NEW YORK (Reuters Health) Jul 01 - Federally funded, comprehensive child fatality review programs should be implemented in order to reduce the high rate of preventable deaths that occur during childhood, Arizona researchers maintain in the July issue of Pediatrics.

Nearly one third of deaths occurring among children under age 18 were tragedies that might have been avoided, according to Dr. William Marshall, of the University of Arizona in Tucson, and associates. "Many child deaths are preventable," Dr. Marshall told Reuters Health. "There are things that communities can do to try to reduce child mortality."

However, far more comprehensive data collection than is the current norm in most states is required, according to investigators in the Arizona Child Fatality Review Program (ACFRP). They used death certificates, hospital records, autopsy and police reports, as well as child protective services records, to review 4806 cases of children who died in Arizona from 1995 to 1999.

"Death certificates frequently are not completed correctly and lack sufficient information to accurately determine the cause of death or its preventability," the group found. They claim that the cause of death was incorrect on 13% of death certificates.

Thus, states whose programs only review death certificates, or worse yet, only those of young children or only deaths that are unexplained or unexpected, are likely to be missing many preventable deaths and should be expanded, Dr. Marshall's group asserts. Expansion of programs will help identify and develop prevention/intervention programs, as well as help communities decide where to invest limited prevention dollars, they add.

Examples of areas that could be beefed up included "inadequate emergency medical services, poor continuity of care, and delay in seeking care because of lack of health insurance."

Overall, the researchers estimate that 29% of deaths were preventable. The likelihood of preventability increased with age, with 38% of the deaths among children over a month in age judged preventable compared with 56% of the deaths of children over age 9 years.

There were 25 deaths due to child abuse among children below the age of 1 year; 29 in those aged 1 to 4 years old; and 13 among those older than 4 years of age. Many of the avoidable deaths might have been prevented if neighbors or relatives had reported any earlier abuse to child protective services, Dr. Marshall noted.

"There's been a tremendous progress in reducing infant and child mortality in past century, yet there's a lot of work that needs to be done," Dr. Marshall concluded. "Hopefully, this will help people's awareness that we can do better."

Pediatrics 2002;110:1-7.