In the evaluation of the health status of a population, the periodic recording of children’s physical growth must occupy a prominent place. It is now recognized that somatic growth is a highly sensitive indicator of the health and nutrition of a population. As developing countries with poor nutrition and high mortality improve their economic and social status and raise the standard of living of their populations, studies on growth will become increasingly important in health evaluation.
Until now, indirect indicators such as maternal, perinatal, infant, preschool, school-age and general mortality have been taken as standards for assessing the development of the population’s health status. Mortality statistics constitute a retrospective record, which may in a certain sense be considered passive. They reflect an indicator that is not only indirect but also negative, since it measures disease through its most unfavorable outcome: death.
By contrast, a large-scale anthropometric survey repeated at regular intervals has the advantage of constituting a more active prospective action. It reveals a conscious and strategic concern for health and provides an indicator closer to the real evaluation of health than the assessment of disease and death.
Beginning in 1959, health activities in Cuba focused on more urgent actions, such as the establishment of healthcare units in rural areas, where more than 40 hospitals were founded; the expansion and reorganization of primary care; and two fundamental programs: one for the reduction of maternal mortality and another for the fight against acute diarrheal diseases in children.
Although these programs were not specifically aimed at reducing infant mortality, they contributed to lowering its rate. Before 1959, despite considerable underregistration, the infant mortality rate was estimated at 70 per 1,000 live births. In 1965, the definition of live birth adopted by the World Health Organization began to be applied. According to this definition, in 1969 the rate fell to 46.7 per 1,000.
It was in 1970 that the Program for the Reduction of Infant Mortality set as its goal a 50% reduction during the decade. This meant achieving a rate of about 24 per 1,000 in 1980. At the same time, it was believed that, if this goal were achieved, from that moment onward the mortality-rate indicator would lose value in the evaluation of child health and would have to be complemented by other positive indicators, such as the recording of children’s growth and development.
National Study
As the result of an in-depth analysis of the situation and a careful evaluation of maternal and child care, Cuba developed, for 1970, different programs in fulfillment of a new health strategy whose main objective was the reduction of maternal, perinatal and infant mortality rates.
The short- and long-term goals of the program included: increased coverage of services, expanded care for pregnant women and institutional deliveries; detection of high-risk pregnant women and newborns; development of specialized and technical human resources; health education; and improvement of the operational resources of the national health system.
At the same time, since there were no national standards for children’s growth and development, and the available foreign standards had proven inappropriate, it was considered justified to carry out a national study directed toward those goals. This decision was based on the assumption that, once the goals of reducing infant mortality were achieved, many children who would previously have died would then survive.
The question that would arise at that moment would be: they do not die, but in what state of health are they? A study of children’s growth would provide a good answer to that question.
The Program for the Reduction of Infant Mortality was a complete success, since by 1977 the goal of a 50% reduction had already been met, with a rate of 24.6 per 1,000 live births. These figures are highly reliable because official investigations carried out by the Pan American Health Organization recognized only minimal underregistration.
The national health system that has developed in Cuba over the past twenty years through regionalization, sufficient human and material resources, and close interaction with the community has surpassed important goals, particularly in the area of maternal and child health.
In 1982, with an overall mortality rate of 5.7 per 1,000 inhabitants, there was a perinatal mortality rate of 21.8 per 1,000 live births; infant mortality of 17.3 per 1,000 live births; mortality among children aged 1 to 4 years of 0.9 per 1,000 inhabitants in that age group; mortality among children aged 5 to 6 years of 0.5 per 1,000 inhabitants in that age group; and maternal mortality of 4.8 per 10,000 live births.
In addition to these achievements, malaria, poliomyelitis, diphtheria and neonatal tetanus have been eradicated. Mortality from infectious and parasitic diseases, which in 1962 had a rate of 94.4 per 100,000 inhabitants, had fallen to 11.3 by 1982. During the same twenty-year period, mortality from acute diarrheal diseases decreased from 57.3 to 4.1 per 100,000 inhabitants. Among children under one year of age, this rate fell from 4.9 per 1,000 live births in 1968 to 1.0 in 1982.
When a developing country achieves significant health gains in reducing child mortality, it reaches the stage at which it becomes necessary to complement the information by carrying out periodic anthropometric surveys. These constitute a true epidemiological method for evaluating the health status of the population.
The results of the 1972–1974 National Growth and Development Study showed an inverse and constant relationship across the different provinces between children’s height and infant mortality. In provinces where mortality was lower, children were taller; conversely, where mortality was higher, physical development was lower.
This work provides information related to that study, its design and some of its results. It also comments on the importance of repeating these investigations every ten years, as has been done in Cuba with the new study carried out in 1982, whose data will be compared with those of the first study.
