| Author |
Message |
Sue Birchmore
Guest
| | Posted on Sunday, June 29, 2003 - 04:45 pm: | |
I have a question on the factors that affect under 5 mortality rates. Although generally the U5M rates correspond with the levels of economic poverty in a country, there are exceptions; Sri Lanka, for example, has had lower U5M rates than would be expected for its level of wealth. Similarly, several countries in Eastern Europe have fairly serious economic poverty yet relatively low U5M rates. I am guessing that the reasons for the relatively low mortality rates are a combination of high levels of female education, absence of diseases such as malaria, and the legacy of former, wealthier, times. Has anyone done any research on this? If economic conditions continue to improve slowly or not at all and education levels continue to fall, should we expect to see increasing mortality rates - and if so, what is the likely timescale for this to become apparent?
Sue Birchmore |
Howard White
Guest
| | Posted on Tuesday, August 12, 2003 - 09:20 pm: | |
It is the case that Sri Lanka used to be a substantial "outlier" , ie have MUCH better (lower) mortality rates than would be expected for a country with its income per capita. This is much less so than it used to be. HOWEVER, there are very few historically observed cases of INCREASING mortality, what Sri Lanka has experienced is a deceleration (still going forward but more slowly). I would expect that to continue to be the case. The cases of increased mortality (all in Africa) are arguably all the result HIV/AIDS, though I have argued this is compounded by long-run economic decline and deteriorating health services. Mortality also rises in conflict situations (and their aftermath), but we don't have systematic data on that. |
Sebastian Mbah
Guest
| | Posted on Wednesday, August 13, 2003 - 11:29 am: | |
Draught, famine, conflicts and diseases are the main factors for the increase in MR/U5M rates. When some African countries embarked on immunization against the "five childhood killer diseases", U5M rates fell. There is no systematic demographic data in most developing countries and this makes research difficult however, high U5M rates reflect the economic realities of the day. |
Sebastian Mbah
Guest
| | Posted on Wednesday, August 13, 2003 - 11:42 am: | |
Drought,famine, conflicts and diseases are the main factors behind increases in mortality and infant mortality in particular. When some African countries embarked on immunization campaigns against the "five childhood killer diseases", U5M rates fell drastically. There is no systematic demographic data in most developing conutries and this makes research difficult. However, high U5M rates reflect the economic realities of the day and necessarily in GDP figures. |
Howard White
Guest
| | Posted on Wednesday, August 13, 2003 - 03:56 pm: | |
It is not so that there are no systematic demographic data for most developing countries. The World Fertility Survey (WFS) in the 1970s and the Demographic Health Survey (DHS) since the late 80s have provided a rich source of data for many countries (mortality, nutrition, use of antenatal care, breastfeeding, contraceptive knowledge and usage etc). Reports and the data themselves are downloadable from www.measuredhs.com.
Adam Wagstaff (University of Sussex on secondment to the World Bank) has produced some interesting papers using these data on inequalities in child mortality (see for example paper at http://www.who.int/docstore/bulletin/pdf/2000/issue1/bu0202.pdf.
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James Patterson
Guest
| | Posted on Thursday, August 14, 2003 - 05:43 am: | |
Broadly, I would suggest you look under the topic 'epidemiological transition' for which there is considerable research on the (shifting) burden of diseases.
In my primative assessment, there are several clusters of inter-related factors related to U5M: political committment, social/cultural factors, infrastruture, and economic. So in places like Sri Lanka, Cuba, Kerala, etc. with 'western' life expenctancies, despite weak economies, success might be attributed to the impressive commitment of the government (political) combined with high female education (social/cultural). In contrast the good health outcomes of western democracies might be compared... for example the US and UK have similiar outcomes, but the UK's committment in the shape of the NHS means then spend less then 1/2 on per capita basis to achieve the same end. Clearly it is not just about money. In Iraq, incredible U5M gains were achieved in a short time during the 1980s before Iraq War I, but were lost during the bombing raids that destroyed electrical systems, sewage plants, etc. (infrastructure).
I did some research along these lines for the impact of war on health transition should you need a more extensive bibliography.
-james
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David Osrin
Guest
| | Posted on Thursday, August 14, 2003 - 06:26 am: | |
Blimey, what an interesting question.
I'm not aware of a significant discussion of these issues in the literature (although I'm not the oracle). A key problem is that we are not clear on the influences of proximate and distant causes on mortality. I agree with the questioner's observation that U5MR does not correlate fully with economic levels, the usual examples being Sri Lanka, Cuba and Kerala. It is this lack of correlation - or, more exactly, this "positive deviance" from the trend by certain countries and states - that has supported the argument that health services can be effective in themselves rather than as a knock-on effect of wealth. Again, I agree that the positive deviant effects on health might result from things other than health services, particularly female education and empowerment (Kerala and Cuba are the usual examples here). I have a vague idea that Amartya Sen has written on this in the last couple of years.
To begin with, I suspect that the answer to the question "If economic conditions continue to improve slowly or not at all and education levels continue to fall, should we expect to see increasing mortality rates?" is yes.
But the important question is the one about timescale. As an exercise, we could look at the main causes of U5M in developing countries. These are presumptive and not certain, but are probably...
1. Neonatal causes: about half of all U5M. Key among them are probably birth asphyxia, preterm and low birth weight, and sepsis (including pneumonia and septicaemia).
2. Postneonatal causes: about half of all U5M. Roughly, diarrhoeal disease, respiratory infection, measles, malaria.
3. Mortality associated with HIV, which is changing the pattern of mortality in many countries.
What could cause these to rise? Well, suppose we look at incidence and then at case-fatality.
