The decline in maternal and infant mortality and its relation to malaria eradication

Abstract In his article 'Malaria eradication and its effect on mortality levels' (Population Studies d21, 3, November 1967) Dr. S. A. Meegama criticised the approach followed by Professor Peter Newman in an earlier investigation of the effects of malaria eradication in Ceylon. In the present series of comments and rejoinders, Professor Newman and Dr. Meegama discuss in detail their interpretations of the data and the methods they have used in assessing the r?le of malaria eradication.     

Malaria eradication and the fall of mortality

Abstract To evaluate the contradictory findings on the role of malaria eradication in the post-war reduction in mortality in Ceylon, the methods of analysis of Newman and Meegama are compared with one constructed by the present author.     

A reply to Mr Palloni’s comments

The protracted and inconclusive debate on the cause of the post-war mortality decline in Ceylon reflects our ignorance of this complex historical event and although I am reticent to prolong this already lengthy discussion, I feel that it is necessary to reply to certain points raised by Mr Palloni. The object of my paper ‘The Decline of Mortality in Ceylon and the Demographic Effects of Malaria Control’⁹ was to re-examine some of the past work on this subject in order to attempt a synthesis of previous theories, was not, however, intended to provide a definitive account of all the causal mechanisms underlying the decline of mortality as it is my view that the data are insufficient for such an undertaking. In the reappraisal I was mainly concerned with the validity of Newman’s regression model and, as far as the data would permit, an assessment of Meegama’s thesis that there were significant disturbing variables which confounded the simple regression of mortality decline and malaria prevalence. I will try first to respond to Mr Palloni’s specific substantive points and then go on to consider the broader question of regression models.     

Malaria eradication and its effect on mortality levels

Abstract It is argued in this article that malaria eradication was only one of a group of factors which were responsible for the lowering of mortality levels in Ceylon in the years after 1946. The magnitude of the contribution made by these other factors has not generally been taken into account since they took effect during the period of malaria eradication, but since some of them were carried out in a few of the endemic malarial areas during the pre-eradication period, some attempt to measure them can be made of their impact on mortality levels. Further the effect of malaria eradication on mortality levels in the absence of these other measures is also studied by examining the case of Guatemala where in spite of malaria eradication the decline in mortality levels has not been so significant as in Ceylon.     

“Roll Back Malaria,Roll in Development”? Reassessing the Economic Burden of Malaria

Recent efforts to mobilize support for malaria control have highlighted the economic burden of malaria and the value of malaria control for generating economic development. These claims have a long history. Beginning in the early twentieth century, they became the primary justification for malaria‐control programs in the American South and in other parts of the globe, including British India. Economists conducted none of these studies. Following World War II and the development of new anti‐malarial drugs and pesticides, including DDT, malaria control and eradication were increasingly presented as instruments for eliminating economic underdevelopment. By the 1960s, however, economists and demographers began to raise serious substantive and methodological questions about the basis of these claims. Of particular concern was the role of rapid population growth, resulting in part from the decline of malaria mortality, in undermining the short‐term economic gains achieved through malaria control. Despite these concerns, malaria continues to be presented as an economic problem in the work of Jeffrey Sachs and others, justifying massive investments in malaria control. The methodological basis of these claims is examined. The paper concludes that while malaria takes a dreadful toll in human lives and causes significant economic losses for individuals, families, and some industries, the evidence linking malaria control to national economic growth remains unconvincing. In addition, the evidence suggests that there are potential costs to justifying malaria‐eradication campaigns on macroeconomic grounds.     

Comments on R. H. Gray's 'The decline in mortality in Ceylon and the demographic effects of malaria control'

Abstract With his article 'The Decline in Mortality in Ceylon and the Demographic Effects of Malaria Control', R. H. Gray has added a new contribution to the long discussion of the effects of malaria eradication on the abrupt mortality decline experienced by Ceylon immediately after World War II. He has used new information and at the same time introduced slight modifications in the statistical procedures designed to evaluate the validity of the hypothesis. However, certain aspects of his article need to be clarified; they are related to the methodology employed and to the theoretical approach used.     

A hazards-Model analysis of the covariates of infant and child mortality in Sri Lanka

The purpose of this paper is twofold: (a) to provide a complete self-contained exposition of estimating life tables with covariates through the use of hazards models, and (b) to illustrate this technique with a substan-tive analysis of child mortality in Sri Lanka, thereby demonstrating that World Fertility Survey data are a valuable source for the study of child mortality. We show that life tables with covariates can be easily estimated with standard computer packages designed for analysis of contingency tables. The substantive analysis confirms and supplements an earlier study of infant and child mortality in Sri Lanka by Meegama. Those factors found to be strongly associated with mortality are mother’s and father’s education, time period of birth, urban/rural/estate residence, ethnicity, sex, birth order, age of the mother at the birth, and type of toilet facility.     

