What can you infer has happened to the family who lived in the house Why is the world the way it is?

1. The exact number of seats depends on the seating configuration and while 524 seats are typical, 620 is on the high end. https://en.wikipedia.org/wiki/Boeing_747

2. ]In 2015 the 193 countries of the UN General Assembly adopted the 2030 Development Agenda titled “Transforming our world: the 2030 Agenda for Sustainable Development”. Here is the document.

3. There is uncertainty in the estimates for the latest level of child mortality. The IGME source used here estimates that in 2015 the child mortality rate was 4.2% while the UN Population Division – which I rely on below – estimated global child mortality in 2015 to be 4.5% [here is the UN data].

   The number of annual child deaths is the global child mortality rate multiplied with the global number of births: 0.0391*140,949,089 = 5,511,109 child deaths

   Child deaths per day: 5,511,109/365= 15,099

   Child deaths per minute: 15,099/24/60= 10.49

   The global child mortality rate is 3.91%

   Total number of births in 2017: 140,949,089

   The number of global births is almost constant, so I have taken the 2017 as the average for the relevant 5-year window.

   Data on the global child mortality rate: https://data.worldbank.org/indicator/sh.dyn.mort

   Data on the number of births: https://ourworldindata.org/grapher/births-and-deaths-projected-to-2100

4. The average number of deaths per year in a world stagnating at an under-5-mortality-rate of 4.5% would be 6,311,793. Over a 16-year time frame this would mean 100,988,688 child deaths.

5. For all countries for which the UN projects a child mortality of less than 2.5% I relied on the UN projections. For all countries for which the UN projects a child mortality rate higher than 2.5% however I modeled here what it would look like if the mortality rate would decline to 2.5%. I then multiplied the number of expected births with the mortality rate projections to arrive at the total number of child deaths.

6. Anthony A.Volk Jeremy A.Atkinson (2013) – Infant and child death in the human environment of evolutionary adaptation. In Evolution and Human Behavior. Volume 34, Issue 3, May 2013, Pages 182-192.
   https://www.sciencedirect.com/science/article/pii/S1090513812001237#s0015

7. In modern health statistics mortality at a young age is commonly reported up to two age-cutoffs: – Just like in Volk and Atkinson’s work the infant mortality rate measures the share who died in their first year of life.

   – The second common cut-off is the mortality up the age of five, which is referred to as ‘child mortality’ in modern health statistics. This mortality rate in the first 5 years of life is not reported by Volk and Atkinson.

   The mortality up to the end of puberty is less commonly reported in modern health statistics. But it is of course also estimated by health statisticians and at the end of this post you find the estimates from the IGME at: https://childmortality.org

   And arguably it is odd to call ‘child mortality’ only the mortality up to age 5, and not include the deaths of those who are older and still very much children.

8. See also M.E. Lewis (2007) – The bioarchaeology of children. Cambridge University Press, NY.

9. The Indian Knoll site was investigated by Francis Johnston and Charles Snow C.E. Snow. See F.E. Johnston, C.E. Snow (1961) – The reassessment of the age and sex of the Indian Knoll skeletal population: Demographic and methodological aspects. In American Journal of Physical Anthropology, 19, pp. 237-244.
   

   And also Indian Knoll skeletons. The University of Kentucky, Reports in Anthropology, Vol. IV, No. 3, Part 11 University Press of Kentucky, Lexington, KY (1948)

10. The 28% infant mortality rate is reported in Volk and Atkinson based on Trinkaus (1995)
    Erik Trinkaus (1995) – Neanderthal mortality patterns. Journal of Archaeological Science, 22 (1995), pp. 121-142. Online here https://www.sciencedirect.com/science/article/pii/S0305440395801707

    Chamberlain (2006) also reports very high mortality rates for subadult Neanderthals (Homo neanderthalensis).
    Andrew T. Chamberlain (2006) – Demography in Archaeology. Cambridge University Press (Cambridge Manuals in Archaeology).

11. In the 97 years between 1920 and 2017 the global child mortality rate fell from 32.1% to 3.9%.
    This reduction by 28.2 percentage points means a daily average reduction of 0.0007965 percentage points.

12. You can find data on the long-run estimates of fertility rate across the world in our entry on Fertility Rate. Across Europe the estimated fertility rate was between 4.5 and 6 children. Across the rest of the world, rates were slightly higher, between 5.5 and 7.5 per woman.

