Haiti Faces Yet Another "Plague" of Cholera

It isn't easy being the poorest country in the western hemisphere even on a good day, but Haiti has had some really bad days over the past several years. First came the disastrous earthquake in 2010, from which the country has never really recovered, and then came cholera in its wake, as a I noted at the time:

Although it has not yet been confirmed, there is suspicion that cholera was brought to Haiti by Nepalese peace-keepers working with the United Nations. All cases have occurred downstream from the camp in which they are based and it is believed that human excrement (the mode of transmission) has been dumped in the nearby river.

Unbelievably, it took six years--until August of this year--for the UN to admit that it had anything to do with the cholera in Haiti, and it has not yet done much to help the situation of victims and their families. And, of course, that was all before this past week's passage of Hurricane Matthews through the Caribbean. CNN reported that:

Haiti's leader says Hurricane Matthew's assault has accelerated the already existing cholera epidemic and undermined the strides made in fighting the disease. "A lot of effort has been made to avoid the spread of this epidemic," said Interim President Jocelerme Privert, "but the hurricane has accelerated it."

Thirteen people have died from cholera since Matthew hit Haiti, he said. This tragedy -- which has killed more than 370 people -- comes after a devastating cholera outbreak in 2010. The United Nations says it has been involved in trying to eradicate the disease in Haiti. 

Cholera, which is spread through water or food contaminated with Vibrio cholerae bacteria, can cause severe diarrhea and vomiting, which leads to extreme dehydration. It can swiftly result in outbreaks, and patients who are not treated quickly can die within hours. 

Haiti has one of the highest rates of cholera in the world, with almost 10,000 people dead from the disease since 2010 and more than 27,000 suspected cases have been reported this year -- an estimated 1 in 3 of them children, UNICEF said.

Keep in mind that there were no known cholera cases in Haiti before the UN peacekeepers came in after the 2010 earthquake. So, the fact that it now has "one of the highest rates of cholera in the world" is a tragedy on top of a tragedy.

Getting the Bigger Picture Through Spatial Modeling of DHS Data

A tweet today from Springer Publishing noted that the latest issue of Spatial Demography is "on the newsstands" and I am co-author on a paper in this issue. I wouldn't necessarily toot my horn on something like this, but the methods we used in the paper presaged a new effort by the DHS Spatial Data Repository team to create spatial models of data from the DHS surveys. Our work was led by one of our PhD students, Stephen Crook, and utilized Empirical Bayesian Kriging, the same method employed by the DHS folks. We focused on a four-region area of southern Ghana and examined the spatial patterns of obesity in that country. DHS data have consistently shown an increase in obesity over time in Ghana (and many other African countries), particularly in the urban areas where there is increasing access to Western-style processed foods. Here is what our map looks like, using data from the 2008 DHS (the 2014 data weren't out yet when we started working on this):

The hot spots are especially Accra (the capital and largest city in the country) in the south, and Kumasi to the northwest of Accra. Kumasi is the nation's second largest city. In particular, the data suggest that the suburban and peri-urban areas of Accra--where the wealthiest residents live--are especially prone to obesity. If you just analyze the DHS data without reference to the spatial patterning, you might get hints of what's going on, but the maps genuinely enhance our understanding.

Could Humans Live Past 122 Years?

Every species on earth has a life span--an oldest age to which one of its members is known to have lived. Notice that I worded that carefully. We are talking about a verified oldest age of one member of the species (whether a human, a dog, a whale, or a redwood tree). The current record holder among humans is a French woman, Jeanne Clement, who died in 1997 at the age of 122 years, as I note in Chapter 5 of my text. I bring this up because a two-page letter published this week in Nature has received a surprising amount of publicity and even pushback, leading to a discussion about it yesterday in Nature and also in yesterday's NYTimes. Here's the deal:

An analysis of global demographic data published in Nature suggests that humans have a fixed shelf life, and that the odds of someone beating Calment’s record are low — although some scientists question this interpretation. They say that the data used in the analysis are not unequivocal, and that the paper doesn’t account for future advances in medicine.

