Malnutrition is a conditioning factor in child mortality, especially in developing countries. It is claimed that malnutrition is the main cause of childhood mortality in the Third World. Without a doubt, malnutrition is a determining cause of infant deaths that is often not identified as such, but instead lies beneath another final diagnosis of cause of death.
In the Inter-American Investigation of Mortality in Childhood, nutritional deficiency was established as the most serious problem revealed, and its participation as a basic or associated cause was present in 57% of deaths. However, its appearance in usual records as the final cause of death does not reflect its true magnitude.
In general, the final disease is recorded, such as infection, diarrhea or pneumonia, without mentioning the decisive weight that malnutrition had in the evolution of that process. For that reason, it is inappropriate, at least in Latin America and the Caribbean, to try to measure its importance through mortality records. There is no doubt that a large number of infant deaths recorded under other causes have their origin in malnutrition.
Conversely, progress in the reduction and control of infectious, diarrheal and acute respiratory diseases involves the nutritional improvement of the populations in which that impact occurs. Reliable, efficient and easily administered means for controlling malnutrition are not yet available, as is the case, for example, with certain vaccines or oral rehydration.
Nevertheless, a health program in the developing world without some effort toward nutritional improvement would be irrational. For that reason, actions to promote the nutrition of women and children are always present in primary healthcare.
Perhaps there is still no single and simple technique for controlling child malnutrition, but breastfeeding is an effective, harmless and economical way to guarantee good nutritional status and protect against infections during the first year of life.
The promotion of breastfeeding, information on feeding practices and other increasingly precise nutritional interventions may play an important role in reducing infant and preschool mortality. At present, there are not enough figures to measure the effects achieved, and it is expected that the improvement of nutritional epidemiological surveillance systems will make it possible to obtain the necessary data in the near future.
Relatively recent data on child mortality in the countries of the Americas have been summarized and analyzed in order to update the figures, outline the trends observed in recent decades, point out some changes in infant and preschool mortality, and estimate the influence of certain health actions and programs on those changes.
Although a general study of the Region reveals considerable progress in the coverage and quality of records, it must be recognized that many inaccuracies and omissions still exist. Therefore, the data must be analyzed with caution and conclusions must be formulated with prudence.
During the 1970s, both infant and preschool mortality declined in most countries, and the pace of those reductions was faster than in the previous decade. Nevertheless, large differences persist among subregions and even among countries within the same subregion.
It is also known that within each country there are extreme variations in infant mortality, and that in Latin America and the Caribbean there are large population sectors in which children are exposed to high, preventable risks.
The inequality in the distribution of goods and services, a consequence of the existing social relations of production, constitutes the explanatory framework for the quality of life endured by human groups in Latin America and the Caribbean where infant and preschool mortality is high.
Within this frame of reference, it is worth asking what has been the scope of modern technologies for the prevention and treatment of diseases, especially the techniques systematized under the concept of primary healthcare.
Changes in the relative importance of the different causes of death, as well as the decline in mortality related to specific techniques, suggest that the capacity of the health sector to reduce infant and preschool mortality has increased.
The central issue lies in the existence of real opportunities to apply knowledge to priority population sectors exposed to greater risks. Although the capacity of the health sector should not be overvalued, the experiences carried out in several countries of the Region show that it is possible to implement health interventions to reduce child mortality.
This implies greater responsibility for the health sector, because if it has effective instruments to reduce infant mortality, negligence would be condemnable.
The data analyzed allow only an approximation to the problem, but they provide valid guidance for later studies, such as case investigations in countries that apply these technologies; studies of programs that apply them in defined geographic areas; exhaustive analyses of the interrelations with the evolution of the economy, income distribution, employment and community behavior; and evaluation of technologies that can be applied to other diseases that cause high mortality, such as those of the perinatal period.
The subject is important for the demographer because the future course of infant mortality will depend largely on the progress made in reducing it. It is of interest to the health professional because, through the application of strategies and technologies, it seeks to avoid the dramatic contrast between the wealth of current knowledge and the restrictions on its equitable application to combat disease and mortality.
Finally, the health team and the entire community acquire a deep ethical meaning in this struggle.
