
Infant Deaths Fall Sharply in Africa with Routine Antibiotics - montrose
https://www.nytimes.com/2018/04/25/health/africa-infant-mortality-antibiotic.html
======
_ph_
My first reaction when reading this of course was: what about resistance? But
then I thought: as long as it is standard practise to heavily use antibiotics
in meat farming, we shouldn't point at any good usage to save human life. And
it indeed seems to be a faszinating and very beneficial usage of antibiotics.
Beyond its obvious humanitarian benefit, lowering child mortality seems to be
the working method to limit population growth.

~~~
enriquto
There is a somewhat unhealthy obsession with antibiotic resistance. The
problem is not as scary as it may sound. It turns out that antibiotic-
resistant strains are much weaker than normal strains in the absence of
antibiotics (because they use a great deal of resources to be antibiotic
resistant), and they tend to disappear quickly.

~~~
Retric
It's not a big deal for healthy people and non fatal diseases. It's however a
big deal when you _need_ antibiotics the most.

So, the choice is to reserve them to the most extreme cases which will save
the most human lives possible. Or, use them all over the place improving the
average quality of life at the expense of significantly more people dying.

I think it's reasonable for humanity to pick either option, but pretending
it's not an important choice is over simplified.

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tim333
Antibiotics can be handy things. It's easy to forget in the modern west how
common it was for bacteria to do people in in the past, though I was reminded
this morning by the HN stuff on Feynman and his watching his wife slowly die
from Mycobacterium tuberculosis. I hope with antibiotic resistance they don't
come back too much.

~~~
mylons
my girlfriend is the Program Manager of the Mordor study. when i told her this
was here, the first thing she said was, "everyone's going to freak out about
resistance. just tell them they've been using these antibiotics in the region
for decades and have been measuring and monitoring resistance levels."

~~~
craftyguy
> measuring and monitoring resistance levels

Ok, but what does that have to do with preventing bacteria from gaining
resistance to antibiotics?

~~~
mylons
they stop using the drug at a certain threshold? first result from a google
search.
[https://www.cell.com/trends/microbiology/abstract/S0966-842X...](https://www.cell.com/trends/microbiology/abstract/S0966-842X\(00\)01873-4)

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neonate
[http://archive.is/aQ2x3](http://archive.is/aQ2x3)

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InclinedPlane
Great to see most of the HN comments here wasting their time freaking out
about too many brown babies living in the world. (Filter it through whatever
level of indirection you like, that's fundamentally the core of these
freakouts.)

Anyway, it'll be interesting to see if these results hold up, because these
are very outsized effects at very low cost compared to many other disease
interventions. Also, it'll be interesting to see how much this is due to body
weight versus other effects. Antibiotics are routinely used in livestock for
weight gain not for disease control, it may be that weight gain gives a
significant survival advantage for other conditions, such as enteric diseases,
independent of their antibacterial effects. In any event, this has the promise
to become an important tool in reduction of child mortality in developing
countries and that will have a tremendous number of positive follow-on results
(in addition to the lives saved, of course).

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quasimodem
I learned in Headlines 101 not to use "Infant", "Fall", and "Sharply" together
in a headline. But what does college matter once you're in the real world?

~~~
jadedhacker
I don't think I get it. I didn't have the wrong impression from reading that
headline in the sense of thinking that infants were falling on sharp objects.
Can you elaborate on the lesson they were trying to teach you? Is for
optimizing for people that don't even fully read the headline?

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adrianN
Let's see how long they last before resistances develop.

~~~
cm2012
Considering in the developing world babies are not dying of infections, its
safe to assume that it can last a long time.

~~~
sadgit
How does a lower infant mortality rate indicate lower antibiotic misuse?
Antibiotic misuse could be constant as a % of overall antibiotic use.

~~~
JBReefer
A lot of negativity in this thread is probably because they're saving the
"wrong kind" of infants

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hacknpol
While this is prima facie good news, it is worth mentioning that Africa’s
population growth doesn’t appear to be slowing down
[http://www.worldometers.info/world-population/africa-
populat...](http://www.worldometers.info/world-population/africa-population/)
The decline in mortality is not followed by a decline in fertility for
Africans.