1. Neonatal causes: birth asphyxia would rise if maternity care deteriorated. In countries where most women give birth at health facilities (such as in the NIS, I think), there would have to be a serious deterioration in the quality of care available, followed by economic or perceived barriers to accessing it. Presumably this would take quite a long time. Preterm and low birth weight would rise with breakdown in hygiene and a higher risk of infection during pregnancy (if you believe that infection is an important trigger of preterm delivery). In the absence of acute starvation, low birth weight rates probably take a couple of generations to rise, since there is an intergenerational effect of mother's body size on the growth of her baby. Sepsis effects would rise if there was a breakdown in hygiene or if treatment became less available.
2. Postneonatal causes. The effect of measles would rise quickly with lapses in immunisation, perhaps within a few years. Similarly, malaria mortality would rise with lapses in prevention, and with emergence of resistance in conditions where treatment became patchy and the population was susceptible. ARI and diarrhoeal disease would be expected to rise in worsening economic conditions, particularly with increased population density and breakdowns in sanitation. On the other hand, many diarrhoeal deaths have been averted by the oral rehydration revolution, which has presumably permeated the public conscious to a degree. How long would it take for such knowledge to disappear?
3. Mortality from HIV is rising already in many settings and we can expect it to continue to rise for some time. We have already seen a reversal of downward trends in U5MR in some countries in Subsaharan Africa. This would be accelerated by poverty, falls in education and breakdown in social structure.
I guess that four themes emerge here:
* A breakdown in sanitation.
* A breakdown in vertical public health programmes such as ARI, EPI and CDD.
* A breakdown in treatment services.
* Increasing poverty leading to everything else, particularly decreased access to services and falls in education.
I've written a lot and not answered the question! Would you like me to ballpark for the sake of argument? All right, with continuing falls in economic status I'll propose a rise in U5MR in 5 years, with a kick in of later factors and a subsequent boost at 15-20 years.
Hope this has been of help, and always happy to be contradicted.
David
--
David Osrin
Clinical Research Fellow
International Perinatal Care Unit
Institute of Child Health, London
Nepal collaboration
GPO Box 921
Kathmandu
Nepal
tel +977 1 4266208
fax +977 1 4265174 |
Paivi Laurila
Member
Username: Paivi
Post Number: 1
Registered: 08-2003
| | Posted on Thursday, August 14, 2003 - 11:00 am: | |
To JamesPatterson I would like to have the bibliography you mentioned in your reply in incussion mortality U5. I am currently a port-grad student, but after this going back to work in health care in conflict and post-conflict areas. Thanks Paivi Laurila |
Michael Keizer
Guest
| | Posted on Thursday, August 14, 2003 - 06:12 pm: | |
There was an interesting article about this in The Lancet of June 28, "Where and why are 10 million children dying every year", by Rebert E. Black, Saul S. Morris, and Jennifer Bryce. Well worth reading. |
Dr Rana Jawad Asghar
Guest
| | Posted on Thursday, August 14, 2003 - 08:42 pm: | |
I would strongly recommend to read Lancet's Child Survival series. It is available online through their website.
Regards
Jawad
=====
Dr Rana Jawad Asghar
Program Manager Child Survival, Mozambique
Provincial Coordinator Sofala Province, Mozambique
Health Alliance International, Seattle, WA, USA
http://depts.washington.edu/haiuw/
Coordinator South Asian Public Health Forum
jawad@alumni.washington.edu http://www.DrJawad.com |
Justine Coulson
Guest
| | Posted on Thursday, August 14, 2003 - 08:48 pm: | |
This is a very timely request as Working Paper 8 in the Young Lives series covers this topic. I am attaching the abstract. A more detailed summary is also available at the following address (http://www.id21.org/society/index.html) The full paper will be avilable on our website next week - www.younglives.org.uk
Can I also mention that Young Lives will be holding a conference on Sept 8 and 9 in London that will discuss a range of issues related to child wellbeing. Details of the conference can also be found on our website.
Best wishes
Justine
Dr. Justine Coulson
Young Lives International Coordinator
Save the Children UK
17 Grove Lane
London SE5 8RD
UK
Tel. 020 7716 2069
Fax. 020 7793 7630
Visit the Young Lives website at www.younglives.org.uk |
Matthew Cadbury
Guest
| | Posted on Friday, August 29, 2003 - 04:59 pm: | |
I am interested in the relationship between economic performance and mortality. I would particularly like to calculate the effect on mortality in developing countries of Western agricultural policies. Does anyone know of analysis of this kind that has already been done? |
Bryan Walker
Member
Username: Bryan
Post Number: 14
Registered: 06-2003
| | Posted on Friday, August 29, 2003 - 05:25 pm: | |
I recall that Professor Michael Drummond was one of the first to analyse the cost of AIDS on society. Since then he has developed several analytical models. I do not know if one of these would fit your case, but he (or someone in his unit) would probably know who would know if he did not know! I downloaded the following from the Internet-
Michael Drummond, PhD Professor of Economics and Director of the Centre for Health Economics, University of York. His particular field of interest is in the economic evaluation of health care treatments and programs, including care of the elderly, neonatal intensive care, immunization programs, services for people with AIDS, eye health care and pharmaceuticals. He is the author of more than 350 scientific papers, has acted as a consultant to the WHO, and was Project Leader of a European Union Project on the Methodology of Economic Appraisal of Health Technology.
Bryan Walker |
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Programme Implementation - Mise en oeuvre 
YL Working Paper 8 - abstract