13. The data shown in this graph are obtained from Gapminder.org.

14. The period measured in this case is the first year at which child mortality began to reduce from one-third (i.e. it does not include a period over which child mortality was consistently one-third, which was the case for many countries in the distant past). The end year represents the first year in which child mortality was 5% or less.

15. The 14 countries where the total number of under-5 deaths were higher in 2017 than 1990 were Benin, Cameroon, Chad, Congo, Democratic Republic of Congo, Dominica, Equatorial Guinea, Iraq, Lesotho, Mauritiana, Somalia, United Arab Emirates, Vanuatu and Venezuela.

16. If you’re interested in the change of the child mortality rate you find the data here.

17. This estimate of the number of child deaths comes from the Institute for Health Metrics and Evaluation (IHME). The IHME is the most complete data source to evaluate how causes of mortality are changing with time. We therefore adopt the IHME figures here for comparison. Another source of data on child mortality we rely on is the UN Inter-agency Group for Child Mortality Estimation (UN IGME), which estimates the number of under-5 deaths in 1990 to have been slightly higher, at 12.6 million. We compare the differences in child mortality estimates from the IHME and UN/WHO sources here.

18. At the same time the number of births has increased slightly so that the rate of child mortality has declined even faster.

19. Troeger, Christopher, et al. “Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.” The Lancet Infectious Diseases 18.11 (2018): 1191-1210.

20. Liu, Li, et al. “Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals.” The Lancet 388.10063 (2016): 3027-3035.

21. Kim, Hyun Joo, et al. “Measuring the Burden of Disease Due to Preterm Birth Complications in Korea Using Disability-Adjusted Life Years (DALY).” International journal of environmental research and public health 16.3 (2019): 519.

22. See the WHO here https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease

23. See the WHO here https://www.who.int/news-room/fact-sheets/detail/congenital-anomalies

24. See the WHO here https://www.who.int/news-room/fact-sheets/detail/measles

25. See the WHO here https://www.who.int/malaria/media/malaria-vaccine-overview/en/

26. We use the term pneumonia here as a broad term for lower respiratory infections, see this section for how these terms are defined and why they are grouped together.

27. Watkins, K., & Sridhar, D. (2018). Pneumonia: a global cause without champions. The Lancet, 392(10149), 718-719.

28. The Lancet Global Health Editorial (2018). The disgraceful neglect of childhood pneumonia. The Lancet. Global health, 6(12), e1253.

29. Troeger, C., Blacker, B., Khalil, I. A., Rao, P. C., Cao, J., Zimsen, S. R., … & Adetifa, I. M. O. (2018). Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Infectious Diseases, 18(11), 1191-1210.

30. Chisti, M. J., Tebruegge, M., La Vincente, S., Graham, S. M., & Duke, T. (2009). Pneumonia in severely malnourished children in developing countries–mortality risk, aetiology and validity of WHO clinical signs: a systematic review. Tropical medicine & international health, 14(10), 1173-1189.

31. Dherani, M., Pope, D., Mascarenhas, M., Smith, K. R., Weber, M., & Bruce, N. (2008). Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under five years: a systematic review and meta-analysis.

    Bulletin of the World Health Organization (2006). Air quality guidelines: global update 2005. p123-124.

32. Nel, A. (2005). Air pollution-related illness: effects of particles. Science, 308(5723), 804-806.

    Öberg, M., Jaakkola, M. S., Woodward, A., Peruga, A., & Prüss-Ustün, A. (2011). Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. The Lancet, 377(9760), 139-146. The study suggested that exposure to secondhand smoke led to 165,000 deaths among children under 5 from lower respiratory diseases that year.
    

33. Theodoratou, E., McAllister, D. A., Reed, C., Adeloye, D. O., Rudan, I., Muhe, L. M., … & Nair, H. (2014). Global, regional, and national estimates of pneumonia burden in HIV-infected children in 2010: a meta-analysis and modelling study. The Lancet Infectious Diseases, 14(12), 1250-1258.

34. Supplement to: McAllister DA, Liu L, Shi T, et al. Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysis. Lancet Glob Health 2018; published online Nov 26.