Incorporating husband-wife differences in place utility differentials into migration decision models

This paper extends the micro-level empirical literature on migration decision making by investigating the manner in which husbands' and wives' subjective place utility expectations jointly feed into migration decisions in a low-income country. The authors use expectational data relating to four place utility dimensions and stated migration intentions of 376 village-resident Egyptian couples to test alternative decision models. An ordinal probit estimation technique is employed. The results of the analyses support the hypothesis of husband dominance in migration decisions in this context. The authors conclude with a discussion of the implications of the paper for further theoretical refinement and for migration survey design in this and other developing countries.Dr. McDevitt is a Research Associate of the Carolina Population Center, The University of North Carolina at Chapel Hill. Dr. Gadalla, former Director of The Social Research Center of The American University in Cairo, is currently Visiting Distinguished Professor of Sociology-Demography, San Diego State University, San Diego.This is a revised version of a paper presented at the 1984 annual meetings of the Population Association of America and cited throughout as McDevitt and Gadalla (1984). The authors wish to acknowledge helpful discussions with Amos Hawley in the early stages of the development of the paper and the guidance of David Guilkey and Larry Taylor with the statistical techniques employed in the work reported in the paper. The research was supported in part by grants 1-R01-HD14943 and 1-T32-HD07168 from the National Institutes of Health.     

WHO on Health and Economic Productivity

The current issue of the World Health Organization's annual flagship publication, titled The World Health Report 1999: Making a Difference, is the first issued under Gro Harlem Brundtland, WHO's Director-General, who assumed the office in 1998. In her preface to the 121-page report Dr. Brundtland identifies four major challenges to be addressed in order to improve the world's health: the need to reduce the burden of excess mortality and morbidity suffered by the poor; the need to counter potential threats to health resulting from economic crises, unhealthy environments, or risky behavior; the need to develop more effective health systems; and finally the need to invest in expanding the knowledge base that made possible the twentieth-century revolution in health. Chapter 1 of the report discusses health and development; subsequent chapters address the problems of emerging epidemics and infectious diseases and of maternal and child disability and mortality; health systems development; and the challenges of rolling back malaria and combating the tobacco epidemic. Chapter 1 consists of two parts: the first documents the twentieth-century revolution in human health, the second discusses the inadequately explored problem of the relationship between health and economic productivity. This second section of Chapter 1 is reproduced below in full, with the permission of WHO. (The endnotes were renumbered.)     

Faster,more accurate pregnancy test developed

A new test for pregnancy is the fastest and most accurate yet is, according to its developer, Cornell University endocrinologist and biochemist Professor Brij B. Saxena. The test, which would enable a woman with an unwanted pregnancy to seek an abortion within hours after the 1st missed menstrual period, is said to be almost 100% accurate. Current pregnancy tests, according to Dr. Saxena, are not reliable until between the 8th-15th day following a missed period. The procedure involves mixing a few drops of blood taken from a woman's finger with radioactive iodine. The level of the hormone human chorionic gonadotropin (HCG) which appears early in pregnancy in the blood is then measured within a few hours in a procedure called radioreceptor assay; a high HCG level indicates pregnancy. Accuracy of the test has been confirmed, according to Saxena, in clinical experience in 4 U.S. medical schools: Harvard, University of Southern California, University of Louisville, and Brooklyn Downstate Medical Center. "Biocept-G" pregnancy test kits containing the radioactive materials needed for the Saxena test have reportedly been made available to some 6000 U.S. hospitals licensed by the Nuclear Regulatory Commission.     

Natural resources and the environment: The challenge of economic and social development

In a global society committed to ever-expanding economic and social development, natural resource professionals must adopt an enlarged perspective of their professions—a truly global perspective. The objective, professional-as-scientist concerned only with a single discipline in a limited region, is no longer adequate to the task. It is no longer enough to limit the focus of our "professional" concern to traditional natural resource management issues. World population pressures, the growing dangers of global air pollution and nuclear war threaten the entire global environment we have sought to conserve. It is time to bring some passion to the service of reason. It is time to understand worldwide air pollution and issues of war and peace as environmental problems. It is time to recognize that population policy is natural resource policy writ large.This paper is adapted from an address of the same title to the Opening General Session of the 1987 National Convention of the Society of American Foresters, Minneapolis on October 19, 1987. Carl Reidel is the Daniel Clarke Sanders Professor of Environmental Studies; and Director of the Environmental Program, The University of Vermont. He is Director and past President of the American Forestry Association; Director of the National Wildlife Federation; former Director of the National Parks and Conservation Association, and has served on the faculties of Williams College, Yale and Harvard Universities, and the University of Minnesota. Send reprint requests to Dr. Reidel, 153 South Prospect Street, Burlington VT 05401 -13595.     

