Seasonal diarrhoeal mortality among Mexican children.

The study investigated the effects on diarrhoeal deaths among under-5-year-old Mexican children of the following variables: season (summer or winter), region (north versus south), age group, and place of death. Examination of death certificates indicated that the distribution of deaths in 1989-90 was bimodal, with one peak during the winter and a more pronounced one during the summer. In 1993-94, however, the winter peak was higher than that in the summer (odds ratio (OR) = 2.04). These findings were due mostly to deaths among children aged 1-23 months (OR = 1.86). Diarrhoeal mortality was highest among children aged 6-11 months (OR = 2.23). During the winter, there was a significant increase in the number of deaths that occurred in medical care units and among children who had been seen by a physician before they died, but deaths occurring at home showed no seasonal variation. In the northern states, the reduction in diarrhoeal mortality was less in winter than in summer (OR = 2.62). In the southern states, the proportional reduction during the winter was similar to that in the summer.

PIP: In this study, the influence of season, region, age group, and place of occurrence of death on diarrheal mortality among under-five Mexican children was examined. Data on diarrheal deaths from 1989 to 1995 were collected from the National Institute of Statistics, Geography and Information, Mexico City. All diarrheal deaths among under-fives were identified by month to determine whether there was any seasonal pattern. Results showed that the distribution of death in 1989-90 was bimodal, with one peak during the winter and a more pronounced one during the summer. However, in 1993-94, the winter peak was higher than that in summer [odds ratio (OR) = 2.04]. This was caused mostly by deaths among children aged 1-23 months (OR = 1.86). Diarrheal mortality was highest among children aged 6-11 months (OR = 2.23). A significant increase in the number of deaths occurred during winter in medical care units, but deaths occurring at home showed no seasonal variation. The reduction in diarrheal mortality in northern states was less pronounced in winter than in summer (OR = 2.62); however, in the southern states, the proportional reduction in winter was similar to that in summer.

Child mortality presents major health problem in Haiti.

PIP: This news brief summarizes some findings from the 1994-95 Survey on Mortality, Morbidity, and Utilization of Services in Haiti. Child mortality has declined in the last 15 years, but the under-five mortality rate is still the highest in the Western Hemisphere. The principal causes of neonatal mortality are low birth weight (24%), obstetrical problems (23%), and neonatal tetanus (15%). The principal causes of mortality among children aged 1-5 years are diarrhea (37%), undernutrition (32%), and acute respiratory infections (25%). Only 68% of mothers giving birth receive prenatal care. 46% of births are delivered with medical assistance. Only 30% of children aged 12-23 months are fully immunized; 75% have received their first doses of DPT and polio vaccines, but only 41% have received their third doses. One in three children aged under 5 years is stunted due to undernutrition. Knowledge of AIDS and sexual modes of transmission is nearly universal. However, only 69% of women and 74% of men believe themselves to be at risk of contracting AIDS. Among the population at risk, 43% of men and only 23% of women reported a change in their behavior to prevent AIDS transmission. Fertility has declined from 6.3 children/woman in 1987 to 4.8 children/woman in 1987. 46% of women with two children desire a stop to childbearing. Although there is a desire for smaller families, only 18% of married women are currently using a family planning method.^ieng

Bolivian villagers embrace new water system.

PIP: The USAID-CARE Bolivia Child Survival and Rural Sanitation Project brought water to Tauca, a community on the shores of Lake Titicaca. Water is used for washing hands and vegetables which leads to better hygiene and nutrition and is crucial in view of the current cholera epidemic in South America. Farmers often start small irrigation projects for vegetable gardens. A gravity-pumped water system was designed by a CARE engineer but built of local materials by local people in the Bolivian village of Phorejoni Junco. 2 community-trained water operators and 2 health workers visit each home and inspect the sanitation system every month. Llamacachi, a model community with 77 families, has built a clinic with minimal material and labor commitments and additional money from water fees. All 17 children under the age of 5 have received health cards. Only 10% of the children are malnourished, and half of the 79 community mothers know how to prepare oral rehydration fluid for children with diarrhea. In 1989 the CARE project, funded by USAID, set out to improve the health and self-sufficiency of 48,000 people in 160 communities in the Bolivian departments of La Paz, Cochabamba, and Santa Cruz. A major objective was to better the survival rates of children under age 5 by constructing water supply systems, reinforcing community organizations and improving hygiene. In Bolivia fewer than 31% of the rural population has water services, fewer than 13% of the people have latrines, and fewer than 30% have access to health services. The mortality rate of children under age 5 is 100/1000, and 75% of those deaths are related to diarrhea or parasitic illness. The Bolivia Child Survival Project reduced infant mortality in these communities from 210 deaths to 100 deaths per 1000 children under age 5. CARE's Bolivia Child Survival Project was recently funded for 4 more years to serve an additional 160 communities, demonstrating that a sound child survival program and a focus on health depends on quality water systems.^ieng

