The Epidemiological Transition Policy and Planning Implications for Developing Countries (1993) / Chapter Skim
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CHILDHOOD PRECURSORS OF ADULT MORBIDITY AND MORTALITY IN DEVELOPING COUNTRIES: IMPLICATIONS FOR HEALTH PROGRAMS
CHILDHOOD PRECURSORS OF ADULT MORBIDITY AND MORTALITY IN DEVELOPING COUNTRIES: IMPLICATIONS FOR HEALTH PROGRAMS
Pages 69-100
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From page 69... ...
In the postwar period, largely as a result of advancements in medical technology directed against infectious and parasitic diseases, there have been rapid declines in infant and child mortality that, coupled with the high levels of fertility, have produced rapidly growing populations with a very young age structure. Beginning in the 1960s and accelerating through the 1970s and 1980s, birth rates declined in much of the developing world, initiating a process of slower population growth.
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From page 70... ...
and then look at the growing literature suggesting that a number of chronic cardiovascular and pulmonary diseases may be related to a range of risk factors beginning in the intrauterine environment (e.g., intrauterine growth retardation) and extending through disease exposures and behavior patterns acquired in childhood (e.g., acute respiratory infections, dietary consumption of fat and salt)
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From page 71... ...
In the concluding section of this paper we take a more integrated approach by examining some of the interactions among childhood risk factors in producing adult diseases. Also, recent trends in adult cause-of-death data from selected developing countries are examined to assess how mortality profiles may be related to conditions acquired in childhood several decades earlier.
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From page 72... ...
More than two-thirds of these occur in the countries of South Asia where approximately one birth in four is low birthweight. The overall risk of delivering a low-birthweight infant in a developing country is three times that in an industrialized country.
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From page 73... ...
completed a study relating birthweight and childhood respiratory infections to risk of death from chronic obstructive pulmonary disease and to pulmonary function among men ages 59-67 years in England. They confirmed that low birthweight and severe respiratory infections in infancy were associated with higher risks of death from COPD as well as with compromised lung function among the survivors.
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From page 74... ...
that can produce permanent disabilities among surviving infants in developing country settings. Brain damage leading to mental retardation, cerebral palsy, and other neurological disabilities would be among the most serious consequences with a lifelong influence on health status.
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From page 75... ...
Mother '\ 50% carrier J 5_ 5oo/o Daughter Sons 14°/0 / Baby ~carrier Livery death I FIGURE 1 Schematic representation of the intergenerational cycle of hepatitis B infection, chronic liver disease, and liver cancer. SOURCE: Beasley (1982:22S)
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From page 76... ...
Figure 2 (from Barnum and Greenberg, 1993) compares the age-specific liver cancer mortality rates from China, where HBV is prevalent, to those from the United States, where maternalinfant HBV transmission is rare, to illustrate the relative importance of this condition in developing country settings.
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From page 77... ...
In the large majority of cases, congenital syphilis will result in spontaneous abortion or perinatal deaths; however, in 10 to 20 percent of cases, there will be a surviving infant with latent congenital syphilis who may develop active manifestations later in life (Hire et al., 19904. These may include blindness, deafness, paralysis, and a variety of bone lesions.
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From page 78... ...
The clinical symptoms of tuberculosis however, are not common with the onset of the infection; rather, after a latent period of some years, approximately 6 to 10 percent of infected individuals will go on to develop active tuberculosis. Eighty-five percent of these cases will be among adults in the most productive age group 15-59 years, as is shown in Figure 3 for several African populations.
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From page 79... ...
. .among the majority of the world's population, rheumatic heart disease remains the most common cardiovascular cause of death in the first four decades of life." Rheumatic heart disease remains a significant problem in the developing world (Michaud et al., 1993~.
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From page 80... ...
With the growing evidence of a genetic risk factor for rheumatic heart disease, there is an urgent need for more research to simplify the identification of susceptible persons so that more specific preventive interventions can be developed. Polio Polio is a viral illness transmissible through fecal-oral and pharyngealoral routes.
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From page 81... ...
Based on epidemiological studies, the World Health Organization (1990) estimates the number of infected people in Latin America to be on the order of 15 to 18 million.
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From page 82... ...
pylori) are bacteria that are associated with chronic atrophic gastritis, an inflammatory precursor of stomach cancer.
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From page 83... ...
Once an individual acquires H pylori, infection persists for life if not treated, producing the chronic atrophic gastritis associated with gastric carcinoma.