Malaria in Pacific populations: seen but not heard?

Most Pacific Island countries are located in the tropics, where there is an abundance of mosquitoes with the potential to carry debilitating or life-threatening vector-borne diseases. This article examines three Melanesian countries in which malaria is endemic—Papua New Guinea, Solomon Islands and Vanuatu—but the threat posed by the spread of malaria gives the issues a broader significance to the Pacific region. After discussing the spatial distribution and prevalence of malaria in the Pacific, the article examines a number of health interventions through which people have sought to control malaria. Although the disease was nearly eradicated in the Pacific in the 1970s, it is no longer in retreat. The article concludes by examining why there are still grounds for cautious optimism, and the challenges that Pacific Island countries face in reducing the impact of malaria on their populations. There is a need for prompt and concerted action on malaria at the national, regional and international levels if the public health concerns arising from the disease are to be adequately addressed.     

The behaviour towards malaria care—a multinomial logit approach

This paper attempts to estimate a disease specific demand function to study the determinants of utilisation of the services of a health care provider or a treatment regiment for malaria. The study adapts a multinomial logit framework to look at both facility characteristics and individual patient features on demand for malaria care in Ghana. The individual patient characteristics form a set of social indicators which can be used to discriminate or put into groups patients with respect to their choice of provider.The study confirms the popular use of self-medication as a first choice of action in treating malaria. The choice of malaria care providers is found to be influenced by facility price, travel time, waiting time for treatment, education, age, sex and quality of care measured in terms of drugs availability. We further find that as income increases, the odds are in favour of self-medication when people get malaria.     

Models and Proposals for Malaria: A Review

Mathematical models to study the dynamics of malaria continue to be developed and upgraded on the parasite component, which is the causative agent for malaria; on the human component that serves as a reservoir of infection for the blood feeding female mosquitoes; on the disease transmitting vector, the component mostly responsible for the movement of the parasite agent from one human to another; or on the life cycle of the malaria parasite as a pathogen both within the human and vector populations. The consideration of so-far neglected features can be beneficial for the control of malaria.     

Export agriculture is feeding malaria: a cross-national examination of the environmental and social causes of malaria prevalence

Malaria rates remain high across many less-developed regions, including Southeast Asia, Sub-Saharan Africa, and parts of Latin America. Although case studies find elevated malaria rates in locales with increased levels of environmental degradation, the current body of comparative environmental research lacks investigation of infectious disease trends. This study draws upon world-system theorizing to consider agricultural export flows and resulting alterations to the natural environment in poor nations as key causes of malaria prevalence. Additionally, relationships among world-system position, economic development, and socio-health characteristics are examined alongside the environmental predictors using structural equation modeling for data on 99 less-developed nations. The findings emphasize that deforestation and biodiversity loss associated with primary sector export flows are key drivers of malaria rates, alongside notable influences of basic health and social services. The results suggest that environmental and social conditions greatly shape malaria transmission in poor societies.     

Number of generations necessary to attain eradication of an insect pest with sterile insect release method: A model study

Summary Simulation of the sterile insect release process was carried out based on a system which consisted of a logistic population model and Poisson-binomial model for normal, sterile and combined matings. From the results, relationship between the intrinsic rate of natural increase and the sterile vs. normal ratio necessary to attain eradication of the target pest species were presented. The effects of weakened sperm competitiveness and the increased number of matings per female were not so strong. On the other hand, a given rate of immigration could be a cause of failure of the eradication. A simple method to calculate relationship between hatchability and sterile vs. normal ratio was presented.     

Features of the demography of Palestine

The objections which Dr Bromberger raises against official vital statistics in Palestine are considered by the author in this paper, and Dr Bromberger's methods of estimation are carefully examined. While defects in the statement of ages and some under-registration of Moslem deaths are admitted, the conclusion is reached that there is no inherent inconsistency in the published figures, and that any errors would not affect the differential rates of growth of the Arab and Jewish populations.