBTAINED FROM HOSPITAL CLINIC OR PHYSICIAN
51 Abnormal None Edema Hyper- Albumi- Convul- Hyper- Anemia Threatened Placenta Other specify sions emeuis abortion previaconditions of tension nuria
pregnancy 0 03 0 0- 0] 0] 0 0 0
5 Conditions None German T b c Syphi- Operation reason findings Trauma specify Other specify
unrelated to measles puli lis
pregnancy n 0 03 0
Spontane-Q Forceps Sedation Length of 5553 Dlivery ous Manipu- Cesarian Azesthe- Other specify 54 Single orlation 0 03 0 sia 0 Q gestation multiple birth
DATA ON CHILD (age in completed months in first line)
56 Age At birth
57 Weight 58 Nutritional status
59 DATA ON NEWBORN FROM RECORD
General state Good 0 Fair 0 Poor 0 Genitals Normal [ Abnormal 0 Activity Normal 0 Abnormal 03 Extremities Normal n Abnormal 0
First cry_ min First breathing_ min Skin color
Movements Normal 0 Abnormal 0 Cyanosis General 0 Extremities [
Muscular tone Increased 0 Normal 0 Decreased 0 Jaundice Yes D3 No [ Time
Head - Size Increased 0 Normal 0 Decreased 0 Hemorrhagic signs Yes [ No C]
Shape Normal [ Abnormal 0) Infection signs
Cephalohematoma 0 Lacerations 0 Lacerations Yes 0 No 1
Eyes nose ears mouth Edema
Neck - Rigidity- Yes 0 No 0 Masses [ Breathing Normal 0 Irregular 0 Chest Secretion
First Voiding __hrs First bowel movement hrs Abdominal Masses 0 Hernia [
hrs Congenital anomalies
Acceptance 0 Rejection [ First feeding b- Type
Progrees
60 PRINCIPAL FINDINGS IN HOSPITAL AND CLINICS PRIOR TO ILLNESS LEADING TO DEATH
61 Sorce of o Private r information Hospital 03 Clinic 0 M D 0] Other 03I ae______ Interviewer
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 5Cosifidentlxl
Serial noName of child
Date of IDate of Sex Age at death yra ___oa days hrsdeuth
PRESENT ILLNESS - EVENTS THAT LED TO DEATH OF THE CHILD
birth
63 How disease started62 Date disease started
64 Main symptoms
65 Description of disease
PHYSICAL EXAMINATION (at aemission to hospital or first outpatient or house visit)
66 Date 67 Height 68 Weight and arm circumference Wt Arm circumference
69 Nutritional status
70 Relevant physical findings
71 Evolution and treatment
72 Source of i Private I information Hospital 3 Clinic 3 MDK t 0 Other [0 Date Interviewer
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD Confidential Death - page 6
Name of child Serial no Date of IDate of Sex Age at birth I death death yrs mon days hrs
DATA OBTAINED FROM HOSPITAL OUTPATIENT SERVICE OR PHYSICIAN 73 Relevant laboratory findings
74 X-rays Site Date Results
75 Other auxiliary examinations
76 Surgical procedures and findings
77 Cytology 78 Biopsy 79 CLINICAL DIAGNOSES
80 Autopsy No [ Yes 0 Date
81 Date ho- 82 Date dis- 83 Where Home I OutpatientD e IHospitalthan 48 hoursless IHospital 48 Otherservice hours or m O pitalized I charged died 0 0 0 0 o 0
84 Source of Hospital I Clinic 1Private Other Date Interviewer information 10 Cn IZ D t [] 111
DATA OBTAINED BY HOME VISIT OF MEDICAL INTERVIEWER 85 Date disease started 86 How disease started
87 Main symptoms 88 Description of disease
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 7Confidential
Serial noName of child
Date of IDate of Sex Age at
birIth - ideathdah- death yr _ MOS days hrs
__ DATA OBTAINED BY MEDICAL INTERVIEWER IN HOME
a) How long was the child ill b) How did illness startf
89 Disease
c) What do you think caused death d) Did someone else have same disease
a) Did the child have fever No [ Little 0 Moderate [ Very high 03 b) How long it9 ever c) Did you take the temperature No 0l Yes 0 d) What was
0 Normal 0 Rapid 01 Difficult 0a) How was the respiration Slow 91 Respiration b) Did the sides of nose move in breathing Yes 0 No 0 c) Noise
a) Did the child cough No 0 Little 0 Moderate 0 Heavy 0 No 03 Little 0 Moderate 0 Heavy shy
9Z Cough b) Expectoration c) Color of expectoration White 0 Yellow 0 Green 0 lth
a) Did the child vomit No [I Little 0 Moderate 0 Severe [
Solid [] Liquid [ Everything []93 Vomiting b) What did he vomit
c) How long did he vomit days d) Did he lose appetite
0 Loose 0 Liquid 0)a) How were the feces Very hard 0 Hard [3 Normal
94 Feces b) Color of the feces Yellow [ Brown [] Green 0 Red [ Black 0
c) How many times per day d) How many days__ e) Were worms seen
a) Difficulty in urination No 0 Yes 0-b) Retention of urineNo [] Yes 0
95 Urine c) Did urine diminish No 0 Yes Od) Eliminated calculiNo 0 Yes [
e) Color of urine Dark 0 Red 03 Dirty 0] a) Did the child lose weight No 0] A little 0 Moderate 0 Severe 0
No [ Yes []d) Face No[QYes[O96 Weight b) Did the arms get thinner No [ Yes []c) Legs
e) Could ribs be seen under skin No [ Yes ]
a) Did the child have swollen legs No 0 Yes [Ob) Swollen abdomen No 0 Yes [] c) Face No [] Yes []
a) Did you see anything on skin No 0 Yes [
98 Skin b) Appearance Yellow 0 Rash [ Pustule [ Cyanotic 03 Pale 0] Blemishes [ Depigmentation 03 Dryness (3
a) Did the child have much hair No 0 Yes 0 b) Pull out easily No 0) Yes 03 99 Hair 0c) Change of color No 0 Yes [ d) Glossy No 03 Yes
a) Did the child move actively No 0 Yes [b)All parts of body No 1 Yes 03 10Neuromuscular
100 activity c) Delay in movement No [ Yes [ d) Since when
___ _ e) Convulsions No 0 Yes 0 No [ Yes Ob) How longa) Did the child have pain No n Yei [d) Associated with whatc) Continuous
a) Did the child have a fall No [0 Yes Qb) Injury
102 Accident c) Other accident No 03 Yes [d) Explain
103 Other What other symptoms
Provide data regarding these items before final illness
104 Observation
a) Did you take child to doctor No [ Yes 0 b) How soon after onset of illness 105 To doctor
c) What was condition of child Slightly ill 03 Moderately ill 0 Very ill 0
106 Source of Mother 0 Father b Other Date Interviewer
information
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 8Confidential
Name of child Serial no
Date of Sex lAge at
birth death death _yrs mo_ day hr
AUTOPSY REPORT
Date of
107 Autopsy number 108 Interval from death to initiation of autopsy
109 Weight 110 Arm circumference
Ill Other anthropometric measurements
112 Description of cadaver (note all positive findings especially on nutrition)
113 Macroscopic examination of cavities and segments (positive findings of head thorax abdomen pelvis neck limbs)
114 Macroscopic examination of organs (positive findings of appearance surfaceweight color consistency etc)
115 Microscopic examination of organs and tissues (positive findings of organs macroscopically abnormal and of those
requested)
116 Positive laboratory findings from autopsy_
117 Final diagnoses from autopsy Direct cause of death
Principal diagnosis (underlying cause)
Secondary diagnoses (associated causes)
cause118 Associated diagnoses not related with underlying
119 Type of Hospital Verification of death Medico-legal Complete Partial Incomplete
0 n biautopsy
Date____________ Interviewer_________
OF MORTALITY IN CHILDHOODINTER-AMERICAN INVESTIGATION
Confidential Death - page 9
Name of child_ Serial no
DDate of Sex [Age at
birth [death death yr mos day hr
120 Medicalcertification of cause of death (ekact copy) Duration Classification
I a _ _ _ _ _ _ _ _
Sb
121 SUMMARY OF INVESTIGATION
Medical interviewer
Basis for diagnosis Classifishycationcation
Underlying cause
1Associated causes
3
-Evaluation of nuitrition
Principal collaborator
122 ASSIGNMENT BY REFEREE Basis Special code Underling cause Iorntrishy
_________ated__auses___tional status
Clinical questionableBasis fordiagnosis 1 Autopsy 4 Hospital 5 Interview only
6 Death certificate only3 Clinical definite
--
___________
B
copyIU1Cl-AInRICAN INVES1I6AIZONCARODabitAMi Of 1ICOALITY I CRILiSUOSSerialla
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Selected Materialfrom Provisional Report for First Year
I QUALITY OF VITAL STATISTICS
a) Deficiency in registration and in hospital records and procedures
Figure 2
DEATHS UNDER 5 YEARS WITHOUT REGISTRATION IN 9 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 5 10 15 20 25
CARTAGENA
LA PAZ AREA
SAN JUAN PROVINCE
KINGSTON AREA
CilACO PROVINCE
MEDELLIN
NONTERREY
SAN SALVADOR AREA
RECIFE
Figure 3
NEONATAL DEATHS WITHOUT REGISTRATION FOR TWO AGE GROUPS IN 9 PROJECTS
FIRST YEAR OF INVESTIGATION
Per cenL Per cent
0 10 20 30 40 50 60 70 0 10 20 30 40 50
Under I day 1-27 days
CARTAGENA
LA PAZ AREA Jmimmiil mf
SAN JUAN PROVINCE
CIIACO PROVINCE t
HONTERREY
MEDEI LN IsN KINGSTON AREA 1
SAN SALVADOR AREA
R)CCEil
b) Incomplete and puzzling data by birth weight
Figure 21
PERCENTAGE DISTRIBUTION OF NEONATAL DEATHS BY BIRTH WEICHT IN 13 PROJECTS FIRST YEAR OF INVESTIGATION AND UNITED STATES 1950
KINGSTON MEDELLIN CARTAGENA SAN SALVADOR CHACO30 AREA AREA PROVINCE
20
RIBEIREO PRETO RECIFE SO PAULO CALU ITA ATEPD10
u 20
oti
NRE0 Y SAN JUAN SANTIAGO MNERY PROVINCE AREA UNITED STATES
10-
Birth weight in grams
Excluding those with weight not stated
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Confidential Death - pag 2
Name of child Serial no -Dateof Dateof Sex Age at birth death death mox ayryaye hrs
20 DATA ON PARENTS Id Name Live Date of birth Age Marital status Education Employed Occupatiln Business no here now c
Father Mother
21 Was the mother of this child seen by physician or in a clinic or hospital during pregnancy Yep(Q No [3 Unknown [ If yes name of physician clinic or hospital Dats _
Reason Months pregnant at first visit Number of visits
22 Length of pregnancy months Unknown [0)
23 Were there complications during pregnancy No [ Yes 0 If yes check below Unknown 01 Edema [Q Convulsions 0 Threatened abortion 0 Hemorrhage 0 Trauma 0 Operation 0 Specify
Infectious disease 0 Specify 24 Where born Home [I Hospital L Name and address Other 0 25 Who attended birth Doctor 0 Midwife (j Other 0 Certificate no 26 Was the delivery spontaneous Nc [0 Yes [ Unknown [ Were instruments used No ] Yes 0 Unknown 0
