# CHILD MORTALITY

CHILD MORTALITY — mortality of children on the first year of life (0 — 12 months). The coefficient (indicator) of D. of page is applied in a dignity. and to demographic statistics (see) for designation of number of deaths among children aged till 1 year counting on 1000 been born live. Among the indicators characterizing the state of health of the population (incidence, mortality, physical. development), D. of page is one of leaders.

D.'s decrease of page promotes increase in an indicator of average life expectancy of the population.

Important social and hygienic value D. of page is defined first of all by the fact that it much more exceeds mortality in all subsequent age groups of the population, except for persons of advanced and senile age (60 years and are more senior).

## Methods of calculation of coefficient of child mortality

several methods of calculation of D. of page Are applied. The simplest of them:

[number of the children who died within the first year of life in this year x 1000] / [the number been born live the same year] (1)

However in practice of health care is more often applied other, more exact method which allows to consider also influence of changes of level of birth rate during the calculation of coefficient of D. of page:

[number of the children who died within the first year of life in this year x 1000] / [2/3 children who were born in this year + 1/3 children, born in previous year] (2)

Since 40th in demographic statistics are used more exact formulas for determination of coefficient of D. of page.

where Mo' — number of the dead aged till 1 year from among been born that year, for to-rogo is defined child mortality; Mo" — number of the dead aged till 1 year from among been born in previous year; M 1 '— number of the dead aged till 1 year in previous year from among been born the same year; No — number been born the same year, for to-rogo is defined child mortality; N 1 — number been born in previous year.

Level of coefficient of D. of page depends on a complex social and biol, factors, the leader biol, a factor is the age of the child. On the first week and the first month of life of the newborn action of such reasons of mortality as asphyxia and an atelectasis, inborn malformations, birth trauma, etc. is more visually shown. After the first month of life of the child among causes of death the specific weight of pneumonia increases, acute went. - kish. and the infectious diseases, accidents and other diseases caused considerably by environmental factors. In this regard it is especially important to allocate the sizes and D.'s reasons for page depending on the age periods of the first year of life.

One of the leading indicators of D. of page depending on age of newborns is early D. of page (neonatal mortality, a neomortality or mortality of children on 1 month of life, to be exact in the first 28 days). In economically developed countries the share of the dead on 1 month of life makes 60 — 80% among all dead of 1 year. Therefore in practice are calculated separately both early (neonatal) D.'s coefficient of page (4), and D.'s indicator of page of the subsequent And month of the first year of life (5). Technique of their calculation following:

[number of the children who died at the age of 0 — 27 days x 1000] / [number been born live] (4)

Rate of mortality of children at the age of 1 — 12 month can be calculated as a difference between D.'s indicator of page and early D.'s indicator of page, however for more exact calculation it is necessary to use a special formula:

[the number of children, dead are aged more senior month (28 days) x 1000] / [number of been born — number of the children who died on the first month (0 — 27 days) of life] (5)

Death rate of newborns (neonatal mortality) in various countries different — on average than 15 — 20 per milles.

## Dynamics of indicators of child mortality

the Published D.'s indicators of page and early D. of page in many developing countries is actually slightly higher in view of incompleteness and inaccuracy of official statistical data.

In the USSR the highest rate of decrease in coefficient of D. of page considerably advancing the corresponding rates of its decrease in the developed capitalist countries is noted. For years of the Soviet power D. of page in the USSR decreased more than by 9 times and made 27,8 per milles in 1974. On the certain republics and areas its level considerably fluctuates. E.g., at coefficient of child mortality in general across RSFSR in 1970 equal of 23 per milles in the Belgorod Region it made 15,8 per milles, in Ryazan — 16,7 per milles, in Krasnodar Krai — 16,8 per milles, in Tyumen and some other areas this indicator is higher, than in general on the republic.

Child mortality during various periods of the first year of life. Along with a neomortality it is accepted to mark out early neonatal mortality (number of the children who died on 1 week of life) and late neonatal mortality (number of the children who died on 2 — 4th week of life). Among the reasons of an early neomortality inborn malformations, birth trauma, post-natal asphyxia, an atelectasis, pneumonia of newborns prevail, fight with to-rymi presents great difficulties. Therefore rates of decrease in an early neomortality significantly differ from pages, those at the general D. So, according to WHO data, in eight developed countries of the world from 1950 to 1970 mortality on 4 — decreased 51 week by 61%, on 1 — 3rd week for 56% while during the first seven days of everything for 32%.

In demographic and a dignity. to statistics, and also in obstetric and pediatric practice the concept «perinatal mortality» is widely applied (of the 28th week of pre-natal development until the end of 1 week of life). Method of calculation of an indicator of perinatal mortality following (6):

[number mortinatus + number of the dead in the first 7 days of life x 1000] / [number been born live and dead]

(6) B 60 — the 70th are 20 century an indicator perinatal mortality (see) from 15 to 30 per milles, and in some countries — to 45 — 60 per milles fluctuate (Portugal, Venezuela, India, Uganda, etc.). The size of an indicator of perinatal mortality is influenced by system of the account and the used definitions of signs of life. In our country a sign of a zhivorozhdennost is breath.

Despite difficulties of fight against perinatal mortality, decrease in its level is noted.

