Effect Measure

Children dying early

They say starting the day with a good breakfast gives you a leg up on the rest of the day, so we thought we’d start out the week with some decent public health news. We’re always bringing you bad public health news, which isn’t what we want to do. We live for the news to be good. That’s what we work for. So here’s some good news. Well, I’d call it good news and bad news:

UNICEF today released new figures that show the rate of deaths of children under five years of age continued to decline in 2008.

The data shows a 28 per cent decline in the under-five mortality rate, from 90 deaths per 1000 live births in 1990, to 65 deaths per 1000 live births in 2008. According to these estimates, the absolute number of child deaths in 2008 declined to an estimated 8.8 million from 12.5 million in 1990, the base line year for the Millennium Development Goals (MDGs).

?Compared to 1990, 10,000 fewer children are dying every day,? said UNICEF Executive Director Ann M. Veneman. (UNICEF Press release)

I only gave you the lede. There’s a lot of other good stuff, too. For example, worldwide childhood mortality has been going down for several decades now, and the pace of decrease is actually accelerating. In the nineties it decreased by 1.4%. Since 2000 it’s gone down a further 2.3%. The biggest gains are in some of the world’s poorest countries. Malawi, a country among the top ten in childhood mortality, might be able to make the UN 2015 goal of decreasing its under five death rate by two-thirds from the 1990 level. The gains are attributed to the kind of international health efforts by WHO, UNICEF, the Gates Foundation and many, many others. While we argue about whether WHO should have called the flu pandemic earlier, they and their workers continued the very tough and often dangerous job of immunizing babies against measles, setting up programs to distribute insecticide-treated bednets, providing vitamin A supplementation and getting villages access to clean water. Malawi is a dramatic example of one of those interventions, provision of insecticide treated bednets. In 1990 the country had 225 child deaths per 1000 live births. Last year the number was 100:

In 2000, only 3 per cent of children under five slept under a mosquito net – a key means of preventing malaria, whereas by 2006 this had risen to 25 per cent. Malawi has focused its limited resources on improvements in health and health systems and the use of the most effective interventions, with the result that significant numbers of children?s lives have been saved.

Malawi deserves tremendous credit for this achievement, but it wouldn’t have happened without the hard work of thousands of technical aid workers from UN agencies and NGOs. Saving the lives of 10,000 children a day is a big deal. Said another way, not doing those things would be like slaughtering 10,000 children a day. So that’s the bad news. The data show that the lives of millions of children can be saved each year. Almost half the deaths in children under the age of 5 are in just three countries: India, Nigeria, and the Democratic Republic of Congo. India is a technologically advanced country. Nigeria is which with oil profits, mostly plundered by corrupt politicians. The Congo is a benighted, war ravaged country where the children that survive are given guns to shoot each other. And Africa’s best developed and most well endowed country, South Africa, has slid backward, presumably the result of equally backward attitudes of the previous government to HIV. When mothers are sick, their children die. It’s pretty simple.

So the good news is that things are getting better, even in the poorest countries. The bad news is that we could be doing even better still. It’s easy not to care about babies living far away in circumstances very different from ours, living lives we can’t even imagine. Some people might even welcome the deaths of these children on the grounds that our planet is over populated already and Nature is culling the herd. I have two responses. The first is practical. Decades of data regularly show that when infant and child mortality decrease, so does the birth rate. That’s the way Nature regulates population. If there is high infant mortality, the population ramps up reproduction. So if we are serious about the population problem (and we should be), then getting infant and child mortality under control is the surest way to do it.

My second response is a bit different. Last night two of my three grandchildren spent the night with us. They are 14 months and 26 months old. For Mrs. R. and me, they have faces and personalities, they give hugs, they laugh and cry and they look to their mom and dad and last night their grandpa and grandma to keep them safe. While they are our own grandchildren, they could be anyone’s. Just as they are worth everything to us, other babies and children have parents and grandparents to whom they, too, are everything.