Was anesthe3ia given NoQ 1es 0 Was sedation given No 0 Yes 0 Cesarian No 0 Yes 0 27 Was the general aspect of child good at birth No 0 Yes 0
If not good what did you notice
28 Birth weight Unknown 0 29 Did you breast feed the child Yes 0 When did you start weaning Age months Reason
When did you finish weaning Age months
No[ Why not Unknown 0 30 Was other milk used No [] Yes 0 At what age months or days Times per day
Composition Milk Water Was use of milk continued
31 Was other weaning food used Was weaning food continued 32 Give age in months when JUICES _ rus CEREALS emos PULSES _mos ROOTS TUBERS MOs
foods were added Times per week_ Times per week Times per week Times per week LEAFY VEGETABLES EGGS MOs POULTRY mos MEAT MOs FISH Mos
Times per Times per week Times per week Times per week Times per week mojns week
33 At what age (in months) did child do the followiag a) raise head b) seat self ) stand alone
d) walk alone a) control bladder f) control bowels_ g) feed self 34 Who cared for child most of day Mother 0 Grandmother 0 Sibling (15 yrs + ) 0 Sibling(-15 yrs ) 0
Other relative 0l Maid 0 Day care [ Other ] 35 Has your child been vaccinated Yes 0 No [] Unknown [] If yes which vaccinations
36 At what age in months did child have following a) German measles b) measles c) chickenpox
d) whooing cough e) mumps
37 Remarks
38 Source of informationi Mother Father 0 Other 0_1 Date Interviewer
INTER-AMERICAN iINVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 3Confidential
Serial noName o child
Date of IDate of Sex Age-at death _yrs _mos __days hrs
deathbirth
has this child been attended by a ph sician or in a clinic or hospital Yes No 0 Unknown 1339 During the past year
NumberDays in viO0tsName of physician clinic or hospital Type Dates hospital Reason
emergency E Indicate whether clinic (health center or hospital) C in-patient in hospital H practicing physician P
Yes r3 No J Unknown [40 Did the child receive medical attention before the past year
NumberReasonDays in visitsDates hospitalName of physician clinic or hospital Type
Indicate whether clinic (health center or hospital) C in-patient in hospital H practicing physician P emergency E
b) How did illness start41 Disease a) How long was the child ill
c) What disease do you think caused the childs death
42 Description of the disease by the mother
43 Home treatment
44 Prescriptions
45 Who prescribed
46 Did the mother see signs of malnutrition (edema loss of weight changes in hair or skin)
b) How many days after onset of illnessa) Was child taken to doctor No 0 Yes 0b c) What was condition of child Slightly ill [01 Moderately ill [ Very ill
47 To doctor
48 Where did child die Home 03 Hospital 0] Name Other 0
49 Death certificate number
50 Source of information Mother 0 Father 0 Other 03 InterviewerDate
INTER-AMEAdCAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Confidential Death - page 4
Serial noName of child
Date of 6 ate of Sei~g t birth 1 death death yrs -MoS days hr
DATA OBTAINED FROM HOSPITAL CLINIC OR PHYSICIAN
51 Abnormal None Edema Hyper- Albumi- Convul- Hyper- Anemia Threatened Placenta Other specify sions emeuis abortion previaconditions of tension nuria
pregnancy 0 03 0 0- 0] 0] 0 0 0
5 Conditions None German T b c Syphi- Operation reason findings Trauma specify Other specify
unrelated to measles puli lis
pregnancy n 0 03 0
Spontane-Q Forceps Sedation Length of 5553 Dlivery ous Manipu- Cesarian Azesthe- Other specify 54 Single orlation 0 03 0 sia 0 Q gestation multiple birth
DATA ON CHILD (age in completed months in first line)
56 Age At birth
57 Weight 58 Nutritional status
59 DATA ON NEWBORN FROM RECORD
General state Good 0 Fair 0 Poor 0 Genitals Normal [ Abnormal 0 Activity Normal 0 Abnormal 03 Extremities Normal n Abnormal 0
First cry_ min First breathing_ min Skin color
Movements Normal 0 Abnormal 0 Cyanosis General 0 Extremities [
Muscular tone Increased 0 Normal 0 Decreased 0 Jaundice Yes D3 No [ Time
Head - Size Increased 0 Normal 0 Decreased 0 Hemorrhagic signs Yes [ No C]
Shape Normal [ Abnormal 0) Infection signs
Cephalohematoma 0 Lacerations 0 Lacerations Yes 0 No 1
Eyes nose ears mouth Edema
Neck - Rigidity- Yes 0 No 0 Masses [ Breathing Normal 0 Irregular 0 Chest Secretion
First Voiding __hrs First bowel movement hrs Abdominal Masses 0 Hernia [
hrs Congenital anomalies
Acceptance 0 Rejection [ First feeding b- Type
Progrees
60 PRINCIPAL FINDINGS IN HOSPITAL AND CLINICS PRIOR TO ILLNESS LEADING TO DEATH
61 Sorce of o Private r information Hospital 03 Clinic 0 M D 0] Other 03I ae______ Interviewer
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 5Cosifidentlxl
Serial noName of child
Date of IDate of Sex Age at death yra ___oa days hrsdeuth
PRESENT ILLNESS - EVENTS THAT LED TO DEATH OF THE CHILD
birth
63 How disease started62 Date disease started
64 Main symptoms
65 Description of disease
PHYSICAL EXAMINATION (at aemission to hospital or first outpatient or house visit)
66 Date 67 Height 68 Weight and arm circumference Wt Arm circumference
69 Nutritional status
70 Relevant physical findings
71 Evolution and treatment
72 Source of i Private I information Hospital 3 Clinic 3 MDK t 0 Other [0 Date Interviewer
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD Confidential Death - page 6
Name of child Serial no Date of IDate of Sex Age at birth I death death yrs mon days hrs
DATA OBTAINED FROM HOSPITAL OUTPATIENT SERVICE OR PHYSICIAN 73 Relevant laboratory findings
74 X-rays Site Date Results
75 Other auxiliary examinations
76 Surgical procedures and findings
77 Cytology 78 Biopsy 79 CLINICAL DIAGNOSES
80 Autopsy No [ Yes 0 Date
81 Date ho- 82 Date dis- 83 Where Home I OutpatientD e IHospitalthan 48 hoursless IHospital 48 Otherservice hours or m O pitalized I charged died 0 0 0 0 o 0
84 Source of Hospital I Clinic 1Private Other Date Interviewer information 10 Cn IZ D t [] 111
DATA OBTAINED BY HOME VISIT OF MEDICAL INTERVIEWER 85 Date disease started 86 How disease started
87 Main symptoms 88 Description of disease
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 7Confidential
Serial noName of child
Date of IDate of Sex Age at
birIth - ideathdah- death yr _ MOS days hrs
__ DATA OBTAINED BY MEDICAL INTERVIEWER IN HOME
a) How long was the child ill b) How did illness startf
89 Disease
c) What do you think caused death d) Did someone else have same disease
a) Did the child have fever No [ Little 0 Moderate [ Very high 03 b) How long it9 ever c) Did you take the temperature No 0l Yes 0 d) What was
0 Normal 0 Rapid 01 Difficult 0a) How was the respiration Slow 91 Respiration b) Did the sides of nose move in breathing Yes 0 No 0 c) Noise
a) Did the child cough No 0 Little 0 Moderate 0 Heavy 0 No 03 Little 0 Moderate 0 Heavy shy
9Z Cough b) Expectoration c) Color of expectoration White 0 Yellow 0 Green 0 lth
a) Did the child vomit No [I Little 0 Moderate 0 Severe [
Solid [] Liquid [ Everything []93 Vomiting b) What did he vomit
c) How long did he vomit days d) Did he lose appetite
0 Loose 0 Liquid 0)a) How were the feces Very hard 0 Hard [3 Normal
94 Feces b) Color of the feces Yellow [ Brown [] Green 0 Red [ Black 0
c) How many times per day d) How many days__ e) Were worms seen
a) Difficulty in urination No 0 Yes 0-b) Retention of urineNo [] Yes 0
95 Urine c) Did urine diminish No 0 Yes Od) Eliminated calculiNo 0 Yes [
e) Color of urine Dark 0 Red 03 Dirty 0] a) Did the child lose weight No 0] A little 0 Moderate 0 Severe 0
No [ Yes []d) Face No[QYes[O96 Weight b) Did the arms get thinner No [ Yes []c) Legs
e) Could ribs be seen under skin No [ Yes ]
a) Did the child have swollen legs No 0 Yes [Ob) Swollen abdomen No 0 Yes [] c) Face No [] Yes []
a) Did you see anything on skin No 0 Yes [
98 Skin b) Appearance Yellow 0 Rash [ Pustule [ Cyanotic 03 Pale 0] Blemishes [ Depigmentation 03 Dryness (3
a) Did the child have much hair No 0 Yes 0 b) Pull out easily No 0) Yes 03 99 Hair 0c) Change of color No 0 Yes [ d) Glossy No 03 Yes
a) Did the child move actively No 0 Yes [b)All parts of body No 1 Yes 03 10Neuromuscular
100 activity c) Delay in movement No [ Yes [ d) Since when
___ _ e) Convulsions No 0 Yes 0 No [ Yes Ob) How longa) Did the child have pain No n Yei [d) Associated with whatc) Continuous
a) Did the child have a fall No [0 Yes Qb) Injury
102 Accident c) Other accident No 03 Yes [d) Explain
103 Other What other symptoms
Provide data regarding these items before final illness
104 Observation
a) Did you take child to doctor No [ Yes 0 b) How soon after onset of illness 105 To doctor
c) What was condition of child Slightly ill 03 Moderately ill 0 Very ill 0
106 Source of Mother 0 Father b Other Date Interviewer
information
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 8Confidential
Name of child Serial no
Date of Sex lAge at
birth death death _yrs mo_ day hr
AUTOPSY REPORT
Date of
107 Autopsy number 108 Interval from death to initiation of autopsy
109 Weight 110 Arm circumference
Ill Other anthropometric measurements
112 Description of cadaver (note all positive findings especially on nutrition)
113 Macroscopic examination of cavities and segments (positive findings of head thorax abdomen pelvis neck limbs)
114 Macroscopic examination of organs (positive findings of appearance surfaceweight color consistency etc)
115 Microscopic examination of organs and tissues (positive findings of organs macroscopically abnormal and of those
requested)
116 Positive laboratory findings from autopsy_
117 Final diagnoses from autopsy Direct cause of death
Principal diagnosis (underlying cause)
Secondary diagnoses (associated causes)
cause118 Associated diagnoses not related with underlying
