Saturday, December 10, 2011

Elsewhere: Lancet assessment of mixed outcomes in Afghan health

The Lancet reports the release of the first national comprehensive mortality survey of Afghanistan as providing cause for both hope and concern.

To improve rebuilding efforts as well as gauging development initiatives and years of multisectoral investment by the international community, the Afghan Public Health Institute of the Ministry of Public Health and the Central Statistics Organisation undertook the Afghanistan Mortality Survey (AMS) 2010. AMS 2010 is the first national comprehensive mortality survey of 222,351 households, 47 848 women aged 12—49 years, and verbal autopsies of 3157 deaths in the 3 years preceding the survey, and covers 87% of the population in 34 provinces in the country. ...

The most encouraging progress is in maternal health, with an overall increase in coverage of antenatal care, skilled birth attendance, and births in health facilities to 63%, 34%, and 32%, respectively. Despite these achievements, fewer than 16% of women reported having at least four antenatal visits (the minimum necessary to provide adequate screening for pregnancy complications), while 71.5% women had not received postnatal check-ups for their last birth, which is vital for monitoring delivery complications.

This is in a context where...

According to a UNICEF fact sheet released last month, Afghanistan is one of the most dangerous places for a pregnant woman or a child to be born. Afghanistan has the highest rate of maternal mortality in the world, with 1400 women out of every 100 000 livebirths dying of a complication related to pregnancy or childbirth, while its mortality rate for children younger than 5 years is ranked second in the world, with 199 deaths per 1000 livebirths. Even if a child is lucky enough to survive birth, he or she could only expect to live 44 years, while the life expectancy at birth of the world overall is 67.2 years for 2005—10.


this report is not without limitations. First, 9% of the total populations in Afghanistan, who live in the rural areas of Helmand, Kandahar, and Zabul provinces in the south zone, are not represented in the survey owing to security reasons, which seriously limits the report’s usefulness for planning. Second, although the survey has suggested much lower maternal, infant, and child mortality rates than previous estimates, given the geographically limited samples and use of verbal autopsy data, the numbers should be treated with caution. ... Finally, anthropometric indicators such as stunting or wasting rates, which can help evaluate malnutrition—the biggest contributor to child mortality by far, are missing. According to UNICEF’s Afghanistan Country programme document 2010—2013, around 1.2 million children younger than 5 years and 550,000 pregnant or lactating mothers are at high risk of severe malnutrition in Afghanistan.

The Lancet concludes, ominously:

To safeguard what has been gained with so much difficulty, sufficient and consistent assistance must be ensured from the international community.

Hear hear! And let’s be reminded again of Tony Blair’s 2001 pledge that we will not abandon Afghanistan.

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Thursday, December 08, 2011

Freddie puts Simon Ferocious back in his box

A program screened recently on the rock group Queen relates an anecdote about an encounter the band had with Sid Vicious of the Sex Pistols.

Scene: Wessex Studios, London, 1977, where Queen were recording their News of the World album, while the Sex Pistols were recording Never Mind the Bollocks.

Vocalist and rock god Freddie Mercury, drummer Roger Taylor and roadie Peter ‘Ratty’ Hince  recall the encounter.

PH: One day we were in the control room and Fred was sat at the desk. And suddenly we heard this voice and it was Sid Vicious who had come in. And he was clearly the worse for wear.
RT: Sid came in. Sid was a moron. You know, he was an idiot.
PH: And he called in to the room, “Have you succeeded in bringing ballet to the masses yet?”
FM: I called him Simon Ferocious or something, and he didn’t like it at all. I said, “What are you going to do about it?”
PH: Fred went and took him by the lapels and pushed him out the door.
FM: He hated the fact that I could even speak like that... I think we survived that test.

Cue Freddie and the band’s anthem...

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Tuesday, December 06, 2011

O brave new climate!

For his final TV show of the year, Andrew Bolt had tantalisingly promised his followersa mention of Tim Flannery.”

So naturally I had to tune in, hoping for his sake he wasn’t going to run with Bunyip’s failed gotcha on Flannery, to which he’d given such prominence on his blog. In the event, he took a somewhat different angle. Phew!

Bolt sought to ease our Flannery-inflamed anxieties by emphasising three points. (See youtube video. Note: creepy presenter warning.)


  • With the expected increase in Australia’s population this century, you’ve got to expect some increase in the number of “weather-related deaths” anyway.

True enough so far as it goes, and we eagerly await the release of Doctor Easychair’s study into what the actual real numbers will be.


  • The “death estimate” presupposes the world warming by “an incredible four and a half degrees this century, when it hasn’t actually warmed for the last decade.”

The supposed absence of warming over the last decade to which he refers is, of course, a recurring fancy of climate change ‘sceptics’ everywhere.

Also noteworthy is that the study he refers to, published in 2008* (way before Flannery was appointed to the Climate Commission), actually considers various public health outcomes, aside from ‘death estimates’, across a range of scenarios.

For his third point, Bolt quoted a snippet from that study:

This assessment does not quantify the extent to which future adaptation to climate change will modify the levels of death...

The document itself continues,

..., injury and ill-health for each health outcome. It will be difficult to make confident quantitative assumptions about the potential adaptive consequences...

Difficult”? Not for our Doctor Easychair, who confidently gushes his third point:

  • “This death estimate comes from researchers who admit they didn't allow for us getting richer and smarter, so much better able to adapt to the new climate. You know, being able to afford better cures, better disease prevention. Cheaper air conditioning!”

Yay, we’re saved!

While we eagerly await the details of Doctor Easychair’s confident quantitative assumptions about our adaptation to this “new climate” — which he may or may not believe in anyway, who can say? — still the prospect of unspecified cures and cheaper air conditioning is welcome relief after all that scary stuff.

And it’s not unreasonable to expect Doctor Easychair will next solve other problems such as war, famine, and... oh, let’s throw in cold fusion and teleportation.

* Garnaut Climate Change Review, June 2008, “The impacts of climate change on three health outcomes: temperature-related mortality and hospitalisations, salmonellosis and other bacterial gastroenteritis, and population at risk from dengue.” Available as PDF document from the Garnaut Review website.


Yep. Andrew Bolt really does believe it’s all about him. On a video of a discussion between Robert Manne and Tim Flannery, he observes:

I’m mentioned so often by the two alarmists that I wonder why they didn’t simply invite me along to have the debate they’d promised.

Promised debate?

Latrobe University, which hosted the event on August 12 this year, billed it as “A Conversation between Tim Flannery and Robert Manne.”

It’s the youtube hosted version (posted, it says, 1 day ago) that for some reason titles it as “Robert Manne vs. Tim Flannery,” with the description, “Robert Manne debates Tim Flannery.”

Anyway, I had to wait 17 minutes for the first mention of Bolt (17:27), then 23 min (40:10) during which Greg Sheridan came up (33:58). Then he was mentioned once during the Q/A where Manne imagined a hypothetical debate between Bolt and Phillip Adams (1:07:55).

So that’s three very brief mentions in over 80 minutes. None of those mentions related to any particular point of science because the focus of the conversation was on Flannery’s role in communicating his brief as Climate Commissioner.

Manne and Flannery did have a number of points of difference, but they maintained the discussion in a spirit of civility (so often missing in political discourse, so Bolt is always saying).

It’s a pity our Doctor Easychair only has ears for himself, because he’d seem to have missed out on hearing a thoughtful, wide-ranging discussion.

Why wasn’t he invited? I guess because it was intended as a thoughtful, wide-ranging discussion.

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