In this business I am confronted on a daily basis with how much misery there is in this world. Not all misery can be prevented. It’s good news that there is less of this kind, a kind that we can prevent. It would be better news if there weren’t still so much misery we’ve already shown we can prevent but haven’t. Is it so different than killing 10,000 children a day with guns or bombs? Or does it just feel different?

Comments

  1. #1 twocrow
    September 14, 2009

    I love babies. But the thought of seven billion humans emptying the oceans and pushing into ever more fragile and marginal areas, that in many parts of the world families with 8, 10, 14 children are not uncommon, that as a society we celebrate the 19th Duggan, that in some places half the population is under 15, curbs my enthusiasm.

    I cherish babies; fat, jolly, gurgling babies, but it is how many we have that makes me ill.

  2. #2 llewelly
    September 14, 2009

    Nigeria is which with oil profits, mostly plundered by corrupt politicians.

    “which” oil profits were those? Please change “which” to “rich” .

  3. #3 kagiso
    September 14, 2009

    While I would in no way wish to diminish the efforts of WHO and other NGO’s; having lived in Malawi, I believe the transfer of power from the dictator Hastings Banda to a democracy, and an increasingly mature democracy as time goes on, is the single critical intervention that has changed the infant mortality figures. WHO et al simply can’t do anything that is long term effective if a country’s own government doesn’t give a fig about its people. It is instructive to compare the trajectories of Malawi with Zimbabwe, once a beacon of hope for Africa. Africa’s fundamental problem remains misgovernance, and democracy is the key ingredient to improving Africa’s future.

  4. #4 Snowy Owl
    September 14, 2009

    H1N1: Quebec Researchers make a discovery
    http://lejournaldequebec.canoe.ca/journaldequebec/actualites/sante/archives/2009/09/20090914-115405.html

    Quebec Researchers now know better on the H1N1 swine flu virus, after being able to evaluate in a precise manner the contagiosity of the people infected by the H1N1.

    The preliminary results of their studies will be presented tomorrow in San Francisco at a prestigious international congress made by the American Association of Microbiology. These datas are important in this race against the clock towards a better understanding of this new H1N1 and in the means to deal with it.

    The group of researchers under the coordination of two Researchers of Quebec Public Health, have gathered informations among 65 Quebec families from May to July 2009.

    Their results shows that about 15% of infected people with H1N1 still were contagious after the 8th day after the beginning of symptoms, but none were still contagious after 10 days.

    More tomorrow from San Francisco

    Snowy Owl

  5. #5 Snowy Owl
    September 14, 2009
  6. #6 Michael Murphy
    September 14, 2009

    This weekend’s swine flu stories from ICAAC leave a question begging to be answered: If IV peramivir is effective in the ICU and has been shown to be safe in Phase I and II trials in the US, and Phase I, II and III trials in Japan, why has the FDA dragged its heels issuing an Emergency Use Authorization, and why have children suffocated to death in the ICU as a result? What Hurricance Katrina was to FEMA, this delayed EUA is to the FDA. It’s a huge story; please break it.

  7. #7 revere
    September 14, 2009

    Michael: I don’t follow the drug world closely so I don’t have any info on this. If you have documents and data and solid info then there’s a story and I’d be glad to look at it. But I don’t know a story to break at the moment.

  8. #8 pft
    September 14, 2009

    Life expectancy in the areas having the most children is very low, in some places it is little more than 50. Poverty is such that most folks consume little throughout their lives. In the US where there are fat, jolly babies, fertility rates have been at or below replacement level for the past 30 years, same as in Europe and much of East Asia. Population growth is due entirely to immigration and immigrants children born in the US.

    This allows made in the usa babies the luxury of wearing clothes and playing with toys made in developing nations and then shipped across the ocean in container ships and trucked to stores to a neighbourhood near you, paid for with credit.

