Investigation of infant and ahild mortality in a Korean rural area
Korea has suffered much during the past twenty-five years. The country was divided at the 38th parallel, then fighting with the army of the north broke out in 1950 and lasted 3 years. During this period about 80 per cent of industrial plants was destroyed. Several millions of refugees from north of the 38th parallel settled in South Korea. All these factors had an unfavourable effect upon the economic condition of the country which has always been poor. This is especially serious in rural area.
One particular area, Kaejong Myon, suffered equally with the rest of the country but was fortunate on having a fairly large dispensary where 40 per cent of the poor received free medical care for ten years 1935-1945. In 1049, 150 beds hospital was added.
As there are as yet no vital statistics in Korea-birth, infant and adult mortality rates can not be compared with other countries. Country people do not report births until the child has lived a few years and ultimate survival seems likely. Therefore neither the birth or death of those who die early is recorded.
Also since "herb" doctors are permitted to sign death certificates, the cause of death reported is not likely to correspond to the WHO list of causes of death.
The present investigation has been made to obtain more accurate data on the infant and child mortality in Kaejong Myon, Okku-Gun, Cholla-Pukdo, based on a house-to-house survey carried out at the end of December, 1953 and in January, 1958 in order to compare the data collected before with that after the public health work was completed.
The content of this investigation include birth, death and infant mortality rates, also the cause of the infant and child deaths, the method of infant feeding, weaning period, and the kind of treatment before death. The results have been ananlized and discussed from the point of view of public health, rural economics, present customs, and the environment, then compared with that of other conturies. The failure to provide adequate care for the rural population is discussed and methods for improvement suggested.
We believe that the result gives a true picture of the health problem of the whole Korean rural area even though based on the smallest administrative unit in Korea namely the Myon.
The results are as follows :
1) Birth rate : During the war there was a slight fall and marked rise is noticed in the birth rate a few years after the war, when there was a big mobilization of young men ; the birth rate remained fairly high with no apparent change and was maintained at an above average 35. The birth rate of Kaejong-Myon in 1957 was 43.5. The birth rate remained same for both surveys.
2) Mortality rate : The mortality rate was fairly high and remained so without apparent change for the ten years preceding the first survey done in 1953 when it averaged about 16.1 per 1,000 live births. In contrast, it averaged 9.0 for the two
years from 1956 to 1957, after the public health activities in Kaejong-Myon had been instituted. Since the birth rate remained high and the mortality rate was much reduced, we find an unusually high increase in population.
3) Fetal death rate : The fetal death rate, when it includes 12-40 weeks gestational period, was high and remained above 85 without showing any apparent difference preceding or after the public health work. However, it was 126.1 in 1944 and 113.1 in 1951, in which years there was a military conflict, and this gives us the impression that the fetal death rate may be increased during war time. The data death rate if it includes more than 28 weeks gestational period, was around 20 in the Myon, which is similar to that of advanced European countries. The majority of the fetal deaths occured at the fetal age of 3 to 4 months.
4) Infant mortality rate : When we observe the infant mortality rate for the five years from 1944 to 1948 was 171.4, from 1949 to 1953 was 98.6, and 61.4 for the two years from 1956 to 1957 after the public health services were provided.
5) Neonatal deaths : The neonatal deaths accounted for 39.9 per cent of the total infant deaths for the 30 years from 1924 to 1953 ; in contrast, neonatal deaths were 62.7 per cent of the total infant deaths for the two years from 1956 to 1957.
This would indicate that neonatal deaths which can be attributed principally to biological factors has not been materially reduced, but that mortality during the latter part of infancy (1-11 months), which can be attributed mainly to environmental and social factors, is remarkably reduced.
6) Cause of infant death : Premature birth is still first in order, and neonatal tetanus is still an important cause of infant death even after the institution of a public health service. In contrast, smallpox, measles and whooping cough, which caused a high mortality before the first survey, has not been remarkably reduced following this public health activity.
7) Child mortality : there was an average child death every year of 32 for the 30 years from 1924 to 1953. In contrast, the number of child deaths every year was reduced to an average of 13 in 1956 and 1957 ; particularly, the number of deaths among the one-year-olds is markedly reduced.
8) Cause of death in childhood : The majority of deaths in children 1 to 4 years of age in the Myon can most commonly be attributed to contagious disease or to diseases caused by microorganisms, diseases which could be largely prevented or
controlled by timely adequate measures. The main causes of death in childhood are still pneumonia, measles and gastroenteritis. Measles which ranked first before the first survey, bacame third afterwards and smallpox, which previously ranked as an important cause of childhood death has completely disappeared.
9) In Kaejong-Myon 96.1 per cent of infants are breast fed. There is no definite weaning period in Korean rural areas. The infant usually remains on breast milk until the mother again becomes pregnant and the milk ceases to flow. The average weaning age found in the first study was 2 years and 3 months.
10)In an analyses the results according the type of treatment in Kaejong-Myon in 3 ten year periods 1924-1953 we find that death without treatment was given remain fairly constant at 50 per cent. The number of deaths of those receiving hospital treatment during the ten years from 1944 to 1953 was 21.6 per cent ; the number of those receiving "herb" treatment in the same period was 16.2 per cent.
It would appear that expensive hospital care did less to reduce the overall infant mortality than less expensive simple public health measures.
Similar public health activities carried out on a nation wide scale would do much to decrease the infant mortality so that it would approximate that in countries when the public health standards are much higher.