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, such treatment is not a practical measure. The dramatic decline in stomach cancer in the developed world is an encouraging sign; it suggests that by improving environmental sanitation to reduce the risk of acquiring H
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From page 85... ...
Further, as noted earlier, maternal stunting is an important determinant of low birthweight; thus, there is an intergenerational consequence of undernutrition. As summarized in the review by Elo and Preston (1992)
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From page 86... ...
represent at present the firmest statistical support for the belief that childhood conditions can make a good deal of difference for adult death rates." With the available data, it is not possible to measure the potential magnitude of the effect growth stunting may have on adult mortality in developing countries. Given the very high prevalence of stunting that is reported above, however, it is probable that the effect is substantial and that significant reductions in adult mortality may be expected with improvements in childhood nutritional status among populations of developing countries.
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From page 87... ...
Lower rates in the range of 10 to 30 percent are seen in Latin America and East Asia. Major associated causes of iron deficiency anemia besides dietary deficiency of iron are heavy parasitic infections (hookworm and schistosomiasis)
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From page 88... ...
These carefully controlled studies suggested that the previously anemic children had long-lasting developmental disadvantages as assessed by a variety of tests of mental and motor development when compared to a control group without anemia in infancy. These developmental disadvantages persisted when the studies were statistically controlled for a variety of other background risk factors.
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From page 89... ...
(1990) review a wide range of epidemiological studies relating household air pollution to acute respiratory infection in children and chronic obstructive pulmonary disease among adults.
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From page 90... ...
_ ~_ _ 35-44 45-54 55-64 65-74 Age FIGURE 5 Chronic obstructive pulmonary disease: Age-specific mortality rates, China and the United States.
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From page 91... ...
Not surprisingly, lead exposure is highest among children in urban areas where there is a high density of air, soil, and dust lead levels. A number of epidemiological studies have documented that the developmental effects of chronic low-level lead exposure in early life include low birthweight, impaired mental development in the first two years of life, I.Q.
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From page 92... ...
Chronic obstructive pulmonary disease is used as an example to illustrate how multiple risk factors in childhood can be operating simultaneously and even synergistically to produce disability and death among adults (Samet et al., 19831. Figure 6 illustrates schematically some of the possible underlying childhood determinants of COPD in developing country settings.
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From page 93... ...
Although the numbers of persons affected on a global scale are in the tens of millions, it is difficult to assess from such data the relative importance of these childhood conditions compared to other diseases acquired later in life that contribute to adult morbidity and mortality. One problem with making such assessments is the fact that very few developing countries have adequate data at the national level on cause of death.
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From page 94... ...
Men (%) Communicable 7.17.8 Tuberculosis 3.5a3.8a Maternal 1.8 Cancer 23.627.3 Liver 4.3a8.3a Stomach 4.8a5.0 Lung 3.83.9 Esophagus 2.52.9 Colon-rectum 1.41.4 Nasopharynx 0.3a0.9 Breast 1.7 Cervix 0.8 Cardiovascular 23.820.4 Cerebrovascular 11.210.8 Ischemic 4.33.6 Rheumatic 4.3a2.2a Hypertensive 2.02.3 Respiratory 9.910.4 Chronic obstructive 9 Sa9.3a pulmonary diseased Digestive 5.67.5 Chronic liver disease 2.6a4.2a Endocrine 0.80.8 Diabetes 0.60.8 Other noncommunicable diseases 6.55.7 Injuries 20.920.1 All causes 100.0100.0 Probability of dying (percent)
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From page 95... ...
Attention should be given not only for direct child health interventions such as vaccines but particularly for interventions that will have crosscutting effects on reducing the risks of multiple conditions simultaneously. Interventions such as reducing indoor air pollution, upgrading housing and
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From page 96... ...
Winter, and S.O. Shaheen 1991 Relation of birth weight and childhood respiratory infection to adult lung function and death from chronic obstructive airways disease.
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From page 97... ...
Bumgarner, J.R., and F.E. Speizer 1993 Chronic obstructive pulmonary disease.
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From page 98... ...
Gray, and C.R. Trivedi 1993 Risk factors for pre-term and term low birth weight in Ahmedabad, India.
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From page 99... ...
Blaser 1991 Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. New England Journal of Medicine 325(16)
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From page 100... ...
Geneva: World Health Organization. World Health Organization 1988 Rheumatic fever and rheumatic heart disease.
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