119 Type of Hospital Verification of death Medico-legal Complete Partial Incomplete
0 n biautopsy
Date____________ Interviewer_________
OF MORTALITY IN CHILDHOODINTER-AMERICAN INVESTIGATION
Confidential Death - page 9
Name of child_ Serial no
DDate of Sex [Age at
birth [death death yr mos day hr
120 Medicalcertification of cause of death (ekact copy) Duration Classification
I a _ _ _ _ _ _ _ _
Sb
121 SUMMARY OF INVESTIGATION
Medical interviewer
Basis for diagnosis Classifishycationcation
Underlying cause
1Associated causes
3
-Evaluation of nuitrition
Principal collaborator
122 ASSIGNMENT BY REFEREE Basis Special code Underling cause Iorntrishy
_________ated__auses___tional status
Clinical questionableBasis fordiagnosis 1 Autopsy 4 Hospital 5 Interview only
6 Death certificate only3 Clinical definite
--
___________
B
copyIU1Cl-AInRICAN INVES1I6AIZONCARODabitAMi Of 1ICOALITY I CRILiSUOSSerialla
Fi thas colm pY Cost Snail ro DATIS LO TOall cardi
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Selected Materialfrom Provisional Report for First Year
I QUALITY OF VITAL STATISTICS
a) Deficiency in registration and in hospital records and procedures
Figure 2
DEATHS UNDER 5 YEARS WITHOUT REGISTRATION IN 9 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 5 10 15 20 25
CARTAGENA
LA PAZ AREA
SAN JUAN PROVINCE
KINGSTON AREA
CilACO PROVINCE
MEDELLIN
NONTERREY
SAN SALVADOR AREA
RECIFE
Figure 3
NEONATAL DEATHS WITHOUT REGISTRATION FOR TWO AGE GROUPS IN 9 PROJECTS
FIRST YEAR OF INVESTIGATION
Per cenL Per cent
0 10 20 30 40 50 60 70 0 10 20 30 40 50
Under I day 1-27 days
CARTAGENA
LA PAZ AREA Jmimmiil mf
SAN JUAN PROVINCE
CIIACO PROVINCE t
HONTERREY
MEDEI LN IsN KINGSTON AREA 1
SAN SALVADOR AREA
R)CCEil
b) Incomplete and puzzling data by birth weight
Figure 21
PERCENTAGE DISTRIBUTION OF NEONATAL DEATHS BY BIRTH WEICHT IN 13 PROJECTS FIRST YEAR OF INVESTIGATION AND UNITED STATES 1950
KINGSTON MEDELLIN CARTAGENA SAN SALVADOR CHACO30 AREA AREA PROVINCE
20
RIBEIREO PRETO RECIFE SO PAULO CALU ITA ATEPD10
u 20
oti
NRE0 Y SAN JUAN SANTIAGO MNERY PROVINCE AREA UNITED STATES
10-
Birth weight in grams
Excluding those with weight not stated
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
INTER-AMERICAN iINVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 3Confidential
Serial noName o child
Date of IDate of Sex Age-at death _yrs _mos __days hrs
deathbirth
has this child been attended by a ph sician or in a clinic or hospital Yes No 0 Unknown 1339 During the past year
NumberDays in viO0tsName of physician clinic or hospital Type Dates hospital Reason
emergency E Indicate whether clinic (health center or hospital) C in-patient in hospital H practicing physician P
Yes r3 No J Unknown [40 Did the child receive medical attention before the past year
NumberReasonDays in visitsDates hospitalName of physician clinic or hospital Type
Indicate whether clinic (health center or hospital) C in-patient in hospital H practicing physician P emergency E
b) How did illness start41 Disease a) How long was the child ill
c) What disease do you think caused the childs death
42 Description of the disease by the mother
43 Home treatment
44 Prescriptions
45 Who prescribed
46 Did the mother see signs of malnutrition (edema loss of weight changes in hair or skin)
b) How many days after onset of illnessa) Was child taken to doctor No 0 Yes 0b c) What was condition of child Slightly ill [01 Moderately ill [ Very ill
47 To doctor
48 Where did child die Home 03 Hospital 0] Name Other 0
49 Death certificate number
50 Source of information Mother 0 Father 0 Other 03 InterviewerDate
INTER-AMEAdCAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Confidential Death - page 4
Serial noName of child
Date of 6 ate of Sei~g t birth 1 death death yrs -MoS days hr
DATA OBTAINED FROM HOSPITAL CLINIC OR PHYSICIAN
51 Abnormal None Edema Hyper- Albumi- Convul- Hyper- Anemia Threatened Placenta Other specify sions emeuis abortion previaconditions of tension nuria
pregnancy 0 03 0 0- 0] 0] 0 0 0
5 Conditions None German T b c Syphi- Operation reason findings Trauma specify Other specify
unrelated to measles puli lis
pregnancy n 0 03 0
Spontane-Q Forceps Sedation Length of 5553 Dlivery ous Manipu- Cesarian Azesthe- Other specify 54 Single orlation 0 03 0 sia 0 Q gestation multiple birth
DATA ON CHILD (age in completed months in first line)
56 Age At birth
57 Weight 58 Nutritional status
59 DATA ON NEWBORN FROM RECORD
General state Good 0 Fair 0 Poor 0 Genitals Normal [ Abnormal 0 Activity Normal 0 Abnormal 03 Extremities Normal n Abnormal 0
First cry_ min First breathing_ min Skin color
Movements Normal 0 Abnormal 0 Cyanosis General 0 Extremities [
Muscular tone Increased 0 Normal 0 Decreased 0 Jaundice Yes D3 No [ Time
Head - Size Increased 0 Normal 0 Decreased 0 Hemorrhagic signs Yes [ No C]
Shape Normal [ Abnormal 0) Infection signs
Cephalohematoma 0 Lacerations 0 Lacerations Yes 0 No 1
Eyes nose ears mouth Edema
Neck - Rigidity- Yes 0 No 0 Masses [ Breathing Normal 0 Irregular 0 Chest Secretion
First Voiding __hrs First bowel movement hrs Abdominal Masses 0 Hernia [
hrs Congenital anomalies
Acceptance 0 Rejection [ First feeding b- Type
Progrees
60 PRINCIPAL FINDINGS IN HOSPITAL AND CLINICS PRIOR TO ILLNESS LEADING TO DEATH
61 Sorce of o Private r information Hospital 03 Clinic 0 M D 0] Other 03I ae______ Interviewer
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 5Cosifidentlxl
Serial noName of child
Date of IDate of Sex Age at death yra ___oa days hrsdeuth
PRESENT ILLNESS - EVENTS THAT LED TO DEATH OF THE CHILD
birth
63 How disease started62 Date disease started
64 Main symptoms
65 Description of disease
PHYSICAL EXAMINATION (at aemission to hospital or first outpatient or house visit)
66 Date 67 Height 68 Weight and arm circumference Wt Arm circumference
69 Nutritional status
70 Relevant physical findings
71 Evolution and treatment
72 Source of i Private I information Hospital 3 Clinic 3 MDK t 0 Other [0 Date Interviewer
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD Confidential Death - page 6
Name of child Serial no Date of IDate of Sex Age at birth I death death yrs mon days hrs
DATA OBTAINED FROM HOSPITAL OUTPATIENT SERVICE OR PHYSICIAN 73 Relevant laboratory findings
74 X-rays Site Date Results
75 Other auxiliary examinations
76 Surgical procedures and findings
77 Cytology 78 Biopsy 79 CLINICAL DIAGNOSES
80 Autopsy No [ Yes 0 Date
81 Date ho- 82 Date dis- 83 Where Home I OutpatientD e IHospitalthan 48 hoursless IHospital 48 Otherservice hours or m O pitalized I charged died 0 0 0 0 o 0
84 Source of Hospital I Clinic 1Private Other Date Interviewer information 10 Cn IZ D t [] 111
DATA OBTAINED BY HOME VISIT OF MEDICAL INTERVIEWER 85 Date disease started 86 How disease started
87 Main symptoms 88 Description of disease
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 7Confidential
Serial noName of child
Date of IDate of Sex Age at
birIth - ideathdah- death yr _ MOS days hrs
__ DATA OBTAINED BY MEDICAL INTERVIEWER IN HOME
a) How long was the child ill b) How did illness startf
89 Disease
c) What do you think caused death d) Did someone else have same disease
a) Did the child have fever No [ Little 0 Moderate [ Very high 03 b) How long it9 ever c) Did you take the temperature No 0l Yes 0 d) What was
0 Normal 0 Rapid 01 Difficult 0a) How was the respiration Slow 91 Respiration b) Did the sides of nose move in breathing Yes 0 No 0 c) Noise
a) Did the child cough No 0 Little 0 Moderate 0 Heavy 0 No 03 Little 0 Moderate 0 Heavy shy
9Z Cough b) Expectoration c) Color of expectoration White 0 Yellow 0 Green 0 lth
a) Did the child vomit No [I Little 0 Moderate 0 Severe [
Solid [] Liquid [ Everything []93 Vomiting b) What did he vomit
c) How long did he vomit days d) Did he lose appetite
0 Loose 0 Liquid 0)a) How were the feces Very hard 0 Hard [3 Normal
94 Feces b) Color of the feces Yellow [ Brown [] Green 0 Red [ Black 0
c) How many times per day d) How many days__ e) Were worms seen
a) Difficulty in urination No 0 Yes 0-b) Retention of urineNo [] Yes 0
95 Urine c) Did urine diminish No 0 Yes Od) Eliminated calculiNo 0 Yes [
e) Color of urine Dark 0 Red 03 Dirty 0] a) Did the child lose weight No 0] A little 0 Moderate 0 Severe 0
No [ Yes []d) Face No[QYes[O96 Weight b) Did the arms get thinner No [ Yes []c) Legs
e) Could ribs be seen under skin No [ Yes ]
a) Did the child have swollen legs No 0 Yes [Ob) Swollen abdomen No 0 Yes [] c) Face No [] Yes []
a) Did you see anything on skin No 0 Yes [
98 Skin b) Appearance Yellow 0 Rash [ Pustule [ Cyanotic 03 Pale 0] Blemishes [ Depigmentation 03 Dryness (3
a) Did the child have much hair No 0 Yes 0 b) Pull out easily No 0) Yes 03 99 Hair 0c) Change of color No 0 Yes [ d) Glossy No 03 Yes
a) Did the child move actively No 0 Yes [b)All parts of body No 1 Yes 03 10Neuromuscular
100 activity c) Delay in movement No [ Yes [ d) Since when
___ _ e) Convulsions No 0 Yes 0 No [ Yes Ob) How longa) Did the child have pain No n Yei [d) Associated with whatc) Continuous
a) Did the child have a fall No [0 Yes Qb) Injury
102 Accident c) Other accident No 03 Yes [d) Explain
103 Other What other symptoms
Provide data regarding these items before final illness
104 Observation
a) Did you take child to doctor No [ Yes 0 b) How soon after onset of illness 105 To doctor
c) What was condition of child Slightly ill 03 Moderately ill 0 Very ill 0
106 Source of Mother 0 Father b Other Date Interviewer
information
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 8Confidential
Name of child Serial no
Date of Sex lAge at
birth death death _yrs mo_ day hr
AUTOPSY REPORT
Date of
107 Autopsy number 108 Interval from death to initiation of autopsy
109 Weight 110 Arm circumference