[Economic and social policies and the health of the Dominican child: a research approach]. / Las politicas economicas y sociales y la salud del nino dominicano. Una aproximacion a su estudio.

PIP: In recent decades the United Nations has established that infant mortality, child mortality, and gross national product are a function of development by observing a clear line of correlation between these factors. Various schemes studying the crisis of the family and poverty have concentrated on the welfare of children measured by their morbidity and mortality and nutritional status. The economic crisis that started at the beginning of the 1970s and peaked during the 1980s in Latin America resulted in the drop of the gross national product, the level of employment, and trade. It led to increased foreign debt, high inflation, currency devaluation, and the transition from an agricultural to an industrial society with urban-service components. The economic crisis increased the percentage of the Dominican population affected by poverty from 30% to 50%. In the 1980s there was a progressive decrease of infant mortality to the average global level. In 1988 the National Center of Maternal-Child Health Investigations conducted a household study on the health and nutritional status of children born in Regions O, IV, and VI by analyzing the socioeconomic situation of the families during this economic crisis. The crisis resulted in: the decrease of income, the increase of black market employment, the decrease in the number of families with access to social programs, and the increase in the costs of education and living. Infant mortality increased from 73% to 80% among infants aged 9-12 months. There was a decrease in malnutrition among those aged less than 2 months of age; however, there was a noteworthy increase in the mortality of malnourished children as well as those with diarrhea and respiratory infections. There was also a slight improvement in living conditions with the decrease of the cost of food, hygiene, and sanitation.^ieng

Mortality due to intestinal infectious diseases in Latin America and the Caribbean, 1965-1990.

PIP: Life expectancy has increased in Latin America and the nonLatin Caribbean (LA/CA) from 51.8-66.6 years and 56.4-72.4 years between 1950-1955 and 1985-1990 respectively. Reduction in mortality due to infectious and parasitic diseases had the most significant effect on this rise in life expectancy. Indeed since the actual number of intestinal infection related deaths did fall while the populations grew considerably, there was a true reduced risk of death from these infections. Improved nutrition, potable water and waste disposal availability, immunizations, and safer food handling directly impacted on this reduction while the downward trend of the birth rate, increased literacy (especially among women), and mass media indirectly prompted the decline. Nevertheless these improvements have not yet reached the levels of the US and Canada during 1965-1970 (.07/1000) and have not been equitably divided among the different population groups. Indeed the technology existed 2 decades earlier to achieve zero deaths from diarrhea, yet deaths rates in LA/CA continued to range from .17-9.83/1000 during 1985-1990. Costa Rica and Chile experienced more of a decline in mortality from intestinal infections than most other countries. For example, the number of deaths fell about 90% for about the entire population and 93% and 95% respectively for children 5 years old. Even though there was a 95% reduction in the number of deaths for 5 year old children in Chile, the 64% reduction in Mexico resulted in more lives saved (355 vs. 529). Further data analysis showed that the death rate for 5 old children was the most valid indicator to analyze changes in mortality from intestinal infections. Over the 25 year period the countries with the least reduction in death rates from diarrhea included Guatemala, Honduras, and Nicaragua.^ieng

[Child survival: magnitude of the problem in Latin America]. / La sobrevivencia en la infancia: las dimensiones del problema en América Latina.