~~~
jake-low
It absolutely is. See this animated chart of birth rate vs child mortality
rate since 1960 (press the play button in the lower right).

[https://www.gapminder.org/tools/#_state_time_delay:172;&mark...](https://www.gapminder.org/tools/#_state_time_delay:172;&marker_axis/_x_which=child/_mortality/_0/_5/_year/_olds/_dying/_per/_1000/_born&domainMin:null&domainMax:null&zoomedMin:1.95&zoomedMax:756.29&scaleType=linear;&axis/_y_which=children/_per/_woman/_total/_fertility&domainMin:null&domainMax:null&zoomedMin:1.12&zoomedMax:8.87;;;&data_/_lastModified:1524803248601&lastModified:1524803248601;&chart-
type=bubbles)

African nations (blue bubbles) are lagging behind the rest of the world, but
the trend is clear: declining infant mortality results in declining birth
rate, often with a delay of just a single generation.

~~~
Alterlife
This is such a great visualization. You can click on the dot you are
interested in to draw a line that tracks it's movement through the years.

The journey of Niger is especially interesting. Between 1947 and 1983, the
birth rate actually increased despite infant mortality declining. Do you
happen to know why that is?

[https://imgur.com/a/qnnHYbQ](https://imgur.com/a/qnnHYbQ)

~~~
jake-low
I'm not sure why that's the case for Niger, but I don't think it's totally
unique. Mali undergoes the same sort of shift (though less dramatic) in the
1950's and 60's. 1947 corresponds roughly to the beginning of the independence
movement in Niger (though France wouldn't acknowledge this until 1958), and
the turbulence shown around 1970 (where child mortality briefly increases
again) was likely caused by the Sahelian drought.

I would (cautiously) speculate that when an oppressive force (either political
or natural) is abruptly removed from a population, that population will tend
to experience increased birthrate and decreased child mortality
simultaneously. Extreme poverty is such a hardship that it can lower the birth
rate (in addition to its obviously adverse effect on child mortality). When
the force is removed (e.g. by a regime change, or a period of economic
growth), child mortality decreases due to better health and better food
security. Simultaneously, people have access to a luxury that they may not
have before: the opportunity to start families. So the birth rate can rise as
well. It takes another generation before the positive effects (better health,
stable food supply, etc.) to translate into better education, higher economic
mobility, and ultimately lower birth rate. So perhaps independence from a
colonial power that often used military force against the civilian population
is the cause of this simultaneous increase in child survival and birth rate,
which we see in several of the poorest African nations shortly after their
independence.

As for the charts, they're among my favorite data visualizations. They were
invented by Professor Hans Rosling, who you may know from this very animated
TED talk [0]. Rosling passed away last year, but his book _Factfulness_ was
just released (co-authored with his children). It's all about the
preconceptions and biases that people in the "developed world" carry with them
that prevent them from thinking rationally about poverty and global
development. The book is well worth your time.

[0]:
[https://www.ted.com/talks/hans_rosling_shows_the_best_stats_...](https://www.ted.com/talks/hans_rosling_shows_the_best_stats_you_ve_ever_seen)

~~~
Retric
Ethiopia from 1935 to 1950 and 1965 to 1985 also slightly increased birth
rates with slightly increased infant mortality. However 1985 to 2018 showed a
very strong correlation.

Looking at other countries I think the effect is strongest under 120 infant
morality and there are plenty of short term counter examples like the US from
WWII to 1958. Or Albania from 1932 to 1968.

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z3t4
This seems to be sponsored by the drug manufacturers, which makes me wary.
Don't forget about for example Nestle giving doctors money to tell new parents
to use Nestle products instead of mothers milk. Mothers milk is the best for
children and is very important for their immune system. I'm all for saving
lives, but there are some very greedy people in the world, and to some account
Hanlon's razor. Antibiotics has side effects, such as killing _all_ bacteria.
Our life depends on many of the bacterias living in our body, especially in
the digestive system.

~~~
baxtr
How did you come up with this conclusion?

~~~
z3t4
I re-read the article and it seems to have charitable incentives. So my
concern hopefully not warranted.