Ill Other anthropometric measurements
112 Description of cadaver (note all positive findings especially on nutrition)
113 Macroscopic examination of cavities and segments (positive findings of head thorax abdomen pelvis neck limbs)
114 Macroscopic examination of organs (positive findings of appearance surfaceweight color consistency etc)
115 Microscopic examination of organs and tissues (positive findings of organs macroscopically abnormal and of those
requested)
116 Positive laboratory findings from autopsy_
117 Final diagnoses from autopsy Direct cause of death
Principal diagnosis (underlying cause)
Secondary diagnoses (associated causes)
cause118 Associated diagnoses not related with underlying
119 Type of Hospital Verification of death Medico-legal Complete Partial Incomplete
0 n biautopsy
Date____________ Interviewer_________
OF MORTALITY IN CHILDHOODINTER-AMERICAN INVESTIGATION
Confidential Death - page 9
Name of child_ Serial no
DDate of Sex [Age at
birth [death death yr mos day hr
120 Medicalcertification of cause of death (ekact copy) Duration Classification
I a _ _ _ _ _ _ _ _
Sb
121 SUMMARY OF INVESTIGATION
Medical interviewer
Basis for diagnosis Classifishycationcation
Underlying cause
1Associated causes
3
-Evaluation of nuitrition
Principal collaborator
122 ASSIGNMENT BY REFEREE Basis Special code Underling cause Iorntrishy
_________ated__auses___tional status
Clinical questionableBasis fordiagnosis 1 Autopsy 4 Hospital 5 Interview only
6 Death certificate only3 Clinical definite
--
___________
B
copyIU1Cl-AInRICAN INVES1I6AIZONCARODabitAMi Of 1ICOALITY I CRILiSUOSSerialla
Fi thas colm pY Cost Snail ro DATIS LO TOall cardi
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Selected Materialfrom Provisional Report for First Year
I QUALITY OF VITAL STATISTICS
a) Deficiency in registration and in hospital records and procedures
Figure 2
DEATHS UNDER 5 YEARS WITHOUT REGISTRATION IN 9 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 5 10 15 20 25
CARTAGENA
LA PAZ AREA
SAN JUAN PROVINCE
KINGSTON AREA
CilACO PROVINCE
MEDELLIN
NONTERREY
SAN SALVADOR AREA
RECIFE
Figure 3
NEONATAL DEATHS WITHOUT REGISTRATION FOR TWO AGE GROUPS IN 9 PROJECTS
FIRST YEAR OF INVESTIGATION
Per cenL Per cent
0 10 20 30 40 50 60 70 0 10 20 30 40 50
Under I day 1-27 days
CARTAGENA
LA PAZ AREA Jmimmiil mf
SAN JUAN PROVINCE
CIIACO PROVINCE t
HONTERREY
MEDEI LN IsN KINGSTON AREA 1
SAN SALVADOR AREA
R)CCEil
b) Incomplete and puzzling data by birth weight
Figure 21
PERCENTAGE DISTRIBUTION OF NEONATAL DEATHS BY BIRTH WEICHT IN 13 PROJECTS FIRST YEAR OF INVESTIGATION AND UNITED STATES 1950
KINGSTON MEDELLIN CARTAGENA SAN SALVADOR CHACO30 AREA AREA PROVINCE
20
RIBEIREO PRETO RECIFE SO PAULO CALU ITA ATEPD10
u 20
oti
NRE0 Y SAN JUAN SANTIAGO MNERY PROVINCE AREA UNITED STATES
10-
Birth weight in grams
Excluding those with weight not stated
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
INTER-AMEAdCAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Confidential Death - page 4
Serial noName of child
Date of 6 ate of Sei~g t birth 1 death death yrs -MoS days hr
DATA OBTAINED FROM HOSPITAL CLINIC OR PHYSICIAN
51 Abnormal None Edema Hyper- Albumi- Convul- Hyper- Anemia Threatened Placenta Other specify sions emeuis abortion previaconditions of tension nuria
pregnancy 0 03 0 0- 0] 0] 0 0 0
5 Conditions None German T b c Syphi- Operation reason findings Trauma specify Other specify
unrelated to measles puli lis
pregnancy n 0 03 0
Spontane-Q Forceps Sedation Length of 5553 Dlivery ous Manipu- Cesarian Azesthe- Other specify 54 Single orlation 0 03 0 sia 0 Q gestation multiple birth
DATA ON CHILD (age in completed months in first line)
56 Age At birth
57 Weight 58 Nutritional status
59 DATA ON NEWBORN FROM RECORD
General state Good 0 Fair 0 Poor 0 Genitals Normal [ Abnormal 0 Activity Normal 0 Abnormal 03 Extremities Normal n Abnormal 0
First cry_ min First breathing_ min Skin color
Movements Normal 0 Abnormal 0 Cyanosis General 0 Extremities [
Muscular tone Increased 0 Normal 0 Decreased 0 Jaundice Yes D3 No [ Time
Head - Size Increased 0 Normal 0 Decreased 0 Hemorrhagic signs Yes [ No C]
Shape Normal [ Abnormal 0) Infection signs
Cephalohematoma 0 Lacerations 0 Lacerations Yes 0 No 1
Eyes nose ears mouth Edema
Neck - Rigidity- Yes 0 No 0 Masses [ Breathing Normal 0 Irregular 0 Chest Secretion
First Voiding __hrs First bowel movement hrs Abdominal Masses 0 Hernia [
hrs Congenital anomalies
Acceptance 0 Rejection [ First feeding b- Type
Progrees
60 PRINCIPAL FINDINGS IN HOSPITAL AND CLINICS PRIOR TO ILLNESS LEADING TO DEATH
61 Sorce of o Private r information Hospital 03 Clinic 0 M D 0] Other 03I ae______ Interviewer
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 5Cosifidentlxl
Serial noName of child
Date of IDate of Sex Age at death yra ___oa days hrsdeuth
PRESENT ILLNESS - EVENTS THAT LED TO DEATH OF THE CHILD
birth
63 How disease started62 Date disease started
64 Main symptoms
65 Description of disease
PHYSICAL EXAMINATION (at aemission to hospital or first outpatient or house visit)
66 Date 67 Height 68 Weight and arm circumference Wt Arm circumference
69 Nutritional status
70 Relevant physical findings
71 Evolution and treatment
72 Source of i Private I information Hospital 3 Clinic 3 MDK t 0 Other [0 Date Interviewer
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD Confidential Death - page 6
Name of child Serial no Date of IDate of Sex Age at birth I death death yrs mon days hrs
DATA OBTAINED FROM HOSPITAL OUTPATIENT SERVICE OR PHYSICIAN 73 Relevant laboratory findings
74 X-rays Site Date Results
75 Other auxiliary examinations
76 Surgical procedures and findings
77 Cytology 78 Biopsy 79 CLINICAL DIAGNOSES
80 Autopsy No [ Yes 0 Date
81 Date ho- 82 Date dis- 83 Where Home I OutpatientD e IHospitalthan 48 hoursless IHospital 48 Otherservice hours or m O pitalized I charged died 0 0 0 0 o 0
84 Source of Hospital I Clinic 1Private Other Date Interviewer information 10 Cn IZ D t [] 111
DATA OBTAINED BY HOME VISIT OF MEDICAL INTERVIEWER 85 Date disease started 86 How disease started
87 Main symptoms 88 Description of disease
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 7Confidential
Serial noName of child
Date of IDate of Sex Age at
birIth - ideathdah- death yr _ MOS days hrs
__ DATA OBTAINED BY MEDICAL INTERVIEWER IN HOME
a) How long was the child ill b) How did illness startf
89 Disease
c) What do you think caused death d) Did someone else have same disease
a) Did the child have fever No [ Little 0 Moderate [ Very high 03 b) How long it9 ever c) Did you take the temperature No 0l Yes 0 d) What was
0 Normal 0 Rapid 01 Difficult 0a) How was the respiration Slow 91 Respiration b) Did the sides of nose move in breathing Yes 0 No 0 c) Noise
a) Did the child cough No 0 Little 0 Moderate 0 Heavy 0 No 03 Little 0 Moderate 0 Heavy shy
9Z Cough b) Expectoration c) Color of expectoration White 0 Yellow 0 Green 0 lth
a) Did the child vomit No [I Little 0 Moderate 0 Severe [
Solid [] Liquid [ Everything []93 Vomiting b) What did he vomit
c) How long did he vomit days d) Did he lose appetite
0 Loose 0 Liquid 0)a) How were the feces Very hard 0 Hard [3 Normal
94 Feces b) Color of the feces Yellow [ Brown [] Green 0 Red [ Black 0
c) How many times per day d) How many days__ e) Were worms seen
a) Difficulty in urination No 0 Yes 0-b) Retention of urineNo [] Yes 0
95 Urine c) Did urine diminish No 0 Yes Od) Eliminated calculiNo 0 Yes [
e) Color of urine Dark 0 Red 03 Dirty 0] a) Did the child lose weight No 0] A little 0 Moderate 0 Severe 0
No [ Yes []d) Face No[QYes[O96 Weight b) Did the arms get thinner No [ Yes []c) Legs
e) Could ribs be seen under skin No [ Yes ]
a) Did the child have swollen legs No 0 Yes [Ob) Swollen abdomen No 0 Yes [] c) Face No [] Yes []
a) Did you see anything on skin No 0 Yes [
98 Skin b) Appearance Yellow 0 Rash [ Pustule [ Cyanotic 03 Pale 0] Blemishes [ Depigmentation 03 Dryness (3
a) Did the child have much hair No 0 Yes 0 b) Pull out easily No 0) Yes 03 99 Hair 0c) Change of color No 0 Yes [ d) Glossy No 03 Yes
a) Did the child move actively No 0 Yes [b)All parts of body No 1 Yes 03 10Neuromuscular
100 activity c) Delay in movement No [ Yes [ d) Since when
___ _ e) Convulsions No 0 Yes 0 No [ Yes Ob) How longa) Did the child have pain No n Yei [d) Associated with whatc) Continuous
a) Did the child have a fall No [0 Yes Qb) Injury
102 Accident c) Other accident No 03 Yes [d) Explain
103 Other What other symptoms
Provide data regarding these items before final illness
104 Observation
a) Did you take child to doctor No [ Yes 0 b) How soon after onset of illness 105 To doctor
c) What was condition of child Slightly ill 03 Moderately ill 0 Very ill 0
106 Source of Mother 0 Father b Other Date Interviewer
information
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 8Confidential
Name of child Serial no
Date of Sex lAge at
birth death death _yrs mo_ day hr
AUTOPSY REPORT
Date of
107 Autopsy number 108 Interval from death to initiation of autopsy
109 Weight 110 Arm circumference
Ill Other anthropometric measurements
112 Description of cadaver (note all positive findings especially on nutrition)
113 Macroscopic examination of cavities and segments (positive findings of head thorax abdomen pelvis neck limbs)
114 Macroscopic examination of organs (positive findings of appearance surfaceweight color consistency etc)
115 Microscopic examination of organs and tissues (positive findings of organs macroscopically abnormal and of those
requested)
116 Positive laboratory findings from autopsy_
117 Final diagnoses from autopsy Direct cause of death
Principal diagnosis (underlying cause)
Secondary diagnoses (associated causes)
