Childhood Precursors of Adult Morbidity and Mortality in Developing Countries: Implications for Health Programs
Citation: Mosley, Gray (1993) Childhood Precursors of Adult Morbidity and Mortality in Developing Countries: Implications for Health Programs.
Interventions in developing countries have led to reduced infant and childhood mortality. However, these short term interventions, such as immunizations and micronutrient supplementation, have not addressed "emerging health problems among the adults and the aged . . . and to what degree these chronic diseases and disabilities might be a consequence of infectious diseases and other adverse conditions that were experienced decades earlier in infancy and childhood" (p. 70). Therefore, this article examines four types of childhood conditions that affect later life morbidity and mortality: (1) perinatal conditions, (2) infectious diseases, (3) nutritional deficiencies, and (4) environmental hazards. Perinatal Conditions: About 80 percent of low-birthweight infants in developing nations are a result of intrauterine growth retardation (IUGR) rather than prematurity. IUGR is typically caused by inadequate calorie and protein intake during pregnancy. Low-birthweight infants have a higher incidence of lower respiratory tract infections than infants of normal weight. Moreover, low-birthweight is associated with increased risk of death from COPD (chronic obstructive pulmonary disease) in later life. Since low-birthweight is common in developing nations (e.g., 25% in South Asia), it is not surprising that COPD is a leading cause in these nations. Birth trauma, which is associated with brain damage, cerebral palsy and neurological disabilities, is another common perinatal condition that is often caused by insufficient medical attention. Perinatal infections, such as Hepatitis B virus (HBV) , also have important long term consequences. For instance, 1-2 million people in developing nations die each year from HBV complications (e.g., liver cirrhosis and liver cancer); many of these cases are contracted in-utero. Other perinatal infections, like syphilis and gonorrhea, contribute to blindness and other disabilities. Infectious Diseases of Childhood: Tuberculosis, rheumatic fever, polio, trachoma, Chagas' disease, schistosomiasis, helicobacter pylori and Epstein-Barr virus are examples of infectious diseases in childhood which can dramatically affect morbidity and mortality at later ages. For instance, tuberculosis is generally contracted in childhood, but it does not manifest clinical symptoms until several years later. Rheumatic fever does cause death among children, but it is also serious because it predisposes people to rheumatic heart disease. Chagas' disease, which affects some 18-20 million people in Latin America, is transmitted to children by reduviid bugs. Although the acute phase of the disease usually passes unnoticed, damage to the heart appears after about 20 years, causing death between the ages of 20-50. Some diseases-like schistosomiasis, which is a type of parasite that invades the liver during childhood that results in tissue destruction and infection of the intestines and urinary tract-are rarely fatal but increase morbidity throughout the life course. Nutritional Deficiencies in Infancy and Childhood: Globally, 25% of the world's children are stunted due to protein-energy malnutrition (PEM). PEM is associated with poor school performance and low productivity in later life. Also, stunting is associated with later life conditions like cardiovascular diseases, tuberculosis and COPD. In addition to PEM, micronutrient deficiencies (e.g., iodine, iron and vitamin A), affect adult morbidity-especially as it relates to intellectual development. Environmental Hazards: Quality of indoor air in most developing regions is very poor due to fuels that are burned inside (e.g., animal dung, wood, coal), generally in a cooking stove. The poor quality of indoor air is contributes to respiratory infection in children and COPD among adults. Also, since many developing nations still use leaded gasoline, problems associated with lead, particularly impaired mental development, are common. Conclusions: This paper dealt with these issues in isolation. In reality, they are interconnected. Therefore, to address the synergy that may exist between them, it is necessary to address underlying conditions of poverty and unsanitary living conditions to make substantial progress. It is important to address this issue, since about one-third of premature deaths among deaths in developing nations is related to a childhood condition.