When Is a Dead Baby Not a Dead Baby? (When It’s Born Outside the United States)

Save The Children has released a report on infant mortality that, among other things, claims the United States has the second highest infant mortality rate among industrialized countries. The problem with this claim, however, is that the United States and other countries can’t quite agree on what counts as a dead baby. As such, infant mortality rates aren’t directly comparable between the United States and other countries.

The problem lies in a fact that, as the Save The Children report notes, most infants who die in the industrialized world die because they are either a) born too early or b) have a very low birth weight (and, of course, the earlier the delivery, the lower the birth weight tends to be).

In the United States, an infant born prematurely and weighing less than 400 grams will receive intensive medical interventions to try to keep it alive. If, as is likely, such expensive interventions fail, the event will be recorded as a) a live birth and b) a death.

In much of the rest of the world — including the industrialized world — such extreme medical interventions would never be attempted. Moreover, this would not be recorded as a live birth or as a subsequent death.

The Save The Children report simply relies on World Health Organization statistics, and the WHO itself recommends that births of less than 1,000 grams not be registered as live births in official records. Most countries follow this definition, whereas the United States doesn’t.

How big of a difference does this make? According to the National Center for Health Statistics, in 2003 infants weighing less than 1,000 grams accounted for 48.7 percent of infant deaths in the United States.

Assuming that rate holds for the 2004 U.S. statistics the Save the Children report covers, that results in a >1,000g infant mortality rate of 3.5 per 1,000 births for the United States. That rate puts the United States barely behind countries like Japan, Finland, and Sweden which clock in at 3 deaths per 1,000 births. Not bad, especially given the largely mono-racial nature of those societies as compared to the United States.

Of course, why should we expect advocacy groups or the media to bother with such arcane statistics when U.S. has second worst newborn death rate in modern world, report says makes such a good headline?

Plague Outbreak in the Democratic Republic of Congo

At least 61 people died in February during an outbreak of the pneumonic plauge in the eastern part of the Democratic Republic of Congo.

About 350 people who worked in a mine in the northern Oriental province were infected with the disesae earlier this year, with at least 61 of them ultimately succumbing to the disease.

The pneumonic plague is the rarest and most deadly of the three types of plague. Unlike bubonic and septicimic plague, the pneumonic form of the disease can be passed from person to person through infected droplets transmitted by coughing or sneezing.

According to the World Health Organization, it is almost always fatal if not treated, but responds well to antibiotics. Unfortunately, the Democratic Republic of Congo is still a relatively chaotic place after the end of its four-year civil war in 2002, and more than 2,000 people who worked at the mine quickly left and dispersed after the outbreak of the disease became widely known.

Plague, of course, used to be a major worldwide killer, famously wiping out a significant proportion of the European population in the late medieval period. The World Health Organization reports that in 2003 there were only about 2,000 cases of the disease worldwide, but almost all of those occurred in Africa.

Sources:

Plague outbreak kills 60 in Congo. The BBC, February 18, 2005.

DR Congo plague outbreak spreads. The BBC, February 23, 2005.

Plague Outbreak in Eastern Congo. Cynthia Kirk, Voice of America, March 2, 2005.

Deadly Plague Outbreak Feared in Congo . Craig Timberg, Washington Post, February 18, 2005.

Locust invasions on West Africa. IRIN News, December 2004.

Will Polio Ever Be Eradicated?

The World Health Organization maintains that it will eradicate polio worldwide, but the disease is beginning to re-emerge in African countries that had previously been polio-free. Will anti-polio campaigners ever manage to eradicate polio?

The current outbreak in Africa is directly traceable to a decision by religious extremists in northern Nigeria to suspended polio vaccinations in 2003.

Shortly after that decision, polio cases in Nigeria began to spike. That was soon followed by cases popping up in nearby countries including Burkina Faso, Central African Republic, Chad, Ivory Coast, and Sudan. All five of those countries had been free of polio until 2003. Along with Nigeria, polio still persisted prior to 2003 in Egypt and Niger.

Polio has since spread to an additional seven African countries that had been free of polio, and the disease could spread further.

Admittedly the number of cases is still very small — Nigeria reported the most cases in Africa in 2004 at 763, but the outbreak of cases in previously polio-free countries is jacking up the costs of immunization. According to Dr. David Heymann, who heads up WHO’s polio eradication program, the resurgence of cases in polio-free countries will add at least $150 million to immunization efforts on the continent.

Source:

Health Officials Say They’ll End Polio In Africa, Despite Its Spread. Lawrence Altman, The New York Times, January 16, 2005.