cause118 Associated diagnoses not related with underlying
119 Type of Hospital Verification of death Medico-legal Complete Partial Incomplete
0 n biautopsy
Date____________ Interviewer_________
OF MORTALITY IN CHILDHOODINTER-AMERICAN INVESTIGATION
Confidential Death - page 9
Name of child_ Serial no
DDate of Sex [Age at
birth [death death yr mos day hr
120 Medicalcertification of cause of death (ekact copy) Duration Classification
I a _ _ _ _ _ _ _ _
Sb
121 SUMMARY OF INVESTIGATION
Medical interviewer
Basis for diagnosis Classifishycationcation
Underlying cause
1Associated causes
3
-Evaluation of nuitrition
Principal collaborator
122 ASSIGNMENT BY REFEREE Basis Special code Underling cause Iorntrishy
_________ated__auses___tional status
Clinical questionableBasis fordiagnosis 1 Autopsy 4 Hospital 5 Interview only
6 Death certificate only3 Clinical definite
--
___________
B
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(cont) IT IV ofI7 I v lt1 y W EI v I IV 1 -I 6v IV ll av6cmlef ItMsIu cglImfiv CCSL$ bull FIIGIIAL AMIIS re 7 (I -Cwd jitlel d ate
C
Selected Materialfrom Provisional Report for First Year
I QUALITY OF VITAL STATISTICS
a) Deficiency in registration and in hospital records and procedures
Figure 2
DEATHS UNDER 5 YEARS WITHOUT REGISTRATION IN 9 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 5 10 15 20 25
CARTAGENA
LA PAZ AREA
SAN JUAN PROVINCE
KINGSTON AREA
CilACO PROVINCE
MEDELLIN
NONTERREY
SAN SALVADOR AREA
RECIFE
Figure 3
NEONATAL DEATHS WITHOUT REGISTRATION FOR TWO AGE GROUPS IN 9 PROJECTS
FIRST YEAR OF INVESTIGATION
Per cenL Per cent
0 10 20 30 40 50 60 70 0 10 20 30 40 50
Under I day 1-27 days
CARTAGENA
LA PAZ AREA Jmimmiil mf
SAN JUAN PROVINCE
CIIACO PROVINCE t
HONTERREY
MEDEI LN IsN KINGSTON AREA 1
SAN SALVADOR AREA
R)CCEil
b) Incomplete and puzzling data by birth weight
Figure 21
PERCENTAGE DISTRIBUTION OF NEONATAL DEATHS BY BIRTH WEICHT IN 13 PROJECTS FIRST YEAR OF INVESTIGATION AND UNITED STATES 1950
KINGSTON MEDELLIN CARTAGENA SAN SALVADOR CHACO30 AREA AREA PROVINCE
20
RIBEIREO PRETO RECIFE SO PAULO CALU ITA ATEPD10
u 20
oti
NRE0 Y SAN JUAN SANTIAGO MNERY PROVINCE AREA UNITED STATES
10-
Birth weight in grams
Excluding those with weight not stated
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 5Cosifidentlxl
Serial noName of child
Date of IDate of Sex Age at death yra ___oa days hrsdeuth
PRESENT ILLNESS - EVENTS THAT LED TO DEATH OF THE CHILD
birth
63 How disease started62 Date disease started
64 Main symptoms
65 Description of disease
PHYSICAL EXAMINATION (at aemission to hospital or first outpatient or house visit)
66 Date 67 Height 68 Weight and arm circumference Wt Arm circumference
69 Nutritional status
70 Relevant physical findings
71 Evolution and treatment
72 Source of i Private I information Hospital 3 Clinic 3 MDK t 0 Other [0 Date Interviewer
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD Confidential Death - page 6
Name of child Serial no Date of IDate of Sex Age at birth I death death yrs mon days hrs
DATA OBTAINED FROM HOSPITAL OUTPATIENT SERVICE OR PHYSICIAN 73 Relevant laboratory findings
74 X-rays Site Date Results
75 Other auxiliary examinations
76 Surgical procedures and findings
77 Cytology 78 Biopsy 79 CLINICAL DIAGNOSES
80 Autopsy No [ Yes 0 Date
81 Date ho- 82 Date dis- 83 Where Home I OutpatientD e IHospitalthan 48 hoursless IHospital 48 Otherservice hours or m O pitalized I charged died 0 0 0 0 o 0
84 Source of Hospital I Clinic 1Private Other Date Interviewer information 10 Cn IZ D t [] 111
DATA OBTAINED BY HOME VISIT OF MEDICAL INTERVIEWER 85 Date disease started 86 How disease started
87 Main symptoms 88 Description of disease
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 7Confidential
Serial noName of child
Date of IDate of Sex Age at
birIth - ideathdah- death yr _ MOS days hrs
__ DATA OBTAINED BY MEDICAL INTERVIEWER IN HOME
a) How long was the child ill b) How did illness startf
89 Disease
c) What do you think caused death d) Did someone else have same disease
a) Did the child have fever No [ Little 0 Moderate [ Very high 03 b) How long it9 ever c) Did you take the temperature No 0l Yes 0 d) What was
0 Normal 0 Rapid 01 Difficult 0a) How was the respiration Slow 91 Respiration b) Did the sides of nose move in breathing Yes 0 No 0 c) Noise
a) Did the child cough No 0 Little 0 Moderate 0 Heavy 0 No 03 Little 0 Moderate 0 Heavy shy
9Z Cough b) Expectoration c) Color of expectoration White 0 Yellow 0 Green 0 lth
a) Did the child vomit No [I Little 0 Moderate 0 Severe [
Solid [] Liquid [ Everything []93 Vomiting b) What did he vomit
c) How long did he vomit days d) Did he lose appetite
0 Loose 0 Liquid 0)a) How were the feces Very hard 0 Hard [3 Normal
94 Feces b) Color of the feces Yellow [ Brown [] Green 0 Red [ Black 0
c) How many times per day d) How many days__ e) Were worms seen
a) Difficulty in urination No 0 Yes 0-b) Retention of urineNo [] Yes 0
95 Urine c) Did urine diminish No 0 Yes Od) Eliminated calculiNo 0 Yes [
e) Color of urine Dark 0 Red 03 Dirty 0] a) Did the child lose weight No 0] A little 0 Moderate 0 Severe 0
No [ Yes []d) Face No[QYes[O96 Weight b) Did the arms get thinner No [ Yes []c) Legs
e) Could ribs be seen under skin No [ Yes ]
a) Did the child have swollen legs No 0 Yes [Ob) Swollen abdomen No 0 Yes [] c) Face No [] Yes []
a) Did you see anything on skin No 0 Yes [
98 Skin b) Appearance Yellow 0 Rash [ Pustule [ Cyanotic 03 Pale 0] Blemishes [ Depigmentation 03 Dryness (3
a) Did the child have much hair No 0 Yes 0 b) Pull out easily No 0) Yes 03 99 Hair 0c) Change of color No 0 Yes [ d) Glossy No 03 Yes
a) Did the child move actively No 0 Yes [b)All parts of body No 1 Yes 03 10Neuromuscular
100 activity c) Delay in movement No [ Yes [ d) Since when
___ _ e) Convulsions No 0 Yes 0 No [ Yes Ob) How longa) Did the child have pain No n Yei [d) Associated with whatc) Continuous
a) Did the child have a fall No [0 Yes Qb) Injury
102 Accident c) Other accident No 03 Yes [d) Explain
103 Other What other symptoms
Provide data regarding these items before final illness
104 Observation
a) Did you take child to doctor No [ Yes 0 b) How soon after onset of illness 105 To doctor
c) What was condition of child Slightly ill 03 Moderately ill 0 Very ill 0
106 Source of Mother 0 Father b Other Date Interviewer
information
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 8Confidential
Name of child Serial no
Date of Sex lAge at
birth death death _yrs mo_ day hr
AUTOPSY REPORT
Date of
107 Autopsy number 108 Interval from death to initiation of autopsy
109 Weight 110 Arm circumference
Ill Other anthropometric measurements
112 Description of cadaver (note all positive findings especially on nutrition)
113 Macroscopic examination of cavities and segments (positive findings of head thorax abdomen pelvis neck limbs)
114 Macroscopic examination of organs (positive findings of appearance surfaceweight color consistency etc)
115 Microscopic examination of organs and tissues (positive findings of organs macroscopically abnormal and of those
requested)
116 Positive laboratory findings from autopsy_
117 Final diagnoses from autopsy Direct cause of death
Principal diagnosis (underlying cause)
Secondary diagnoses (associated causes)
cause118 Associated diagnoses not related with underlying
119 Type of Hospital Verification of death Medico-legal Complete Partial Incomplete
0 n biautopsy
Date____________ Interviewer_________
OF MORTALITY IN CHILDHOODINTER-AMERICAN INVESTIGATION
Confidential Death - page 9
Name of child_ Serial no
DDate of Sex [Age at
birth [death death yr mos day hr
120 Medicalcertification of cause of death (ekact copy) Duration Classification
I a _ _ _ _ _ _ _ _
Sb
121 SUMMARY OF INVESTIGATION
Medical interviewer
Basis for diagnosis Classifishycationcation
Underlying cause
1Associated causes
3
-Evaluation of nuitrition
Principal collaborator
122 ASSIGNMENT BY REFEREE Basis Special code Underling cause Iorntrishy
_________ated__auses___tional status
Clinical questionableBasis fordiagnosis 1 Autopsy 4 Hospital 5 Interview only
6 Death certificate only3 Clinical definite
--
___________
B
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ts5 G S IlrtO 2 Age meiht Is 3 4 5 6 loof CoW IRIO 1 O 1MF sIzLAs SoRIlL EJ N3J
CCUzu11AjVs at MMlLSCard 8 2719
CAUSS o fiel Age eiqt I tatoratary Clinical Olaguess Nosp P loter- Swopound e C I TV Z IV I IVP3ot tev kAll eCer ll Ten Ev 3fshy
aol s o UN ILYNG GM cWo l CAUSES COIIOIIIIAL CAUSS
(cont) IT IV ofI7 I v lt1 y W EI v I IV 1 -I 6v IV ll av6cmlef ItMsIu cglImfiv CCSL$ bull FIIGIIAL AMIIS re 7 (I -Cwd jitlel d ate
C
Selected Materialfrom Provisional Report for First Year
I QUALITY OF VITAL STATISTICS
a) Deficiency in registration and in hospital records and procedures
Figure 2
DEATHS UNDER 5 YEARS WITHOUT REGISTRATION IN 9 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 5 10 15 20 25
CARTAGENA
LA PAZ AREA
SAN JUAN PROVINCE
KINGSTON AREA
CilACO PROVINCE
MEDELLIN
NONTERREY
SAN SALVADOR AREA
RECIFE
Figure 3
NEONATAL DEATHS WITHOUT REGISTRATION FOR TWO AGE GROUPS IN 9 PROJECTS
FIRST YEAR OF INVESTIGATION
Per cenL Per cent
0 10 20 30 40 50 60 70 0 10 20 30 40 50
Under I day 1-27 days
CARTAGENA
LA PAZ AREA Jmimmiil mf
SAN JUAN PROVINCE
CIIACO PROVINCE t
HONTERREY
MEDEI LN IsN KINGSTON AREA 1
SAN SALVADOR AREA
R)CCEil
b) Incomplete and puzzling data by birth weight
Figure 21
PERCENTAGE DISTRIBUTION OF NEONATAL DEATHS BY BIRTH WEICHT IN 13 PROJECTS FIRST YEAR OF INVESTIGATION AND UNITED STATES 1950
KINGSTON MEDELLIN CARTAGENA SAN SALVADOR CHACO30 AREA AREA PROVINCE
20
RIBEIREO PRETO RECIFE SO PAULO CALU ITA ATEPD10
u 20
oti
NRE0 Y SAN JUAN SANTIAGO MNERY PROVINCE AREA UNITED STATES
10-