PIP: This document summarizes the most relevant epidemiologic characteristics of infant and child mortality in Latin America. The gap in infant mortality rates between Latin America and the developed countries is wide and appears to be increasing. In the developed countries, 980 of each 1000 infants survive to the age of 5, but only 900 did so in Latin America in 1975-80. Infant mortality declined in Latin America between 1950-55 and 1980-85 from 128 to 63/1000 live births, with a slight increase in the rate of decline over the past decade. The great differences in social and economic development within Latin America are reflected in mortality rates before the age of 5 that also vary widely, from 34/1000 in Cuba to 221/1000 in Bolivia in 1975-80. Latin American countries with moderate risk of early childhood mortality are led by Cuba and Costa Rica, with rates of 34-35/1000. The 2 countries are very different politically but both have implemented vigorous social policies that benefitted their entire populations. Both had sustained mortality declines between 1955-80. Argentina, Chile, Uruguay, Venezuela, and Panama had mortality rates of 46-56/1000. Within the region, 16.4% of births and 8% of deaths in children under 5 are estimated to occur in these 7 countries. The countries of very high mortality include the least developed Caribbean, Central American, and Andean countries: Haiti, guatemala, Honduras, Nicaragua, Bolivia, and Peru. 3 of these countries contain large indigenous populations that have largely remained outside the development process. Their average rate of infant mortality is 162/1000. 14.7% of births and 27.0% of deaths in children under 5 in Latin America occur in these 6 countries. The intermediate group contains the 2 most populated countries of the region, Brazil and Mexico. The risk of death under age 5 ranges from 74 to 114/1000 and averages 99/1000. The 7 countries account for 68.9% of births and 68% of deaths in children under 5. The rate of decline in infant mortality in Latin America is on the whole moderate, with no sign of acceleration. Progress is slowest in the countries with the highest rates. Available data clearly demonstrate excess mortality in rural areas, especially when compared to capital cities, but the degree of disparity varies among countries. In countries with high mortality and a large rural population, sustained decline in national mortality rates will require rural populations to be incorporated in the decline. In 1985, about 40% of Latin American children under 5 were believed to be in rural areas, but the proportion rural was 57% in the countries with highest mortality. Statistical information on causes of death in children under 5 is most deficient in exactly the areas where it is most needed. Most deaths are clearly due to infectious diseases and conditions preventable by vaccination. Social inequalities in survival of young children have been extensively described as a function of paternal occupational status, maternal education, and geographic factors. More effective policies are needed to ensure a more equitable distribution of wealth that will make possible a major improvement in child survival.^ieng

Costa Rica saves infants' lives.

PIP: Even though Costa Rica is underdeveloped economically, life expectancy has been increasing over the past decade and the illiteracy rate was only 7% in 1984. Infant mortality rates have plummeted since 1972 when the 1st national health plan and social security were instituted (pre-1972: 2.3% annual reduction in infant mortality; 1972-1980: 13% decline annually). Decreased risk in the 1st postnatal month of life was responsible for 34% of the decrease from 1972-1980. Control of disease, especially diarrhea and acute respiratory infection, accounted for most of the decline (51%). Immunizations accounted for 8%, prevention of infectious diseases for 10%, control of malnutrition for 5%, and control of death due to premature birth for 14% of the decrease in mortality. Infant death due to pregnancy and delivery complications and congenital defects did not decrease during this period. Socioeconomic conditions normally influence survival rates strongly, but socioeconomic change in Costa Rica during 1970-1980 accounted for only 1/3 of the reduction in infant mortality. These improvements included an increase in the number of educated women, economic growth and decline in fertility (a decrease from 7.6 to 3.4 births between 1960-1980). The majority of the reduction stemmed from utilization of family planning techniques and the reduction of health risk factors. By 1980, the health program initiated in the 1970's provided primary care to 60% of the population, immunized 95% of the children against poliomyelitis, diptheria, pertussis, tetanus, and measles, and by 1984, provided almost all households with a sewage system. Analyses of the impact of socioeconomic development, fertility regulation, hospital care, outpatient services, and primary health care on infant mortality showed that, before 1970, those areas with better economies had a lower mortality rate, and after 1970, the economy and mortality rate had become independent variables. Furthermore, the introduction of health programs in the 1970's correlated with the accelerated decrease in mortality.^ieng

An analysis of health progress in Chile.

