INFANT MORTALITY

Dominion, Volume 21, Issue 186, 9 May 1928, Page 5

INFANT MORTALITY

DOMINIONS LOW RATE AN INTERNATIONAL RECORD NEW ASPECTS OF PROBLEM In a study of the vital statistics of New Zealand for recent years, three, outstanding features, immediately present themselves —a constant decline in the birth-rate: the maintenance of the general death-rate at an exceedingly low level; and a continued reduction in an alrearly astonishingly low infantmortality rate, The latest monthly Abstract of Statistics in an article of outstanding interest deals with various aspects of the question. The results of the analysis of the position may be', briefly summarised as follow: —

(a) The infant-mortality rate is gradually declining ill. New Zealand for the

two sexes separately, for the total, and the 3927 rate is the lowest ou record.

(b) While the total infant-mortality rate is declining, the position is not so satisfactory for earlier periods of the first year of life, particularly for those periods under, one month, where the rate shows a general tendency to in-' crease slightly in P£7. The closer to the moment of birth that the investigations are taken, the higher the proportion; of deaths, reflecting the effect of the ante-natal factors.

(c) The above is borne out still further by the data relating to causes of death, which show that the proportion of deaths from ante-natal causes is easily greatest at the earliest, division, thereafter decreasing with increasing age.

, (d) The South Island has a higher infant-mortality rate than the North Island, and for 1927 Canterbury provincial district had the highest and Southland provincial district the lowest rate. (e) Au international comparison reveals that New Zealand has the lowest infant-mortality rate in the world,'

(f) .The inclusion of still-births raises the infant-mortality rate very considerably, but does not offset the general downward tendency, in spite of the tact that the still-birth rate has an upward trend. For individual sexes, males show a tendency to decline and females to increase, although this position is reversed for 1927. Record .Low Death Rate. For the year 1927 tjiere were only 1080 deaths of infants under one year 'of age, which is an improvement on the figure for the previous year of 52. or 41 per cent. The rate per 3.000 live births fell from 39.76 in 1926 to 38.74 in 1927, thus reaching a phenomenally low level —one, indeed, which has never hitherto been approached either in this country or in any other country in the world. The following tables show for the last five years the numbers and rates of infant deaths in New Zealand for the two sexes separately and to-

Not only is the total rate for 1927 the lowest on record, but for each sex taken separately the same remark applies. The rate for males is invariably higher than that for females.

Many and variedjare the factors operating towards this immense saving in infant life effected in reeent years. While it is impossible to measure with any degree of accuracy the efficacy of the separate influences, a study of the deaths at various divisions of the first year of life isolates some of the more obvious. The following table subdivides the death rate per 1000 live births of infants under one year during each of the last five years:—

The above table shows that the highest death-rate amongst infants has always occurred in the first month of ide. Moreover, generally speaking, the deathrate for infants under the age of one month has really shown little_ improvement in recent years (in 1927 it actually increased slightly in spite of the heavy fall in the total infant-mortality rate), whereas the rates for the later division of the year show a definite trepd towards a decline. In other words, the diseases that can be combated openly, such as epidemic diseases, respiratory diseases, and diseases due to faulty nourishment,, etc. (i.e.. diseases ot the digestive system), have shown 4 definite response to the strenuous campaigns launched against them. While due credit must be accorded the efficacy of these health measures, it cannot be disguised that much has yet to be accomplished in the realm of ante-natal treatment. This is further accentuated by a table which shows similar information to the preceding table for further divisions of the first month of life. The figures reveal that in every division of the first month of life there is little indication of any definite improvement in the death-rate during the last five years. A study of the two tables in conjunction brings into prpminence the following facts: First, that of the total deaths of infants under one year of age, by far the greatest proportion occur during the first mouth of life; second, tjiat of those deaths occurring during the first month of life, the greatest proportion do not attain to one week of life; third, that of this latter number an exceedingly high proportion die during the first day; fourth, that while very little stable ■ improvement has been effected during the past five years in the death-rate for any of these three principal groups, it is gratifyipg to note that in two out of the three the year 1027 witnessed a definite decline in the mortality rate. Nevertheless, it is obvious from the above that attention needs to be focused upon those factors that tend to cause death during the first day or first week of life. With the elimination of these causes, a reduction in the rates for older age

periods must under present conditions automatically fellow. ,

Causes-of Infant Mortality

In view of this statement it is advisable to consider next the various diseases that take such a heavy toll of infulit life. In the following table these have been summarised into related groups, and figures given for each group of causes for each of the five years 1923-27 of deaths of infants under one year of age by causes:—

Totals . 1225 1127 1325 1132 1080

A table now follows showing for the main divisions of the first year of life the percentages of deaths of infants from certain causes of the total infant deaths. The figures are for the five years 192327 combined: —

It needs but a casual glance at the above figures to discover when the various classes of disease begin to take their toll of infant lives. The early effect of the two “ante-natal” classes is at once apparent. Malformations commence with a percentage of 7.84 at age “under one day,” and the proportion increases throughout the first month. The class “diseases peculiar to early infancy, as might be expected, takes its heaviest toll under one day, a rapid and continued fall being thereafter observed. All Uie other diseases increase in proportion with increasing age, especially after the first month is passed. Convincing evidence is thus given in support of the remarks contained in an earlier paragraph of this discussion relative to the necessity of reducing the neo-natal mor-tality-rate by combating more strenuously the ante-natal causes of death.