Birth weight in grams
Excluding those with weight not stated
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD Confidential Death - page 6
Name of child Serial no Date of IDate of Sex Age at birth I death death yrs mon days hrs
DATA OBTAINED FROM HOSPITAL OUTPATIENT SERVICE OR PHYSICIAN 73 Relevant laboratory findings
74 X-rays Site Date Results
75 Other auxiliary examinations
76 Surgical procedures and findings
77 Cytology 78 Biopsy 79 CLINICAL DIAGNOSES
80 Autopsy No [ Yes 0 Date
81 Date ho- 82 Date dis- 83 Where Home I OutpatientD e IHospitalthan 48 hoursless IHospital 48 Otherservice hours or m O pitalized I charged died 0 0 0 0 o 0
84 Source of Hospital I Clinic 1Private Other Date Interviewer information 10 Cn IZ D t [] 111
DATA OBTAINED BY HOME VISIT OF MEDICAL INTERVIEWER 85 Date disease started 86 How disease started
87 Main symptoms 88 Description of disease
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 7Confidential
Serial noName of child
Date of IDate of Sex Age at
birIth - ideathdah- death yr _ MOS days hrs
__ DATA OBTAINED BY MEDICAL INTERVIEWER IN HOME
a) How long was the child ill b) How did illness startf
89 Disease
c) What do you think caused death d) Did someone else have same disease
a) Did the child have fever No [ Little 0 Moderate [ Very high 03 b) How long it9 ever c) Did you take the temperature No 0l Yes 0 d) What was
0 Normal 0 Rapid 01 Difficult 0a) How was the respiration Slow 91 Respiration b) Did the sides of nose move in breathing Yes 0 No 0 c) Noise
a) Did the child cough No 0 Little 0 Moderate 0 Heavy 0 No 03 Little 0 Moderate 0 Heavy shy
9Z Cough b) Expectoration c) Color of expectoration White 0 Yellow 0 Green 0 lth
a) Did the child vomit No [I Little 0 Moderate 0 Severe [
Solid [] Liquid [ Everything []93 Vomiting b) What did he vomit
c) How long did he vomit days d) Did he lose appetite
0 Loose 0 Liquid 0)a) How were the feces Very hard 0 Hard [3 Normal
94 Feces b) Color of the feces Yellow [ Brown [] Green 0 Red [ Black 0
c) How many times per day d) How many days__ e) Were worms seen
a) Difficulty in urination No 0 Yes 0-b) Retention of urineNo [] Yes 0
95 Urine c) Did urine diminish No 0 Yes Od) Eliminated calculiNo 0 Yes [
e) Color of urine Dark 0 Red 03 Dirty 0] a) Did the child lose weight No 0] A little 0 Moderate 0 Severe 0
No [ Yes []d) Face No[QYes[O96 Weight b) Did the arms get thinner No [ Yes []c) Legs
e) Could ribs be seen under skin No [ Yes ]
a) Did the child have swollen legs No 0 Yes [Ob) Swollen abdomen No 0 Yes [] c) Face No [] Yes []
a) Did you see anything on skin No 0 Yes [
98 Skin b) Appearance Yellow 0 Rash [ Pustule [ Cyanotic 03 Pale 0] Blemishes [ Depigmentation 03 Dryness (3
a) Did the child have much hair No 0 Yes 0 b) Pull out easily No 0) Yes 03 99 Hair 0c) Change of color No 0 Yes [ d) Glossy No 03 Yes
a) Did the child move actively No 0 Yes [b)All parts of body No 1 Yes 03 10Neuromuscular
100 activity c) Delay in movement No [ Yes [ d) Since when
___ _ e) Convulsions No 0 Yes 0 No [ Yes Ob) How longa) Did the child have pain No n Yei [d) Associated with whatc) Continuous
a) Did the child have a fall No [0 Yes Qb) Injury
102 Accident c) Other accident No 03 Yes [d) Explain
103 Other What other symptoms
Provide data regarding these items before final illness
104 Observation
a) Did you take child to doctor No [ Yes 0 b) How soon after onset of illness 105 To doctor
c) What was condition of child Slightly ill 03 Moderately ill 0 Very ill 0
106 Source of Mother 0 Father b Other Date Interviewer
information
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 8Confidential
Name of child Serial no
Date of Sex lAge at
birth death death _yrs mo_ day hr
AUTOPSY REPORT
Date of
107 Autopsy number 108 Interval from death to initiation of autopsy
109 Weight 110 Arm circumference
Ill Other anthropometric measurements
112 Description of cadaver (note all positive findings especially on nutrition)
113 Macroscopic examination of cavities and segments (positive findings of head thorax abdomen pelvis neck limbs)
114 Macroscopic examination of organs (positive findings of appearance surfaceweight color consistency etc)
115 Microscopic examination of organs and tissues (positive findings of organs macroscopically abnormal and of those
requested)
116 Positive laboratory findings from autopsy_
117 Final diagnoses from autopsy Direct cause of death
Principal diagnosis (underlying cause)
Secondary diagnoses (associated causes)
cause118 Associated diagnoses not related with underlying
119 Type of Hospital Verification of death Medico-legal Complete Partial Incomplete
0 n biautopsy
Date____________ Interviewer_________
OF MORTALITY IN CHILDHOODINTER-AMERICAN INVESTIGATION
Confidential Death - page 9
Name of child_ Serial no
DDate of Sex [Age at
birth [death death yr mos day hr
120 Medicalcertification of cause of death (ekact copy) Duration Classification
I a _ _ _ _ _ _ _ _
Sb
121 SUMMARY OF INVESTIGATION
Medical interviewer
Basis for diagnosis Classifishycationcation
Underlying cause
1Associated causes
3
-Evaluation of nuitrition
Principal collaborator
122 ASSIGNMENT BY REFEREE Basis Special code Underling cause Iorntrishy
_________ated__auses___tional status
Clinical questionableBasis fordiagnosis 1 Autopsy 4 Hospital 5 Interview only
6 Death certificate only3 Clinical definite
--
___________
B
copyIU1Cl-AInRICAN INVES1I6AIZONCARODabitAMi Of 1ICOALITY I CRILiSUOSSerialla
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CCUzu11AjVs at MMlLSCard 8 2719
CAUSS o fiel Age eiqt I tatoratary Clinical Olaguess Nosp P loter- Swopound e C I TV Z IV I IVP3ot tev kAll eCer ll Ten Ev 3fshy
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(cont) IT IV ofI7 I v lt1 y W EI v I IV 1 -I 6v IV ll av6cmlef ItMsIu cglImfiv CCSL$ bull FIIGIIAL AMIIS re 7 (I -Cwd jitlel d ate
C
Selected Materialfrom Provisional Report for First Year
I QUALITY OF VITAL STATISTICS
a) Deficiency in registration and in hospital records and procedures
Figure 2
DEATHS UNDER 5 YEARS WITHOUT REGISTRATION IN 9 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 5 10 15 20 25
CARTAGENA
LA PAZ AREA
SAN JUAN PROVINCE
KINGSTON AREA
CilACO PROVINCE
MEDELLIN
NONTERREY
SAN SALVADOR AREA
RECIFE
Figure 3
NEONATAL DEATHS WITHOUT REGISTRATION FOR TWO AGE GROUPS IN 9 PROJECTS
FIRST YEAR OF INVESTIGATION
Per cenL Per cent
0 10 20 30 40 50 60 70 0 10 20 30 40 50
Under I day 1-27 days
CARTAGENA
LA PAZ AREA Jmimmiil mf
SAN JUAN PROVINCE
CIIACO PROVINCE t
HONTERREY
MEDEI LN IsN KINGSTON AREA 1
SAN SALVADOR AREA
R)CCEil
b) Incomplete and puzzling data by birth weight
Figure 21
PERCENTAGE DISTRIBUTION OF NEONATAL DEATHS BY BIRTH WEICHT IN 13 PROJECTS FIRST YEAR OF INVESTIGATION AND UNITED STATES 1950
KINGSTON MEDELLIN CARTAGENA SAN SALVADOR CHACO30 AREA AREA PROVINCE
20
RIBEIREO PRETO RECIFE SO PAULO CALU ITA ATEPD10
u 20
oti
NRE0 Y SAN JUAN SANTIAGO MNERY PROVINCE AREA UNITED STATES
10-
Birth weight in grams
Excluding those with weight not stated
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
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INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 7Confidential
Serial noName of child
Date of IDate of Sex Age at
birIth - ideathdah- death yr _ MOS days hrs
__ DATA OBTAINED BY MEDICAL INTERVIEWER IN HOME
a) How long was the child ill b) How did illness startf
89 Disease
c) What do you think caused death d) Did someone else have same disease
a) Did the child have fever No [ Little 0 Moderate [ Very high 03 b) How long it9 ever c) Did you take the temperature No 0l Yes 0 d) What was
0 Normal 0 Rapid 01 Difficult 0a) How was the respiration Slow 91 Respiration b) Did the sides of nose move in breathing Yes 0 No 0 c) Noise
a) Did the child cough No 0 Little 0 Moderate 0 Heavy 0 No 03 Little 0 Moderate 0 Heavy shy
9Z Cough b) Expectoration c) Color of expectoration White 0 Yellow 0 Green 0 lth
a) Did the child vomit No [I Little 0 Moderate 0 Severe [
Solid [] Liquid [ Everything []93 Vomiting b) What did he vomit
c) How long did he vomit days d) Did he lose appetite
0 Loose 0 Liquid 0)a) How were the feces Very hard 0 Hard [3 Normal
94 Feces b) Color of the feces Yellow [ Brown [] Green 0 Red [ Black 0
c) How many times per day d) How many days__ e) Were worms seen
a) Difficulty in urination No 0 Yes 0-b) Retention of urineNo [] Yes 0
95 Urine c) Did urine diminish No 0 Yes Od) Eliminated calculiNo 0 Yes [
e) Color of urine Dark 0 Red 03 Dirty 0] a) Did the child lose weight No 0] A little 0 Moderate 0 Severe 0
No [ Yes []d) Face No[QYes[O96 Weight b) Did the arms get thinner No [ Yes []c) Legs
e) Could ribs be seen under skin No [ Yes ]
a) Did the child have swollen legs No 0 Yes [Ob) Swollen abdomen No 0 Yes [] c) Face No [] Yes []
a) Did you see anything on skin No 0 Yes [
98 Skin b) Appearance Yellow 0 Rash [ Pustule [ Cyanotic 03 Pale 0] Blemishes [ Depigmentation 03 Dryness (3
a) Did the child have much hair No 0 Yes 0 b) Pull out easily No 0) Yes 03 99 Hair 0c) Change of color No 0 Yes [ d) Glossy No 03 Yes
a) Did the child move actively No 0 Yes [b)All parts of body No 1 Yes 03 10Neuromuscular
100 activity c) Delay in movement No [ Yes [ d) Since when
___ _ e) Convulsions No 0 Yes 0 No [ Yes Ob) How longa) Did the child have pain No n Yei [d) Associated with whatc) Continuous
a) Did the child have a fall No [0 Yes Qb) Injury
102 Accident c) Other accident No 03 Yes [d) Explain
103 Other What other symptoms
Provide data regarding these items before final illness
104 Observation
a) Did you take child to doctor No [ Yes 0 b) How soon after onset of illness 105 To doctor
c) What was condition of child Slightly ill 03 Moderately ill 0 Very ill 0
106 Source of Mother 0 Father b Other Date Interviewer