PIP: Chile has been no exception to the Latin American trend of declining general mortality, i.e., over the past 20 years (between 1961-81) general mortality in Chile fell by some 47%. A number of circumstances makes Chile a suitable place for studying the factors leading to these favorable developments. National information is available, including reasonably reliable data on the magnitude of health problems, the risks of dying, and the collection of conditioning factors affecting health. Adjusting for age and sex, overall mortality in Chile fell by 20% in the 1960s and 29% in the 1970s, but the most marked declines, especially in the latter decade, occurred among infants (a 60% reduction) and children 1-4 years old (a 67% reduction). Morbidity indicators suggest that overall morbidity declined little, but considerable reductions were observed in infectious disease cases preventable by immunization as well as in moderate and severe cases of malnutrition. Data on deaths attributed to specific causes show that mortality due to certain causes, including communicable diseases, malnutrition, maternal problems, and stomach cancer, dropped sharply, while mortality caused by a wide range of mostly chronic problems remained relatively stable. This implies that health efforts made to combine those latter problems failed to greatly modify the mortality involved. It is difficult to quantify the mental health status of any group unless data on reliable and representative indicators are available. In Chile, information is available only on mortality caused by problems whose genesis normally involves a change in mental health. This happens in the case of alcoholism and cirrhosis of the liver, the latter generally being caused in Chile by excess alcohol consumption. Accidents and violent acts also have been associated frequently in Chile with excess alcohol consumption and emotional disturbances. With the exception of mortality attributed to alcoholism, which increased by 0.3 deaths/100,000 inhabitants between 1970-80, mortality caused by the rest of the conditions associated with mental problems decreased during the decade. The major economic crisis of the 1970s seemed to have no effect on the mortality trend, so that declining mortality appears independent of the significant variations in per capita income during this period. Since the 1960s the Chilean health policy has assigned top priority to maternal and child health, emphasizing periodic checkups for expectant mothers, infants, and young children. Available evidence strongly supports the idea that a notable extension of coverage provided by the Chilean health services, especially primary care and infant oriented health services, was principally responsible for the rapid decline of infant and young child mortality.^ieng

[Child health in Chile during the 70's]. / La salud infantil en Chile durante la década del setenta.

PIP: Changes in the Chilean health situation during the period 1970-80 are discussed in this report. The most important feature was the decrease in the death risk in children ages 1 month-5 years. The downward trend in mortality risk was observed in both urban and rural areas. There was also a fall in the number of cases of infectious diseases with vaccinations and in the number of diseases noticed by the mothers during the home surveys. As a consequence of these changes, respiratory and infectious diseases decreased in relative importance from 58% to 25% of total children deaths; perinatal problems increased from 17-30% and congenital pathology from 4-10%. The downward trend in morbidity and mortality in Chile was not associated with the economic situation in the country nor the changes in national organization. It is estimated that 1/3 of the decline is related to the changes in type and number of children as a result of the family planning programs. 2/3 are related to the progress in medical care with an increased number of medical visits, well-baby clinics, hospital admissions, births in hospitals, vaccinations, and malnutrition control programs. (author's modified)^ieng

[Chile: mortality between 1 and 4 years of age. Trends and causes]. / Chile: mortalidad de 1 a 4 anos de edad. Tendencias y causas.

PIP: The great decline in infant mortality in Chile in the last 2 decades provokes interest in the current situation in child mortality (for children 1-4 years of age). For the present analysis, central death rates and probabilities of dying are used, calculated with Greville's method from birth and death data. Mortality trends of the group between 1961-78, sex differentials, and causes of death are studied. The findings indicate that mortality in this age group has declined dramatically during the period of analysis, mainly due to the decrease in mortality from respiratory diseases, diarrhea, and diseases avoidable through vaccination. To attain the future approach of the Chilean rate to that of more developed countries, the reduction of mortality from respiratory diseases and diarrhea should continue together with the achievement of substantial reduction in mortality from violence and accidents. This, the primary cause of death in children, ages 1-4, has not varied during the period under study. (author's)^ieng