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El material contiene consejos que consideramos pueden ser útiles para evitar o disminuir los accidentes en el hogar. Está dirigido, fundamentalmente a médicos y enfermeras de la familia, pediatras, maestros, administradores de salud, especialmente en el área materno-infantil y a todos aquellos que se solidaricen con esta campaña contra este flagelo que tantas vidas, lesiones e incapacitados cobra en nuestra sociedad.

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BACKGROUND: The Discontinuity Index (DI), which measures the percentage of infants who were exclusively breastfed (EBF) at the beginning of a given age interval and had abandoned this mode of feeding at its end, and the relative weight of this discontinuation, was introduced and employed in the National Survey on Breast Feeding and Infant Feeding Practices carried out in Cuba in 1990. The aim of this article is to illustrate, through a specific example, the quality of DI as a simple procedure for assessing breastfeeding trends. METHODS: The prevalence of EBF in the 14 provinces of Cuba at discharge from the maternity services and at 30, 60, 120, and 180 days of age, was obtained using data from a national sample of 6661 infants (4820 urban and 1791 rural) which were processed by means of a logistic regression model. Cumulative DI were calculated for the intervals 0-30, 0-60, 0-120 and 0-180 days, and partial DI for the terms 30-60, 60-120 and 120-180 days, for each province and for the whole country. RESULTS: Cumulative DI show the progress of cessation of breastfeeding and are strongly influenced by previous intervals. The Eastern provinces showed the lowest figures at most of the terms. Discontinuation during the first month of life was particularly high in two Western provinces. Partial DI are more specific and allow discrimination of the intervals at which EBF discontinuation is more frequent. The highest values were observed between 4 and 6 months. CONCLUSIONS: Discontinuity indices are useful complements to prevalence rates in epidemiological studies of breastfeeding. The separate analysis of discontinuation in different periods can be highly useful when comparing trends and in the study of the impact of breastfeeding promotion programmes focused on different age intervals.

PIP: The Discontinuity Index (DI), which measures the percentage of infants who were exclusively breastfed (EBF) at the beginning of a given age interval and had abandoned this mode of feeding at its end, and the relative weigh of this discontinuation, was introduced and employed in the National Survey on Breast Feeding and Infant Feeding Practices carried out in Cuba in 1990. The aim of this article is to illustrate, through a specific example, the quality of DI as a simple procedure for assessing breastfeeding trends. The prevalence of EBF in the 14 provinces of Cuba at discharge from the maternity services and at 30, 60, 120, and 180 days of age, was obtained using data from a national sample of 6661 infants (4820 urban and 1791 rural) which were processed by means of a logistic regression model. Cumulative DIs were calculated for the intervals 0-30, 0-60, 0-120, and 0-180 days, and partial DIs for the terms 30-60, 60-120, and 120--180 days for each province and for the whole country. Cumulative DIs showed the progress of cessation of breastfeeding and were strongly influenced by previous intervals. The eastern provinces showed the lowest figures at most of the terms, and the opposite occurred in the central and western ones. Discontinuation during the first month of life was particularly high in the city of Havana and Matanzas, two western provinces. At 4 months, 74.9% of all the infants who started EBF had abandoned it. DIs were above 99% in two western provinces, Pinar del Rio and Matanzas, whereas the national mean for this age was 90.6%. Partial DI (between 2 given ages) were more specific and allowed discrimination of the intervals at which EBF discontinuation was more frequent. The highest values were observed between 4 and 6 months. Only the city of Havana showed the highest DI between 2 and 4 months. Discontinuity Indices are useful complements to prevalence rates in epidemiological studies of breastfeeding.

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In order to analyze breast-feeding trends in the Region of the Americas vis-à-vis trends observed in Cuba, information was culled from a selection of national surveys on the prevalence and duration of breast-feeding conducted in the 1970s and compared with the results of a national survey carried out in Cuba in 1973. Similarly, information from PAHO Document HPN/92.7, which contains reports from countries of the Americas for the period 1986-1991, was compared with the results of the National Survey carried out in Cuba in 1990. A cessation index (CI) was calculated with a view to comparing the relative extent to which the cessation of breast-feeding occurred at different ages in the two time periods. The study revealed a consistent pattern: typically, a relatively high percentage of newborns were initially breast-fed, but the prevalence of exclusive breast-feeding was low and the percentage of breast-fed infants declined quickly. However, the more recent data showed improvements in most of the countries involved with respect to both the prevalence and duration of breast-feeding. Cuba was found to have intermediate values relative to the other countries. Although a slight decline in the initial prevalence of breast-feeding was observed in 1990 (as compared to 1973), notably higher percentages of infants were being breast-fed at 30, 60, 90, and 120 days, and the CI values for the corresponding intervals up to 90 days were lower. These results suggest that positive changes have taken place in factors promoting a longer duration of breast-feeding.

