Infant Deaths Fall Sharply in Africa with Routine Antibiotics | Hacker News Reader

Infant Deaths Fall Sharply in Africa with Routine Antibiotics

nytimes.com

161 pointsmontrose46 comments

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.

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.

Thank you for saying this. I have been looking for the correct verbage to say this for a while.

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.

There are deaths from resistant strains. Because people got an infection, and there was no medicine to treat it. Untreated infections are like russian roulette - many survive them, but not all. After centuries where people would just die of infections, we had a few good decades. Where we had many viruses covered by vacinations and bacterial infections by antibiotics. But vaccination rates are not as good as they could be, and we are putting the antibiotics at risk. That is a step back.

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.

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."

> measuring and monitoring resistance levels

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

they stop using the drug at a certain threshold? first result from a google search. https://www.cell.com/trends/microbiology/abstract/S0966-842X...

http://archive.is/aQ2x3

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).

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?

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?

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

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

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

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

Well, yet. Resistances are on the rise. It will probably get a lot worse before we start using antibiotics more responsibly.

That is not how it work. Resistant strains, once evolved, do not need to 'start from scratch'.

It's much more complicated than you seem to think, otherwise there would be almost no non-resistant strains left.

For example, there typically seems to be a cost associated with maintaining resistance, and particularly maintaining multiple forms of resistance, and strains will often drop resistance absent constant selection pressure.

Adding onto this, I saw a very interesting seminar a few years ago from a biologist who sequenced bacterial samples from the arctic permafrost. He found resistance genes for antibiotics that had definitely not been created by humans at the time that the samples were deposited.

So "new" antibiotics aren't actually new, and resistance to them probably already exists somewhere -- bacteria have been fighting this war for as long as there have been bacteria.

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... The decline in mortality is not followed by a decline in fertility for Africans.

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...

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.

I'm reminded of a similar notion that Bill & Melinda Gates wrote in their 2018 letter[0]:

"When more children live past the age of 5, and when mothers can decide if and when to have children, population sizes don’t go up. They go down. Parents have fewer children when they’re confident those children will survive into adulthood. Big families are in some ways an insurance policy against the tragic likelihood of losing a son or a daughter. We see this pattern throughout history. All over the world, when death rates among children go down, so do birth rates. It happened in France in the late 1700s. It happened in Germany in the late 1800s. Argentina in the 1910s, Brazil in the 1960s, Bangladesh in the 1980s."

[0] https://www.gatesnotes.com/2018-Annual-Letter (#5)

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

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_...

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.

The animated chart is interesting. If you compare the migration of Europe vs Africa, Europe was much more linear, whereas Africa seems to go through a period of low mortality / high fertility. There are other factors such as war, migrations, diseases, etc, but everything else being equal that should mechanically result in the population exploding in the next 30 years, which is consistent with UN forecasts (population to roughly double over the next 30 years).

Is education the answer?

http://www.pewresearch.org/fact-tank/2015/01/15/for-most-hig...

South Africa’s fertility rate has dropped in the last few decades and is now 2.34. It was 6 in 1960.

Your own link shows a fertility decline (look at the table at the bottom of the page).

There is no reason to suppose that this won’t happen in other African countries, as education, immunisation, and urbanisation take effect.

There's very good reason to think it won't happen. This [1] paper from the UN provides a good overview of South Africa's extremely unique situation. Similar information is available here [2]. The gist of it is that South Africa's declining fertility rate was exclusively the result of extensive efforts, not entirely benevolently motivated, by their former [apartheid] government.

[1] - https://www.un.org/esa/population/publications/completingfer...

[2] - https://sarpn.org/documents/d0000104/page2.php

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.

How did you come up with this conclusion?

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

It's like the 4 paragraph.... please RTA.

"The Bill and Melinda Gates Foundation, which paid for the study..."

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