Breilh, Jaime; Granda, Edmundo; Campaña, Arturo; Betancourt, Oscar. Ciudad y muerte infantil. [City and infant death.] Quito Ediciones CEAS, 1983. 188p.

Objectives: To demonstrate the existence of a significant differential in the infant mortality rate between social classes in a society of peripheral capitalism and to make evident the deep contradictions of urban progress within the capitalist societies of the Third World.

Design: Study linking infant mortality records (death certificates) with records of socio-economic stratification in the city of Quito, Ecuador.

Theoretical Framework: An historical, geographical, and epidemiological analysis focuses on variations in mortality by social class. The authors consider critically the historical development of the capital city of Ecuador, in order to explain the growing differences in social and epidemiological levels by distinct zones of the city. The authors conceptualize social class through equivalencies of “social class proxies” and by analysis of mortality according to zones of social stratification within the city.

Patients or participants: Children in Quito who died during the first year of life, analyzed by age, social class, and residential area.

Applications: The study enabled the Ministry of Public Health to be informed of the inconsistencies in its analysis of urban infant mortality, and in its effort to reduce the infant mortality.

Principal Results: Differences in infant mortality (especially post-neonatal) occurred among the zones into which the city of Quito is divided (infant mortality rate, IMR, of 20.1 per 1000 in upper class areas; 42 per 1000 and 54 per 1000 in middle class and working class areas, respectively; and 108.4 per 1000 in marginal zones. Likewise, significant differences were found within each zone among social classes. An important finding: in areas where the Ministry of Health wielded influence, through established programs that reached the entire population, significant differences nevertheless existed between sub-zones that were equidistant from a clinic. This finding indicates that differences in infant mortality were not related to problems of access.

Conclusions: Very marked contrasts exist in the quality of life and in infant mortality among socially differentiated areas of metropolitan Quito. Health outcomes characteristic of developed countries are evidenced in some zones, while outcomes characteristic of Third World countries are found in other zones.
State and municipal policies continue to offer palliative approaches that do not carry a sufficient impact to modify these differences. The authors demonstrate that official healthcare services provided inadequate and inefficient coverage.

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