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[Unpublished] 1982. Presented at the 51st Annual Meeting of the Population Association of America, San Diego, California, April 29-May l, 1982. 35 p.The purpose of this paper was to consider the estimates and projections produced by the UN Population Division about infant mortality (IM) worldwide between 1950-2025. 46 countries were selected and estimates of IM were based on registered data on births and infant death. The data in developed countries posed few problems and thus IM estimates are considered to be accurate. In developing countries where vital registration is complete and where no independent sources of information are available to check completeness, registered data were used. Where adequate registration statistics were lacking, other sources of data had to be used to estimate IM. For other countries data relevant to IM were nonexistent. Direct and indirect methods have been used to estimate these rates. The direct method is characterized by measures of births and infant deaths during a given period of time; the primary indirect method transforms the proportions of children dead by age of mother into probabilities of dying before a given age. Projections of IM in the UN Infant Mortality Project (UNIMR) were based on the overall methods of mortality projections prepared at the UN Population Division. To prepare mortality projections, an estimate of life expectancy at birth is established for a given date and then assumptions are made concerning future trends. IM rates have declined dramatically; for the less developed regions it declined from 164 to 100/1000. The most rapid mortality decline was seen in East Asia. The Soviet Union had the most rapid decline among the developed nations. Projections presuppose that the 1980 ranking of countries will be maintained in the future; the likelihood, however, is that the regions will be markedly different by 2000. 5 examples are presented relevant to the substantive and methodological issues encountered in the UNIMR Project. These included: Sweden, Turkey, Tunisia, Bahrain, and Swaziland, Togo, and Kenya. Results clearly indicate that impressive declines have occurred since 1950 and these are likely to continue into the future. However, IM will remain high in certain less developed countries unless greater effort is expended in these areas to bring the rate down to 50/1000 by 2000. From a methodological perspective, the results of this project emphasize base data. Good data clearly result in more accurate estimates. Future research should examine these results and more attention should be paid to past declines in overall mortality. Also, analyses for some past trends in IM are necessary.
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):452-9.This summary of the worldwide impact of measles discusses epidemiology, reported incidence, clinical severity, community attitudes toward measles, and the impact of immunization programs on measles. Measles, 1 of the most ubiquitous and persistent of human viruses, occurs regularly everywhere in the world except in very remote and isolated areas. Strains of measles virus from different counties are indistinguishable, and serum antibodies from diverse population have identical specificity. Yet, the epidemic pattern, average age at infection, and mortality vary considerably from 1 area to another and provide a contrasting picture between the developing and the developed countries. In the populous areas of the world, measles causes epidemics every 2-5 years, but in the rapidly expanding urban conglomerations in the developing world, the continuous immigration from the rural population provides a constant influx of susceptible individuals and, in turn, a sustained occurrence of measles and unclear epidemic curves. In the economically advanced nations, measles epidemics are closely tied to the school year, building up to a peak in the late spring and ceasing abruptly after the summer recess begins. Maternal antibody usually confers protection against measles to infants during the 1st few months of life. The total number of cases of measles reported to WHO for 1980 is 2.9 million. Considering that in the developing world alone almost 100 million infants are born yearly, that less than 20% of them are immunized against measles, and that various studies indicate that almost all nonimmunized children get measles, less than 3 million cases of measles in 1980 is a gross underestimate. There was adecrease in the global number of reported cases of measles during the 1979-80 period due primarily to the reduction in the number of cases in the African continent and, to a lesser extent, in Europe. It is premature to conclude that such a reported decline is real and that it reflects the beginning of a longterm trend. The contrast between the developed and the developing worlds is most marked in relation to the severity and outcome of measles. Case fatality rates of more than 20% have been reported from West Africa. It has been estimated that 900,000 deaths occur yearly in the developing world because of measles, but data available to WHO indicate that the global case fatality rate in the developing world approaches 2% (in contrast to 2/10,000 cases in the US), and the actal mortality may be greater than 1.5 million deaths per year. The advent of WHO's Expanded Program on Immunization has brought about an awareness of the measles problem. Whenever and wherever measles vaccine has been used effectively on a large scale, a marked reduction in the number of cases has been recorded.