The data in question come from the Human Mortality Database originally developed at UC Berkeley by John Wilmoth, who is now Director of the Population Division of the UN. That project was undertaken in collaboration with the Max Planck Institute for Demographic Research in Germany, where the data are now housed. Jan Vijg, a geneticist at Albert Einstein College of Medicine in New York City and two of his graduate students, "reasoned that if there’s no upper limit on lifespan, then the biggest increase in survival should be experienced by ever-older age groups as the years pass and medicine improves. Instead, they found that the age with the greatest improvement in survival got steadily higher since the early twentieth century, but then started to plateau at about 99 in 1980. (The age has since increased by a very small amount)."

The data suggest that the odds are pretty slim of living past 115 (you can get a quick shot of similar data at this website of record holders). Jeanne Clement is clearly an outlier, but at the same time she redefined upward what the human life span really is. Could someone live longer? My view is yes, but the chances are clearly slim. That seemed to be Vijg's reasoning also, and if you've read my book, you know that I agree with his view that we should spend our time and resources increasing human health span (the number of healthy years we live) rather than on thinking that we can somehow increase the maximum age to which a single human could live.

Polish Women Take to the Streets Over Abortion

Poland already has one of most restrictive set of abortion rules in Europe, but the country's legislature is trying to make it even harder for women to get an abortion. The BBC reports on this, as follows:

If the law - which has cleared one parliamentary hurdle so far - goes through it will make Poland's abortion laws as restrictive as those in two other countries in Europe: Malta and the Vatican.

Women found to have had abortions would be punished with a five-year prison term. Doctors found to have assisted in an abortion would also be liable for jail time.

The Catholic Church appears to be the primary pusher of this legislation, but women have taken to the streets to protest--most to protest against the proposed legislation, but some to protest the protesters.

Abortion is already banned in most circumstances in Poland. The current exceptions are:

* where the woman's life is in danger
* where there is a risk of serious and irreversible damage to the fetus
* where the pregnancy is as a result of rape or incest - this must be confirmed by a prosecutor

So, the new law would take away those exceptions. These are the kind of issues that have cropped up regularly in the United States and so it was not surprising that abortion was on the table, so to speak, at tonight's vice-presidential debate between Tim Kaine and Mike Pence. Although Catholic and personally opposed to abortion, Kaine argued that women need to be able to make the decision about an abortion which, after all, is legal in the U.S. Pence thought otherwise. It still astounds me that men really think they should make reproductive decisions for women. We still have a long way to go.

UPDATE: The protests did, in fact, cause Poland's legislature to rethink this legislation and it was voted down.

Breastfeeding vs Baby Formula Pops Up as an Issue in Egypt

Many years ago Nestle and other companies that make baby formula were tried in the court of public opinion for pushing formula onto mothers, even though they had to know that breast-feeding is almost always better for the child. The world then pivoted back to encouraging new mothers to breast-feed for several months after birth. It seems, though, that the pivot wasn't quite so big in Egypt and that has created a fresh controversy in that country, as reported in a Public Radio International story pointed out to me by Debbie Fugate. The Egyptian government is struggling to stay afloat and so it has lowered its subsidy of baby formula, creating a supply problem for mothers that has caused a lot of consternation. The government has also implemented a very unusual test for mothers to confirm that they are not producing sufficient breast milk and thus need the formula.

New mothers in hospitals were the first to get the exams last month, intended to prove their need for extra milk. This measure symbolizes, some say, a depraved regime that disrespects women.

But why is there such a demand for formula?

“There is a need to better inform mothers and communities on the importance of breastfeeding for their child’s survival and mental and physical development,” said Bruno Maes, UNICEF’s Egypt representative. The agency says fewer than one-third of children in Egypt aged 4 to 5 months are exclusively breastfed. 

“The formula companies have done too good a job in marketing their product,” said Salma Ramadan, a pediatrician at Helwan General Hospital. “Many new mothers are not interested in hearing what we have to say about breastfeeding and start asking for the cans of subsidized milk even before they give birth.”

The 2014 Demographic and Health Survey in Egypt showed that stunting was apparent in children under the age of 6 months. It also shows that almost all Egyptian mothers breastfeed their babies, but a high proportion also supplement breastfeeding with baby formula very early on. Most mothers are apt to prefer that convenience, but it may not be beneficial either for the baby or for the current economy.