35. Cohen, C., Von Mollendorf, C., De Gouveia, L., Lengana, S., Meiring, S., Quan, V., … & Madhi, S. A. (2017). Effectiveness of the 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in South African children: a case-control study. The Lancet Global Health, 5(3), e359-e369.
    

    Lucero, M. G., Dulalia, V. E., Nillos, L. T., Williams, G., Parreño, R. A. N., Nohynek, H., … & Makela, H. (2009). Pneumococcal conjugate vaccines for preventing vaccine‐type invasive pneumococcal disease and X‐ray defined pneumonia in children less than two years of age. Cochrane Database of Systematic Reviews, (4).
    

    Moore, M. R., Link-Gelles, R., Schaffner, W., Lynfield, R., Holtzman, C., Harrison, L. H., … & Thomas, A. (2016). Effectiveness of 13-valent pneumococcal conjugate vaccine for prevention of invasive pneumococcal disease in children in the USA: a matched case-control study. The Lancet Respiratory Medicine, 4(5), 399-406.

36. Chen, C., Liceras, F. C., Flasche, S., Sidharta, S., Yoong, J., Sundaram, N., & Jit, M. (2019). Effect and cost-effectiveness of pneumococcal conjugate vaccination: a global modelling analysis. The Lancet Global Health, 7(1), e58-e67.

37. Read more about pneumococcal vaccines in the section below.

    In addition, vaccinating children with PCV can protect adults via herd effect, which means that benefits are not limited to one age group the population — especially important because pneumonia has a significant burden in older people. 
    Chen, C., Liceras, F. C., Flasche, S., Sidharta, S., Yoong, J., Sundaram, N., & Jit, M. (2019). Effect and cost-effectiveness of pneumococcal conjugate vaccination: a global modelling analysis.The Lancet Global Health, 7(1), e58-e67.

38. Troeger, C., Blacker, B., Khalil, I. A., Rao, P. C., Cao, J., Zimsen, S. R., … & Adetifa, I. M. O. (2018). Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.The Lancet Infectious Diseases, 18(11), 1191-1210.

39. Lamberti, L. M., Zakarija-Grković, I., Walker, C. L. F., Theodoratou, E., Nair, H., Campbell, H., & Black, R. E. (2013). Breastfeeding for reducing the risk of pneumonia morbidity and mortality in children under two: a systematic literature review and meta-analysis. BMC public health, 13(3), S18.

40. 41% number is estimated by the UNICEF based on the most recent data available for the countries from surveys between 2013-2018. 
    UNICEF DATA. (2019). Infant and young child feeding. [online][Accessed 4 Sep. 2019].

41.  WHO, U. (2006). Air quality guidelines: global update 2005. p123-124. World Health Organization. 
    

42. Ferdous, F., Ahmed, S., Das, S. K., Chisti, M. J., Nasrin, D., Kotloff, K. L., … & Wagatsuma, Y. (2018). Pneumonia mortality and healthcare utilization in young children in rural Bangladesh: a prospective verbal autopsy study.Tropical medicine and health, 46(1), 17.

43.  UNICEF DATA. (2018). Pneumonia in Children. [online] [Accessed 5 Sep. 2019]

44.  World Health Organization. (2014). Revised WHO classification and treatment of pneumonia in children at health facilities: quick reference guide (No. WHO/FWC/MCA/14.9). World Health Organization.

45. Unicef.org. (2018). Amoxicillin Dispersible Tablets: Market and Supply Update. [online] [Accessed 26 Sep. 2019].

46. Unicef. (2016). The State of the World’s Children 2016. New York: United Nations Children’s Fund.

47. Lazzerini, M., Sonego, M., & Pellegrin, M. C. (2015). Hypoxaemia as a mortality risk factor in acute lower respiratory infections in children in low and middle-income countries: systematic review and meta-analysis. PLoS One, 10(9), e0136166.

48. The air we breathe contains 21% of oxygen gas, but it is possible to concentrate this gas using special oxygen concentrators. The oxygen-enriched air can then be supplied to a person with pneumonia via a breathing mask, in this way compensating for reduced oxygen exchange in the lungs.