information
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 8Confidential
Name of child Serial no
Date of Sex lAge at
birth death death _yrs mo_ day hr
AUTOPSY REPORT
Date of
107 Autopsy number 108 Interval from death to initiation of autopsy
109 Weight 110 Arm circumference
Ill Other anthropometric measurements
112 Description of cadaver (note all positive findings especially on nutrition)
113 Macroscopic examination of cavities and segments (positive findings of head thorax abdomen pelvis neck limbs)
114 Macroscopic examination of organs (positive findings of appearance surfaceweight color consistency etc)
115 Microscopic examination of organs and tissues (positive findings of organs macroscopically abnormal and of those
requested)
116 Positive laboratory findings from autopsy_
117 Final diagnoses from autopsy Direct cause of death
Principal diagnosis (underlying cause)
Secondary diagnoses (associated causes)
cause118 Associated diagnoses not related with underlying
119 Type of Hospital Verification of death Medico-legal Complete Partial Incomplete
0 n biautopsy
Date____________ Interviewer_________
OF MORTALITY IN CHILDHOODINTER-AMERICAN INVESTIGATION
Confidential Death - page 9
Name of child_ Serial no
DDate of Sex [Age at
birth [death death yr mos day hr
120 Medicalcertification of cause of death (ekact copy) Duration Classification
I a _ _ _ _ _ _ _ _
Sb
121 SUMMARY OF INVESTIGATION
Medical interviewer
Basis for diagnosis Classifishycationcation
Underlying cause
1Associated causes
3
-Evaluation of nuitrition
Principal collaborator
122 ASSIGNMENT BY REFEREE Basis Special code Underling cause Iorntrishy
_________ated__auses___tional status
Clinical questionableBasis fordiagnosis 1 Autopsy 4 Hospital 5 Interview only
6 Death certificate only3 Clinical definite
--
___________
B
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C
Selected Materialfrom Provisional Report for First Year
I QUALITY OF VITAL STATISTICS
a) Deficiency in registration and in hospital records and procedures
Figure 2
DEATHS UNDER 5 YEARS WITHOUT REGISTRATION IN 9 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 5 10 15 20 25
CARTAGENA
LA PAZ AREA
SAN JUAN PROVINCE
KINGSTON AREA
CilACO PROVINCE
MEDELLIN
NONTERREY
SAN SALVADOR AREA
RECIFE
Figure 3
NEONATAL DEATHS WITHOUT REGISTRATION FOR TWO AGE GROUPS IN 9 PROJECTS
FIRST YEAR OF INVESTIGATION
Per cenL Per cent
0 10 20 30 40 50 60 70 0 10 20 30 40 50
Under I day 1-27 days
CARTAGENA
LA PAZ AREA Jmimmiil mf
SAN JUAN PROVINCE
CIIACO PROVINCE t
HONTERREY
MEDEI LN IsN KINGSTON AREA 1
SAN SALVADOR AREA
R)CCEil
b) Incomplete and puzzling data by birth weight
Figure 21
PERCENTAGE DISTRIBUTION OF NEONATAL DEATHS BY BIRTH WEICHT IN 13 PROJECTS FIRST YEAR OF INVESTIGATION AND UNITED STATES 1950
KINGSTON MEDELLIN CARTAGENA SAN SALVADOR CHACO30 AREA AREA PROVINCE
20
RIBEIREO PRETO RECIFE SO PAULO CALU ITA ATEPD10
u 20
oti
NRE0 Y SAN JUAN SANTIAGO MNERY PROVINCE AREA UNITED STATES
10-
Birth weight in grams
Excluding those with weight not stated
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
INTER-AMERICAN INVESTIGATION OF MORTALITY IN CHILDHOOD
Death - page 8Confidential
Name of child Serial no
Date of Sex lAge at
birth death death _yrs mo_ day hr
AUTOPSY REPORT
Date of
107 Autopsy number 108 Interval from death to initiation of autopsy
109 Weight 110 Arm circumference
Ill Other anthropometric measurements
112 Description of cadaver (note all positive findings especially on nutrition)
113 Macroscopic examination of cavities and segments (positive findings of head thorax abdomen pelvis neck limbs)
114 Macroscopic examination of organs (positive findings of appearance surfaceweight color consistency etc)
115 Microscopic examination of organs and tissues (positive findings of organs macroscopically abnormal and of those
requested)
116 Positive laboratory findings from autopsy_
117 Final diagnoses from autopsy Direct cause of death
Principal diagnosis (underlying cause)
Secondary diagnoses (associated causes)
cause118 Associated diagnoses not related with underlying
119 Type of Hospital Verification of death Medico-legal Complete Partial Incomplete
0 n biautopsy
Date____________ Interviewer_________
OF MORTALITY IN CHILDHOODINTER-AMERICAN INVESTIGATION
Confidential Death - page 9
Name of child_ Serial no
DDate of Sex [Age at
birth [death death yr mos day hr
120 Medicalcertification of cause of death (ekact copy) Duration Classification
I a _ _ _ _ _ _ _ _
Sb
121 SUMMARY OF INVESTIGATION
Medical interviewer
Basis for diagnosis Classifishycationcation
Underlying cause
1Associated causes
3
-Evaluation of nuitrition
Principal collaborator
122 ASSIGNMENT BY REFEREE Basis Special code Underling cause Iorntrishy
_________ated__auses___tional status
Clinical questionableBasis fordiagnosis 1 Autopsy 4 Hospital 5 Interview only
6 Death certificate only3 Clinical definite
--
___________
B
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Card 2 Floii 3ECIt sL2 2srv-ui i i3I 70
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(cont) IT IV ofI7 I v lt1 y W EI v I IV 1 -I 6v IV ll av6cmlef ItMsIu cglImfiv CCSL$ bull FIIGIIAL AMIIS re 7 (I -Cwd jitlel d ate
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Selected Materialfrom Provisional Report for First Year
I QUALITY OF VITAL STATISTICS
a) Deficiency in registration and in hospital records and procedures
Figure 2
DEATHS UNDER 5 YEARS WITHOUT REGISTRATION IN 9 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 5 10 15 20 25
CARTAGENA
LA PAZ AREA
SAN JUAN PROVINCE
KINGSTON AREA
CilACO PROVINCE
MEDELLIN
NONTERREY
SAN SALVADOR AREA
RECIFE
Figure 3
NEONATAL DEATHS WITHOUT REGISTRATION FOR TWO AGE GROUPS IN 9 PROJECTS
FIRST YEAR OF INVESTIGATION
Per cenL Per cent
0 10 20 30 40 50 60 70 0 10 20 30 40 50
Under I day 1-27 days
CARTAGENA
LA PAZ AREA Jmimmiil mf
SAN JUAN PROVINCE
CIIACO PROVINCE t
HONTERREY
MEDEI LN IsN KINGSTON AREA 1
SAN SALVADOR AREA
R)CCEil
b) Incomplete and puzzling data by birth weight
Figure 21
PERCENTAGE DISTRIBUTION OF NEONATAL DEATHS BY BIRTH WEICHT IN 13 PROJECTS FIRST YEAR OF INVESTIGATION AND UNITED STATES 1950
KINGSTON MEDELLIN CARTAGENA SAN SALVADOR CHACO30 AREA AREA PROVINCE
20
RIBEIREO PRETO RECIFE SO PAULO CALU ITA ATEPD10
u 20
oti
NRE0 Y SAN JUAN SANTIAGO MNERY PROVINCE AREA UNITED STATES
10-
Birth weight in grams
Excluding those with weight not stated
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
OF MORTALITY IN CHILDHOODINTER-AMERICAN INVESTIGATION
Confidential Death - page 9
Name of child_ Serial no
DDate of Sex [Age at
birth [death death yr mos day hr
120 Medicalcertification of cause of death (ekact copy) Duration Classification
I a _ _ _ _ _ _ _ _
Sb
121 SUMMARY OF INVESTIGATION
Medical interviewer
Basis for diagnosis Classifishycationcation
Underlying cause
1Associated causes
3
-Evaluation of nuitrition
Principal collaborator
122 ASSIGNMENT BY REFEREE Basis Special code Underling cause Iorntrishy
_________ated__auses___tional status
Clinical questionableBasis fordiagnosis 1 Autopsy 4 Hospital 5 Interview only
6 Death certificate only3 Clinical definite
--
___________
B
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(cont) IT IV ofI7 I v lt1 y W EI v I IV 1 -I 6v IV ll av6cmlef ItMsIu cglImfiv CCSL$ bull FIIGIIAL AMIIS re 7 (I -Cwd jitlel d ate
C
Selected Materialfrom Provisional Report for First Year
I QUALITY OF VITAL STATISTICS
a) Deficiency in registration and in hospital records and procedures
Figure 2
DEATHS UNDER 5 YEARS WITHOUT REGISTRATION IN 9 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 5 10 15 20 25
CARTAGENA
LA PAZ AREA
SAN JUAN PROVINCE
KINGSTON AREA
CilACO PROVINCE
MEDELLIN
NONTERREY
SAN SALVADOR AREA
RECIFE
Figure 3
NEONATAL DEATHS WITHOUT REGISTRATION FOR TWO AGE GROUPS IN 9 PROJECTS
FIRST YEAR OF INVESTIGATION
Per cenL Per cent
0 10 20 30 40 50 60 70 0 10 20 30 40 50
Under I day 1-27 days
CARTAGENA
LA PAZ AREA Jmimmiil mf
SAN JUAN PROVINCE
CIIACO PROVINCE t
HONTERREY
MEDEI LN IsN KINGSTON AREA 1
SAN SALVADOR AREA
R)CCEil
b) Incomplete and puzzling data by birth weight
Figure 21
PERCENTAGE DISTRIBUTION OF NEONATAL DEATHS BY BIRTH WEICHT IN 13 PROJECTS FIRST YEAR OF INVESTIGATION AND UNITED STATES 1950
KINGSTON MEDELLIN CARTAGENA SAN SALVADOR CHACO30 AREA AREA PROVINCE
20
RIBEIREO PRETO RECIFE SO PAULO CALU ITA ATEPD10
u 20
oti
NRE0 Y SAN JUAN SANTIAGO MNERY PROVINCE AREA UNITED STATES
10-
Birth weight in grams
Excluding those with weight not stated
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
--
___________
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Selected Materialfrom Provisional Report for First Year
I QUALITY OF VITAL STATISTICS
a) Deficiency in registration and in hospital records and procedures
Figure 2
DEATHS UNDER 5 YEARS WITHOUT REGISTRATION IN 9 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 5 10 15 20 25
CARTAGENA
LA PAZ AREA
SAN JUAN PROVINCE
KINGSTON AREA
CilACO PROVINCE
MEDELLIN
NONTERREY
SAN SALVADOR AREA
RECIFE
Figure 3
NEONATAL DEATHS WITHOUT REGISTRATION FOR TWO AGE GROUPS IN 9 PROJECTS
FIRST YEAR OF INVESTIGATION
Per cenL Per cent
0 10 20 30 40 50 60 70 0 10 20 30 40 50
Under I day 1-27 days
CARTAGENA
LA PAZ AREA Jmimmiil mf
SAN JUAN PROVINCE
CIIACO PROVINCE t
HONTERREY
MEDEI LN IsN KINGSTON AREA 1
SAN SALVADOR AREA
R)CCEil
b) Incomplete and puzzling data by birth weight
Figure 21
PERCENTAGE DISTRIBUTION OF NEONATAL DEATHS BY BIRTH WEICHT IN 13 PROJECTS FIRST YEAR OF INVESTIGATION AND UNITED STATES 1950
KINGSTON MEDELLIN CARTAGENA SAN SALVADOR CHACO30 AREA AREA PROVINCE
20
RIBEIREO PRETO RECIFE SO PAULO CALU ITA ATEPD10
u 20
oti
NRE0 Y SAN JUAN SANTIAGO MNERY PROVINCE AREA UNITED STATES
10-
Birth weight in grams