Area Distribution.

The distribution of infant. mortality over the Dominion is shown in the following table giving the rate of deaths under one year of age per 1000 births for 1927. which was free from any epidemic of importance:—

( It will be observed that the rate lor the South Island is considerably higher than that for the North Island. Ol individual districts, Canterbury has the highest rate, while that for Southland is easily the lowest. Taking the sexes separately, Canterbury has a phenomenally high rate for mules (55.68). while Southland has the lowest rate with 33.85.. For females, Canterbury is.again the highest with a rate of 40.75, and Southland the.lowest with 25.94. . ■ Lowest in the World.

New Zealand’s infant mortality rate is the lowest in the world, as is shown by the following rates per 1900 live hirfhs in various countries for 1926: —

Country New Zealand 40 Australia -• Switzerland Sweden South Africa 65 England and Wales tO Irish Free State <4 Scotland gg Northern Ireland So Uruguay France Germany Jni Canada Spain 125 Japan 4O< Trinidad a-j-s Lithuania -Wb Egypt . Czecho-Slovakia Hungary 16 < Jamaica Ceylon I‘ 4 Still-Births and Infant Mortality.

Closelv related with the question of infant mortality is the problem ot the still-birth. In New Zealand, still-births are included, in neither births nor deathsAt the same time most of the causes of a' child being still-born are the same as those that would have caused its death within one month of birth had it been born alive. In other words, the antenatal factors are responsible largely tor the high still-birth rate and. the high mortality rate of infants under one month of age. The data available indicates that the still-birth rate in New Zealand appears to be on the increase, but this rising tendency is not sufficient to reverse the trend of the declining intautmortality rate, when still-births are taken into consideration with this latter ngure. In illustration of this a table is now appended showing, for every year since the registration of still-births was made compulsory, the infant-mortality rates both inclusive and exclusive of stillbirths. . , For some years past 111 the figures inclusive of still-births the male rate has been steadily decreasing, while the female rate has been steadily increasing, the combined rate tending to decline, with an odd exception here apd there. Ihe figures for 1927, however, reverse the position for the two sexes, the male rate showing a substantial rise and the female rate an even more substantial decline.

1923 1924 1925 1926 1927 Epidemic diseases -19 49 40 92 59 Tuberculosis 10 7 19 14 13 Infantile ' convulsions 40 24 44 31 22 Respiratory diseases 114 126 127 142 117 Gastric and intestinal diseases . 112 63 56 55 Congenital malformations 157 160 142 119 141 Diseases peculiar , to early infancy .... 695 581 603 590 5S6 Other diseases 95 98 87 88 87

Causes of death. : U c C« 5 h = S s « © S 5 5 Epidemic diseases 0.21 0.14 1.49 0.11 0.43 0.03 13.48 5.0S 1.11 2.83 11.00 . — Convulsions Respiratory diseases . 0.13 0.0!) 4.89 1.47 3.04 0.89 3.09 9.03 3.05 2.83 2.43 25.S7 Gastric and intestinal 0.0! 1 7.81 6.35 diseases Malformations 14.79 11.92 1&00 12'89 10.70 12.11 Diseases peculiar to early infancy ...... Other diseasas 89.(15 1.90 74.02 4.22 80.31 3.25 57.48 8.57 75.03 4.52 14.42 14.32 '&00 Totals 100.00 100.00 100.00 100.00 100.00 100.00 100.00

Males Females Total 1923 ..... 720 505 1225 1924 ....; 644 483 1127 1925 639 486 1125 1926 638 494 1132 1927 .... 610 470 1080 Rate per 1000 Live Births. Males Females Total 1923 ... 49.55 37.59 43.80 1924 .. 45.05 35.21 40.23 1925 ■ ... 44.01 35.64 39.96 1926 ... 43.55 35.73 39.76 1927 .. ' 42.68 34;58 38.74

'e T5 cl o B g ■q s ® ® g 05 S tn ~tt 5 a g MtD o 5 *i 'tS 2 s a a cs o o Hw 1023 .. 29.07 6.62 2.93 5.18 43.80 1924 .. 23.95 5.32 4.6S 40.23 1925 1926 .. 26.43 25.46 5.54 4.60 3.16 3.62 4.S3' 6.08 39.96 39.76 1927 .. 25;83 4.84 3.30 4.77 38.74

district. Males. Females. Total. Auckland 37.98 34.23 <56.18 Hawke’s Bay .... 50.92. 34.03 43.01 Taranaki 39.40 31.69 35.53 Wellington ...... 40.S6 35.20 38.0G Totals — North Island .. ■10.03 34.37 37.27 Marlborough .... 37.50 35.00 36.32 Nelson 3S.05 32.6S oii.41 Westland' •••••• 4G.03 36.70 ■41.58 Canterbury .... 55.68 47.76 40.78 31.87 48.49 40.00 Southland 31.85 25.04 28.92 Totals— South Island 47.26 34.06 41.28 Totals—Dominion 42.08 34.58 38.74