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  • Title: [Problems and priorities in child survival].
    Author: Bobadilla JL.
    Journal: Salud Publica Mex; 1988; 30(3):470-81. PubMed ID: 3187742.
    Abstract:
    This work synthesizes the conclusions and recommendations of the 1985 International Workshop on Child Survival held in Teotihuacan, Mexico. Data are presented which document the extent of the problem of child survival in Latin America and the deficiencies of available data. Malnutrition, diseases preventable through vaccination, diarrheal diseases, acute respiratory infections, perinatal disorders, and shortcomings in quality of care are separately discussed following an assessment of their socioeconomic and cultural determining factors. Recent advances in the preventive component of primary health care programs are discussed. In Latin America, 900 of each 1000 live born babies survive to the 5th year of life compared to 980 in developed countries. Although the mortality rate of children under 5 in Latin America declined from 128 in 1950-55 to 63 in 1980-85, there are wide disparities between countries. Most countries of Latin America were classified as having high or very high infant and child mortality. There are serious differences in child survival between geographic regions and social groups of each country. The mortality decline in Costa Rica, Cuba, and Chile demonstrates that other countries could avoid a large proportion of deaths by ensuring that benefits of current programs have broader coverage. The severe economic crisis in Mexico and other countries threatens the progress already achieved in child survival. The recommendations of the conference are based on the premise that recent efforts to improve survival have been insufficient and a more rational use of the available resources and knowledge is required. In the area of health policy, priority should continue to be given to providing care for mothers and small children. Investments should be reoriented toward extending coverage of primary health care. The proportion of mothers attended during delivery by trained paramedical personnel or physicians should be increased, and family planning programs in rural areas should be strengthened. At least 80% of the target population should be immunized, and the use of oral rehydration therapy should be promoted. Educational programs to promote lactation through the 5th month and introduction of appropriate solids should be reinforced. Programs are needed to control acute respiratory infections by recognizing danger signs and seeking help. Excessive use of obstetrical interventions in urban areas should be curtailed. Quality of primary health care and other services should be assured and community participation in decision making and service delivery encouraged. In the area of research policy, funds for operational research should be included in primary health care budgets. Research by multidisciplinary teams should focus on improvement of service delivery systems and evaluation of quality of care and extent of coverage.
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