World Hits Milestone for Drinking Water Availability

The Christian Science Monitor recently noted that for the first time in history, the world’s glass is literally half full. According to World Health Organization and UNICEF statistics, about 700 million people in the developing world have gained access to safe drinking water in their residence, pushing the percentage of people with access to drinking water in their homes to more than 50 percent of the entire world population for the first time ever.

This has led to a number of related improvements in quality of life. The obvious improvement is a decline in hygeine-related diseases. Although it hasn’t kept up with the advance in drinking water availability, improvements in sanitation in the developing world have also helped reduce the incidence of such diseases.

Another important advantage is the empowerment of women. For many women in developing countries, obtaining enough safe drinking water is a task which can take up to an entire working day. The Christian Science Monitor notes, for example, that in Tanzania, women might walk four to six hours to obtain safe drinking water for themselves and their families. With women no longer devoting so much time simply obtaining water, they are able to devote themselves to other projects.

Source:

Finally, the world’s drinking glass is more than half full. G. Jeffrey MacDonald, Christian Science Monitor, December 30, 2004.

About that Impending Bird Influenza Pandemic

Saw this item at Boing! Boing!,

World Health Organization’s bird flu warning: 100 million deaths

Matt Vine sez: Since yesterday, the rest of the world has been buzzing with news of the World Health Organization’s warnings of a impending flu pandemic that could kill up to 100 million. These warnings are suspiciously missing from American news sites – we get things like “Godzilla honored with ‘Walk of Fame’ star” from CNN’s front page.” Link

posted by Mark Frauenfelder at 08:47:00 AM

Of coures if you actually bother to read any of the articles that Boing! Boing! links to you, you learn that the impending epidemic is not so impending.

In fact, there is no evidence that the bird flue can be spread from human to human, which would be necessary before it could become a pandemic. There are apparently two cases of bird flu where researchers haven’t yet figured out how the individuals contracted the disease, but otherwise all cases of the bird flu have been transmitted directly from birds to human beings. It is telling that unlike the SARS outbreak, so far there appear to be no cases of infections among health care workers who have treated victims.

So why is the WHO going around saying that there’s this impending pandemic? Well, the short version is that it isn’t. The long version is that its Pacific regional director made the claims about the bird flu pandemic, and the rest of WHO appears to be scratching its head about where he came up with these claims.

For example, here’s the New York Times’ coverage,

Dr. Shigeru Omi, the W.H.O.’s regional director for Asia and the Pacific, said that if a pandemic should strike – an outcome he termed “very, very likely” – governments should be prepared to close schools, office buildings and factories to slow the rate of new infections. They also should work out emergency staffing to prevent a breakdown in basic public services like electricity and transportation, he said.

. . .

W.H.O. officials in Geneva said later that they had not received an advance copy of Dr. Omi’s remarks and did not know the basis for his estimates and why he believed a pandemic was so likely.

. . .

In sounding the alarm about avian influenza, “W.H.O. is trying to raise concern because we’re concerned, but W.H.O. is not trying to scare the planet,” Dick Thompson, a spokesman for the agency, said in a telephone interview.

“No one knows how many are likely to die in the next human influenza pandemic,” or even when it will occur, said Dr. Klaus Stöhr, the agency’s top influenza expert. “The numbers are all over the place.”

The same thing happened with SARS, you might remember, where there were a few individuals who claimed SARS was going to turn into a pandemic.

Obviously such a pandemic is always possible should a virus like the bird flu mutate into a highly communicable form, but a pandemic is far from impending.

Source:

W.H.O. Official Says Deadly Pandemic Is Likely if the Asian Bird Flu Spreads Among People. Keith Bradsher and Lawrence K. Altman, The New York Times, November 30, 2004.

WHO Reports Polio Setback

At the same time that some countries are complaining that the polio vaccine is dangerous, the World Health Organization announced in January that new cases of polio had been discovered in two African countries where WHO had previously labeled the disease as eradicated.

Polio cases were discovered in both Benin and Cameroon in early January, apparently having spread from Nigeria. Nigeria still experiences about 300 cases of polio annually and Muslim leaders in northern Nigeria have led a local fight against the polio vaccine saying it contains hormones that are used to sterilize girls.

Sources:

West Africa Polio Cases a Setback for WHO’s Eradication Plan. UN Wire, January 12, 2004.

UN says polio is spreading to countries where it had been eradicated. Press Release, United Nations, January 9, 2004.