Excluding those with weight not stated
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
C
Selected Materialfrom Provisional Report for First Year
I QUALITY OF VITAL STATISTICS
a) Deficiency in registration and in hospital records and procedures
Figure 2
DEATHS UNDER 5 YEARS WITHOUT REGISTRATION IN 9 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 5 10 15 20 25
CARTAGENA
LA PAZ AREA
SAN JUAN PROVINCE
KINGSTON AREA
CilACO PROVINCE
MEDELLIN
NONTERREY
SAN SALVADOR AREA
RECIFE
Figure 3
NEONATAL DEATHS WITHOUT REGISTRATION FOR TWO AGE GROUPS IN 9 PROJECTS
FIRST YEAR OF INVESTIGATION
Per cenL Per cent
0 10 20 30 40 50 60 70 0 10 20 30 40 50
Under I day 1-27 days
CARTAGENA
LA PAZ AREA Jmimmiil mf
SAN JUAN PROVINCE
CIIACO PROVINCE t
HONTERREY
MEDEI LN IsN KINGSTON AREA 1
SAN SALVADOR AREA
R)CCEil
b) Incomplete and puzzling data by birth weight
Figure 21
PERCENTAGE DISTRIBUTION OF NEONATAL DEATHS BY BIRTH WEICHT IN 13 PROJECTS FIRST YEAR OF INVESTIGATION AND UNITED STATES 1950
KINGSTON MEDELLIN CARTAGENA SAN SALVADOR CHACO30 AREA AREA PROVINCE
20
RIBEIREO PRETO RECIFE SO PAULO CALU ITA ATEPD10
u 20
oti
NRE0 Y SAN JUAN SANTIAGO MNERY PROVINCE AREA UNITED STATES
10-
Birth weight in grams
Excluding those with weight not stated
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
b) Incomplete and puzzling data by birth weight
Figure 21
PERCENTAGE DISTRIBUTION OF NEONATAL DEATHS BY BIRTH WEICHT IN 13 PROJECTS FIRST YEAR OF INVESTIGATION AND UNITED STATES 1950
KINGSTON MEDELLIN CARTAGENA SAN SALVADOR CHACO30 AREA AREA PROVINCE
20
RIBEIREO PRETO RECIFE SO PAULO CALU ITA ATEPD10
u 20
oti
NRE0 Y SAN JUAN SANTIAGO MNERY PROVINCE AREA UNITED STATES
10-
Birth weight in grams
Excluding those with weight not stated
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
I MORTALITY BY AGE
a) Under 5 yAars in cities and suoburban and ruAral areas
Figure 4
MORTALITY UNDER 5 YEARS IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 10 20 30
RECIPE
LA PAZ
SAN SALVADOR
REUISTENCIA
S1O PAULO
MONTERREY
CALl
MEDELLIN
CARTAGENA
RIEZIRXO PETO
SANTIAGO
KINGSTON
SAN JUAN
1967
UNITED STATES
CANADA i
Figure 5
MORTALITY UNDER 5 YEARS IN 7 PROJECTS WITH URBAN AND RURAL ARIAS
FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
30 500 10 20 40
SAN SALVADOR Rural AREA City
LA PAZ Viacha AREA City
RIBEIRAO PRETO francamp ARIA Rural City
sANJUAN- Rural
PROVINCE Suburbs City
CHACO Rural
PROVINCI Resistencia
SANTIAGO Suburban AREA City
KINGSTON Rural AREA City
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
-4shy
b) -Tnfnnt mortality
INFANT MORTALITY BYAGE GROUP IN CENTRAL CITIES
FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births
0 20 40 60 SO 100
- 77RECIFE SAYSALADO
=LA PAZ
RESISTENCIA
SAO PAULO
MONTERREY -
CALI
SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
SAN JUAN
KINGSTON
1967
UNITE STAT2S
CANADA
Under 127 28 daysshyday d ys 11 months
Table 6 Neonatal Deaths and Deaths Under 5 Years Expeoted and Obtained in Selected Cities
First Year of Investigation
Deaths under5 yearsNeonatal deaths
City Obtained Obtained Ee Num- Per EXpeC Num- Pertected tectedber cent ber cent
Cmli 372 297 798 1039 964 928 Cartagena 235 218 928 638 621 973 Medellin 250 191 764 751 692 921 Monterrey 993 856 862 2458 2321 944 Ribeir~o Prito 112 108 964 255 251 984 San Juan 72 68 944 137 133 971 San Salvador 399 361 905 1328 1334 968 Santiago 474 309 652 1080 915 847
Based on 30 neonatal deaths expected per 1000 live births in cities with infant death rates of 50 or over and 25rneonatal deaths per 1000 live births in cities with infant death rates of less than 50
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
-5-
III UNDERYING AND ASSOCIATED CAUSES OF MORTALITY
Figure 12
UNDERLYING AND ASSOCIATED CAUSES OF INFANT DEATHS BY BROAD GROUPS IN
9 CITIES FIRST YEAR OF INVESTIGATION
UNDERLYING ASSOCIATED UNDERLYING ASSOCIATED
Deaths per 1000 live births Deaths per 1000 live births
Grouss o 0 10 20 30 0 10 20 30 40 0 10 20 30 0 10 20 30 40causes________________ __
Cali Honterrey
Infectious M Respiratory M Nutritional def immaturityOth r perinatal Other causes 11
Cartagn Rec e
infuctious illzilllll41itliFM m Resp iratory 4 Nutritional def Immaturi ty R W Other perinatal M= Other causes shy
47
Kingston Santiago
Infectious Respiratory Nutritional def Immaturity Other perinatal S C Other causes M
La Paz Sao aulo
Infectious f Respiratory Nutritional def Immaturity Other perinatal Other causes
44
Medellrn
Infectious Respiratory Nutritional def Immaturity Other perinatal Other causes
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
IV MORTALITY WITH NUTRITIONAL DEFICIENCY
Figure 25
MORTALITY FROM ALL CAUSES AND WITH NUTRITIONAL DEFICIENCY OF CHILDREN 1-4 YEARS
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Deaths per 1000 population
0 2 4 6 8 10 0 2 4
All causeu uLritiona deficiency
RECIFE LA PAZ
SAN SALVADOR
CALI
MEDELLIN
CARTAGENA
RESISTENCIA
MONTERREY
SAO PAULO RIBEIRAO PRETO
KINGSTON SANTIAGO
SAN JUAN
1967
Underlying
Contributory
c Consequential
UNITED STATES
6
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
Figure 32
NUTRITIONAL DEFICIENCY ASUNDERLYING OR ASSOCIATED CAUSE OF DEATH
FORTHREE AGE GROUPS IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
o
40
30
0
RECIFE SAO PAULO
iESISTENCIA LA PAZ MEDELLIN
SAN
SALVADOR MONTERREY CALI
RIBEIRAO
PRETO
SANTIAGO
SAN JUAN
CARTAGENA KINGSTON
a
10
o
Under 1 year I year 2-4 years
Under I year deaths per 1000 live births
1-4 years deaths per 1000 population
Figure 33
NUTRITIONAL DEFICIENCY AS UNDERLYING OR ASSOCIATED CAUSE OF DEATH FOR THREE AGE GROUPS
IN URBAN AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
40
SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE RIBEIRAO PRETO AREA
Rural City Rural Suburban City Rural City Franca City
a
30
A 20
10 _
Under Iymar lyear t 2z4 ysir
Under I year deaths par 1000 live births1-4 years deaths per 1000 population
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
VI OUTCOME OF PREVIOUS PREGNANCIES - EXAMPLE OF INFANT MORTALITY
Figure 60 INFANT MORTALITY IN CENTRAL CITIES AND IN PRODUCTS OF PREVIOUS PREGNANCIES
OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50
I 100 0 I
50 i i
100 I
150 200
Mortality in cities Mortality in previous products
REC IFE
SAN SALVADOR
LA PAZ
RESISTENCIA _ _ _ _ _ _ _ _ _ _
SAO PAULO
MONTERREY
CALl SANTIAGO
CARTAGENA
RIBEIRAO PRETO
MEDELLIN
KINGSTON
SAN JUAN
Under 28 days 28 days-li months
Figure 61
INFANT MORTALITY IN URBAN AND RURAL AREAS OF 4 PROJECTS AND IN PRODUCTS OF PREVIOUS PREGNANCIES OF MOTHERS OF DECEASED CHILDREN FIRST YEAR OF INVESTIGATION
Deaths per 1000 live births 0 50 100 0 50 100 150 200
SAN SALVADOR AREA Mortality in projects Mortality in previous products
Rural
City
SAN JUAN PROVINCE
Rural
Suburban city
CHACO PROVINCE
Rural Resistencia
RIBEIRAO PRETO AREA
Francsa
City
i Under 28 days E- 28 days-il months
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
V MORTALITY DUE TO MEASLES AND VACCINATIONS
Figure 49
FREQUENCY OF VACCINATION AGAINST SPECIFIED DISEASES AND DEATH RATES FOR 13 PROJECTS FIRST YEAR OF INVESTIGATION
VACCINATION DEATH RATE
Per cent Per 100000 population
0 20 40 60 80 0 100 200 300
TotalPR TO ARE 10 dathRIB IR m ---10 Poliomyelitis deaths
SAN JUAN PROVINCE RIEIRIO PRETO ARA
MONTERREYSAO PAULO
SANTIAGO AREA
MEDELLIN SAN SALVADOR AREA CALL CHACO PROVINCE RECIPE
CARTAGENA KINGSTON AREA LA PAZ AREA
Diphtheria Total
SANTIAGO AREA Ii43 deaths RIDEIRAO PRETO AREA MEDELLIN SAN JUAN PROVINCE CALl SAO PAULO SAN SALVADOR AREA MONTERREY CARTAGENA KINGSTON AREA --
RECIFE CHACO PROVINCE
LA PAZ AREA
Measles 81 MeIIleRECIFE
LA PAZ AREA SAN SALVADOR AREA SAN JUAN PROVINCE CHACO PROVINCE
MONTERREY RIBEIRAO PRETO AREA CALl MEDELLIN SAo PAULU CARTAGENA Total
TotalSANTIAGO AREA
KINGSTON AREA 1198 deaths
Children 1-4 yeara Deatha under 5 years
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
-- 10 -
II BREAST EDING
Figure 64
PERCENTAGE OF DECEASED CHILDREN UNDER 5 YEARS BREAST FED ONE MONTH
OR LONGER IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent 0 20 40 60 80 100
CARTAGENA LA PAZ KINGSTON RESISTENCIA CALI HEDELLIN MONTERREY SANTIAGO SAN JUAN RIBEIRAO PRETC SAN SALVADOR SAO PAULO RECIFE
Excluding neonatal deaths
VIII PROVISION OF WATER SUPPLIES
Figure 68
WATERPERCENTAGE OF HOMES OF DECEASED CHILDREN WITH PIPED
IN CENTRAL CITIES FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
KINGSTON
CALI
SANTIAGO timesMEDELLIN
CARTAGENA
SAN JUAN
MONTERREY
RIBEIRAO PRETO
SAN SALVADOR
LA PAZ
SAO PAULO RECIFE
RESISTENCIA
In house outside
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
Figure 69
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER IF URBAN
AND RURAL AREAS OF 4 PROJECTS FIRST YEAR OF INVESTIGATION
Per cent
0 20 40 60 80 100
SAN JUAN PROVINCE
City
Suburban
Rural
RIBEIRAO PRETO AREA city
Franca
SAN SALVADOR city
Rural
CHACO PROVINCE Resistencia f
Rural
= In house = Outside
Figure 70
PERCENTAGE OF HONES OF DECEASED CHILDREN WITH PIPED WATER AND MORTALITY UNDER 5 YEARS IN URBAN AND RURAL AREAS OF 4 PROJECTS
FIRST YEAR OF INVESTIGATION
ir rent Rate per 1000 population
0 20 40 60 80 100 0 10 20 30 40 50
SAN JUAN PROVINCE Water supply Hortality
City
Suburban
Rura
RIBEIRXO PRETO AREA Cit~
Franca
SAN SALVADOR AREA
city
Rural
CHACO PROVINCE Resistencia
Rural
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
FiGure 5
AL CAUSES AHIM M h TIO VEF CEBiCY OR ASSOCIATED AUE
D PER OlF TF IPED W RIu 0S PROWECTS ]EPT RTE FR 93M F( IT9AL UPTIhEfLYI
FOR 8
PER CEt1TDEATHS PER 1000 POPULATiOR OECT
0 2 4 3 10 12 0 2 4 6 S- it 12 0 20 bi0 60 8 120
LL CAUSES 1FUTRiT0AL DEFiECQ HOMES hITFH PIPEn 1iIP
I -LA
LA p17 e~l A -
iDO I - R-
-7 - -
SAREA 77- 777
sllC A R
jnrN7
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