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TABLE 4.7 The Median Infant Mortality Equivalence Values for Respondents from Developing Countries

 

Infant Mortality Equivalents

Morbidity Category

Description

Unit

Under 5 Years

5–14 Years

15–59 Years

60 Years and Over

A

Moderate localized pain and/or mild systemic reaction, or impairment requiring minor change in normal activities, and associated with some restriction of work activity

Days

40,000

32,500

8,750

50,000

B

Moderate pain and/or moderate impairment requiring moderate change in normal activities, e.g., housebound or in bed, and associated with temporary loss of ability to work

Days

23,713

17,500

5,650

25,000

C

Severe pain, severe short-term impairment, or hospitalization

Days

2,000

2,244

2,000

5,000

D

Mild chronic disability (not requiring hospitalization, institutionalization, or other major limitation of normal activity, and resulting in minor limitation of ability to work)

Cases

75

62.5

30

550

E

Moderate to severe chronic disability (requiring hospitalization, special care, or other major limitation of normal activity, and seriously restricting ability to work)

Cases

5.5

5.5

2.75

23.125

F

Total impairment

Cases

1

0.4

0.309

5

G

Reproductive impairment resulting in infertility

Cases

100

22.5

16.5

n.a.

H

Death

Cases

1

0.5

0.4

5

higher in the age-neutral perspective. When fetal deaths from ectopic pregnancy were considered equal in undesirability to all other deaths/ gonorrhea also ranked relatively higher in the age-neutral perspective.

The committee derived a second set of IME values for this study based on trade-off questionnaires (see Appendix E) completed by individuals in the United States who are involved in improving health in developing countries. Table 4.8 presents these values. (The committee recognizes that the medians shown in Tables 4.7 and 4.8 were not drawn from statistically valid samples.) Adopting the perspective represented in Table 4.8 rather than Table 4.7 would lower the relative rankings for diseases that primarily cause mild acute morbidity, but would raise the rankings of diseases that cause very severe (total) chronic disability.

Adopting particular IME perspectives is comparable in some ways to ranking diseases or vaccines for particular age groups in the population. For example, an IME perspective that highly disfavors diseases affecting children would emphasize the relative ranking of pediatric



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