    Do not confuse American babies with babies in the 3rd world. The 3rd world babies consume little and are not fat and jolly. The neo-malthusians say to themselves let them stay poor and die young to keep them from consuming resources our fat and jolly babies need, while giving lip service to actually giving a darn about 3rd world babies.

    But then, no suprise here, secular science and humanists founded eugenics to solve these “population and consumption” problems, although they had to drop the name after WW II since Hitler discredited it.

    Democracy is of course a danger to the neo-malthusians which is why we have sought to stamp out democracy in the developing or 3rd world for 50 years by labelling it socialism and ending up with a dictator or military despot who will serve the Wests neo-malthusian and commercial interests by selling out their people in return for living the good life.

    Today, we no longer have the Cold war so must label such countries terrorist havens or we subject them to economic attacks via the IMF witholding credits and financial speculators attacking their currency for not engaging in Free Trade and opening up their land to the global corporate vultures.

  9. #9 caia
    September 14, 2009

    So if we are serious about the population problem (and we should be), then getting infant and child mortality under control is the surest way to do it.

    I agree, although I’d say it only gets you halfway there. The other half is educating and empowering women, so that they may be economically independent and socially capable of choosing when and how many children to have.

  10. #10 caia
    September 14, 2009

    pft — I really don’t think neo-malthusians have anything to do with the U.S. history of meddling in foreign affairs. Nor do I really see humanists as prime pushers of genocide.

  11. #11 kagiso
    September 15, 2009

    “Do not confuse American babies with babies in the 3rd world. The 3rd world babies consume little and are not fat and jolly.”

    I lived in Malawi for two years, and in most of the areas, where maize is the staple, the babies were indeed ridiculously jolly and fat. Universal breast feeding, very high quality parental care and the high protein content of maize combine to give babies, children and indeed adults that were psychologically more balanced, and yes more happy than most westerners; despite the endemic poverty. (In the smaller areas where cassava is the staple, things are different, cassava is very poor in protein, and malnourishment is widespread.)

    In many ways western societies have lost major elements of support networks, and could learn valuable lessons from countries like Malawi.

    Don’t make assumptions about societies that you have no knowledge of.

  12. #12 Snowy Owl
    September 15, 2009

    2 cases of H1N1 deaths in U.S. by a mutated H1N1 and more in India
    H1N1 strain turns virulent?: Health officials Patrick Berche, Head of Medicine Faculty of Paris-V Descartes and Chief of bacteriology-parasitology-virology at Necker Hospital stated in the French Prestigious paper Le Monde that;

    If the deaths of youger people in good health multiply in the weeks to come, it will then be cause of alarm. In the History of Viruses, scientifics have notice that these change their virulence about the same time World Wide.

    While Didier Raoult, sp├ęcialist of infectious diseases in Marseille Timone Hospital gave the following example;

    One thing is sure, this is not an ordinary flu. This flu is unique, it follows a particular scheme not seen until now.

    I just got back from an International Congress on H1N1 in the U.S.A.
    ing a mutated version of H1N1.

    This mutation might not explain all deaths without underlying medical conditions, but it has to be considered.
    http://www.flutrackers.com/forum/showthread.php?t=125386

  13. #13 Tunji
    September 16, 2009

    It is good news to hear that child mortality rate has dropped in Malawi. However to sustain this in Malawi and replicate it in other countries, there is a need to consider the wider determinants of health.
    While the resources to reduce the burden of diseaes may be available, such as the provision of insecticide treated nets for malarial prevention, one thing that is very often overlooked is getting these interventions to those who need them.
    Majority of people within rural communities and remote places are cut out of reach of health care services and as such die needlessly of easily preventable diseases. This is as a result of lack of reliable transport, difficult terrain among other things.
    According to a World Bank study, transportation problems have been identified as reasons which can significantly limit reaching the targets set for the fourth and fifth (maternal and child health) millennium development goals.
    Hence, there is a need for enhanced multisectoral approaches in order to see more decline in child mortality rates.