During the studying of perinatal mortality it is accepted to divide it into three periods; a prenatal mortality (death of a fruit after 28 weeks of pregnancy and prior to childbirth), intranatal mortality (death of a fruit during a childbed) and a postnatal mortality (death of a fruit in the first 7 days after the birth). According to WHO data, the indicator of a prenatal mortality makes 5 — 7 per milles, intranatal — 7,5 — 8,6 per milles and post-natal — 2,5 — 3,2 per milles.

## The reasons of child mortality

In the 70th 20 century in economically developed countries the main reasons for death on the first year of life were diseases of the perinatal period which arise at a fruit, in the course of childbirth or the child on 1 month has lives (a hemolitic disease, pre-natal pneumonia, asphyxia and an atelectasis, a birth trauma, etc.). Structure of perinatal mortality is as follows: to 60% occupy asphyxia, 10 — 12% birth trauma, 7 — 8% — inborn malformations, 5 — 6% — pneumonia, to 3% — a hemolitic disease of newborns.

Special influence on indicators and D.'s reasons for page renders a nedonashivayemost of pregnancy. It is established that in the majority of the developed countries of the world about 60% of all cases of still births, to 70% early neonatal and to 66% of child mortality fall to the share of premature children. In structure of the reasons of mortality premature on the first year of life the leading places are taken by an intracranial birth trauma (47 — 63%), asphyxia (10 — 14,5%), inborn malformations (8 — 12%), pneumonia (7 — 13%) and sepsis (6 — 6,5%). Among the reasons of mortality of premature newborns the leading place is taken asphyxia (more than 50%), by birth trauma (to 17%) and inborn malformations, incompatible with life (to 13%).

D.'s indicator of page depends also on number of childbirth, age of the woman, an interval between childbirth, extent of not wearing out of pregnancy, frequency of abortions, the nature of feeding of the child, the result of the previous pregnancy, diseases of mother, seasonality, social and labor and living conditions, time of the first appeal of the pregnant woman to clinic for women, etc. Among boys rates of mortality on the first year of life are 10 — 20% higher, than among girls.

It is established that growth of social and economic development of the country, culture and material well-being of the population, improvement of medical aid to women and children are the leading conditions of decrease in D. of page. In the USSR in the absence of class contradictions and consequently, and social contrasts in indicators of public health there are no essential distinctions in levels D. of page among children of workers, collective farmers and the intellectuals. In the conditions of capitalist society «social genesis» and class contrasts find direct reflection in the sizes D. of page. In the USA among the color population, in the Republic of South Africa among the Black and Asian population, in New Zealand among aboriginals (Maori) D.'s indicators of page, early D. pages, perinatal mortality and a mertvorozhdennost always were and continue to remain much higher, than among white, persons of the European origin, prosperous layers and classes of bourgeois society. So, in Scotland mortinatality among children financially families in 1939 made of the most secure 34,1 on 1000 childbirth, and in 1963 — 10,8, i.e. decreased by 3 times, and among children of the most low-secure financially of families decreased for the same years from 42,7 to 25,1 ‰, i.e. only by 1,7 times. In 1970 — 1972 in the Republic of South Africa among the white population D. made page 21, among the Asian — 36 and among the indigenous (Black) people 127 on 1000 been born live. In the USA in 1965 D.'s indicator of page among the white population made 21,5 and early D. page — 16,1, and among color — respectively 40,3 and 25,4 ‰.

In the socialist countries of D. of page steadily decreases. So, e.g., in Bulgaria in 1926 — 1930 it made 147,5 on 1000 live-born, in 1965 — 30,8, and in 1974 — 25,5; in Hungary in 1931 — 1940 D. made page 144,4, in 1960 — 48,0, and in 1974 — 34,0.

Considerable decrease in D. of page in the countries of socialism is the evidence of achievements of these countries in social and economic and cultural construction, in improvement of system of health protection of pregnant women, women in labor and women in childbirth, newborns and babies.

Extremely high level of D. of page — an effect of policy of colonialism and neo-colonialism — is still characteristic of many developing countries of Asia, Africa, Central and South America because of low level of social, economic and cultural development, an unsatisfactory condition of medical aid to the population. Data of official publications of these countries are insufficiently exact and contradictory: so, in the majority of the countries of Africa aged till 1 year 150 — 200 children on 1000, and according to selective researches — from 200 to 300 children on the same number of the population die (Kenya, Nigeria, Tunisia, Uganda, etc.).

At the same time the general progress of mankind, achievements of science and technology, achievement of medicine and health care show that in the modern world there are great opportunities for further decrease in D. of page.

Bibliography: Belitskaya E. Ya. Problems of social hygiene, page 198, L., 1970; Questions of studying of incidence and the organization of medical care to the population, under the editorship of E. I. Udintsev and B. D. Petrakov, page 89, M., 1973; Dobrovolsky Yu. A. Health of world's population in the 20th century, page 87, M., 1968; Lys and tsyn Yu. P. Social hygiene and organization of health care, page 191, M., 1973; The M e republics about in A. M. and P about l I to about in L. E. Sanitary statistics, page 255, L., 1974; The Organization of health care in the USSR, under the editorship of N. A. Vinogradov, page 196, M., 1962; Petrov-Maslakov M. A. and I. I Klimets. Perinatal mortality, L., 1965, bibliogr.; Infant and child mortality in selected countries, 1951 — 1962, Epidem. vital Statist. Rep., v. 17, p. 536, 1964.

B. D. Petrakov.