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To determine breast-feeding trends in the Region of the Americas and compare them with those observed in Cuba in the last decade, information was complied from a select group of national surveys conducted in the 1970s on the prevalence and duration of breast-feeding and then compared with information from a survey carried out in Cuba in 1973. In addition, data were taken from document HPN/92.7 of the Pan American Health Organization, which contains reports corresponding to the period 1986-1991, and these were compared to the results of the national study carried out in Cuba in 1990. The discontinuation rate (DR) was also calculated. The study found a sustained pattern of initial breast-feeding of a relatively high proportion of babies, with rapid declines in subsequent days and low prevalence of exclusive breast-feeding. In most countries, prevalence and duration showed a tendency to increase. In Cuba intermediate values were observed with a discrete decline in initial prevalence, increases up to 180 days, and lower DR values up to 90 days in 1990 as compared to 1973. This suggests that there have been favorable changes in the factors that help to prolong the duration of breast-feeding. Calculation and analysis of the DR at various intervals proved useful for comparing the trends observed in the different countries.

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PIP: This paper discusses the 50% reduction in infant mortality achieved in Cuba during the decade 1970-1979. After an analysis of the various factors that contributed to such a reduction, it is pointed out that early neonatal mortality during that period declined by 36.2%; late neonatal mortality by 67.2%, and postnatal mortality by 59.3%. By province, the lowest mortality rates were in Matanzas (14.9%), Villa Clara (15.6%), and the city of Havana (16.2%). The highest rates were in Las Tunas (26.1%), Guantanamo (24.1%), and Granma (23.9%) in infants of 1 year of age/1000 live births. With respect to cause of death, diarrheal diseases dropped from 2nd to 6th place, with a reduction of 71.4% in mortality. As a result of decreases in other causes, congenital malformations moved up to 2nd place. Also, acute respiratory diseases were lowered by 43.4%. Furthermore, it is pointed out that 11 consultations/delivery and 6.7 checkups/healthy infant under 1 year of age were attained as an annual average. In the same decade, the birth rate declined from 27.7 to 14.7/1000 inhabitants. (author's)^ieng

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Con anterioridad a 1959 y durante los primeros anos del decenio de 1960, las cifras existentes sobre mortalidad infantil en Cu ba eran poco fidedignas. Sin embargo,debido a sucesivas mejoras en la consecucion de los datos, desde 1968 se han comenzado a conocer en detalle los distintos componentes de la mortalidad infantil y se han precisado las causas de muerte

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PIP: The authors examine the various factors associated with the decline in infant mortality in Cuba between 1970 and 1979. Variations in infant mortality by province, causes of death, and the role of infant health services are discussed. (summary in ENG, FRE, GER, )^ieng

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Se revisa la evolucion y el estado actual de las enfermedades diarreicas en la Republica de Cuba

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A brief description is made of how acute diarrheal diseases, known as gastroenterites, were the cause of diseases and death since the beginning of the Republic. Different results of works carried out by different authors on the mortality due to such diseases is reported. Statistical data show the situation in Latina America according to the criteria of several authors and synthesis is made of the general picture of diarrheal diseases in Cuba, beginning on the decade of 1960. The different causes of these acute diarrheal diseases in our country are analyzed and all the plans and control programs that have been developed up to the presented with the idea of eradicating these diseases are pointed out.

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The programs and activities that were developed from the first years of the 1960's devoted to improve, in a general sense, the people's health are stated. The present state of mother-and child-health is exposed and analysis is made on population, natalily, demographic growth, human resources, availability of beds, mother-and child-care units, nursing personnel, organization of mother-and child-care and programs for the integral care to woman and the child. The working prospectivenesses for the coming years, lead to maintain the successes reached as well as to solve other problems derived from the development obtained, are presently considered and reviewed.

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Analysis is made of the results of the reduction program of infantile mortality which began in 1970. Said reduction dropped from 38.7 in 1970 to 22.8 per thousand live births in 1976, for a diminution of 41.5%. The early neonatal decreased from 18.2 to 12.3 per thousand live births for a drop of 32.7%. The late noenatal decreased from 5.3 to 2.30/100 live births with 57.2% reduction and the postneonatal dropped from 15.2 to 8.2 per thousand live births for a diminution of 46.5%. Infantile mortality is reported for the different departments and the order in which the main causes of death are grouped is stressed as follows; 1st, perinatal affections (B43-B44); 2nd, congenital anomalies (B42); 3rd, influenza and pneumonia (B31-B32); 4th, enteritis and other acute diarrheal diseases (B4) AND 5th, sepsis (A21). The average number of puericulture office visits per infant under 1 year of age increased from 2.7 to 6.7. Institutional births increased from 93.3 to 97.8%. The steps taken to achieve these results are described.

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Se plantean los programas y actividades que se desarrollaron desde los primeros años de la década de 1960 destinados a mejorar en sentido general la salud del pueblo. Se expone la situación actual de la salud maternoinfantil, y se analizan la población, natalidad, crecimiento demográfico, recursos humanos, recursos-camas, unidades para la atención maternoinfantil, personal de enfermería, organización de la atención maternoinfantil, programas de atención integral a la mujer y al niño. Se exponen las perspectivas de trabajo en los próximos años, encaminando a mentener los éxitos alcanzados, así como a solucionar otros problemas-producto del desarrollo obtenido-y que actualmente son considerados(AU)

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