49. World Health Organization. (2016). Oxygen therapy for children: a manual for health workers.
    

50.  World Health Organization. (2019). WHO model list of essential medicines: 7th list, August 2019.
    

51. Delarosa, J., Hayes, J., Pantjushenko, E., Keith, B., Ambler, G. and Lawrence, C. (2017). Oxygen Is Essential: A Policy and Advocacy Primer. [online] PATH. [Accessed 5 Sep. 2019].

52. The data can be seen here. The precise numbers are 793,823+405,346+26,445+129,720=1,355,334

53. Troeger, Christopher, et al. “Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016.” The Lancet Infectious Diseases 18.11 (2018): 1211-1228.

54. Troeger, C., Blacker, B. F., Khalil, I. A., Rao, P. C., Cao, S., Zimsen, S. R., … & Alvis-Guzman, N. (2018). Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Infectious Diseases, 18(11), 1211-1228.

55. Das, J. K., Salam, R. A., & Bhutta, Z. A. (2014). Global burden of childhood diarrhea and interventions. Current Opinion in Infectious Diseases, 27(5), 451-458.

56. Cairncross, S., Hunt, C., Boisson, S., Bostoen, K., Curtis, V., Fung, I. C., & Schmidt, W. P. (2010). Water, sanitation and hygiene for the prevention of diarrhoea. International Journal of Epidemiology, 39(suppl_1), i193-i205.

57. Victoria, C. G. (2000). Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet (British edition), 355(9202), 451-455.

58. Apps.who.int. (2019). Weekly Epidemiological Record. [online] Available at: https://apps.who.int/iris/bitstream/handle/10665/258763/WER9234.pdf?sequence=1 [Accessed 12 Aug. 2019].

    Sinclair, David, et al. “Oral vaccines for preventing cholera.” Cochrane Database of Systematic Reviews 3 (2011).

59. Jonesteller, Christine L., et al. “Effectiveness of rotavirus vaccination: a systematic review of the first decade of global postlicensure data, 2006–2016.”Clinical Infectious Diseases 65.5 (2017): 840-850.

    Aliabadi, Negar, et al. “Global impact of rotavirus vaccine introduction on rotavirus hospitalisations among children under 5 years of age, 2008–16: findings from the Global Rotavirus Surveillance Network.” The Lancet Global Health 7.7 (2019): e893-e903.

60. Fontaine, Olivier, Paul Garner, and M. K. Bhan. “Oral rehydration therapy: the simple solution for saving lives.” BMJ,334.suppl 1 (2007): s14-s14.

61. Munos, M. K., Walker, C. L. F., & Black, R. E. (2010). The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality. International Journal of Epidemiology, 39(suppl_1), i75-i87.

62. Adapted from: Das, J. K., Salam, R. A., & Bhutta, Z. A. (2014). Global burden of childhood diarrhea and interventions. Current Opinion in Infectious Diseases, 27(5), 451-458.

63. 95,636 in Nigeria and 44,078 in the DRC

64. Figures for 2016 according to the WHO: http://www.who.int/malaria/en/

65. The age-specific mortality figures are those published by the IHME’s Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. The share of children younger than 5 among malaria victims fell slightly over the course of the last generation, from 79% in 1990 to 72% in 2015. Here is the data: https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative

66. Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria. But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine. For an overview see Adrian V. S. Hill (2011) – Vaccines against malaria. In Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806–2814. doi: 10.1098/rstb.2011.0091. This has possibly changed with the malaria vaccine RTS,S, the world’s first licensed malaria vaccine, which has been approved by European regulators in 2015. See RTS,S Clinical Trials Partnership (2015) – Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online here.

67. Both the WHO and the IHME report a strong decline of malaria deaths since 2000. But throughout this period the IHME consistently estimates the number of annual deaths to be higher. For more details on the differences between these two global sources see our entry on malaria https://ourworldindata.org/malaria

68. Bhatt et al. (2015) – The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 526, 207–211 (08 October 2015) doi:10.1038/nature15535. Online here.

69. Citation: Institute for Health Metrics and Evaluation (IHME), Malaria Atlas Project. Global Malaria Incidence, Prevalence, and Mortality Geospatial Estimates 2000-2019. Seattle, United States of America: Institute for Health Metrics and Evaluation (IHME), 2020. https://doi.org/10.6069/CG0J-2R97 
    Shown is the mortality rate due to plasmodium falciparum – direct link to the interactive maps as published by the IHME http://ihmeuw.org/5dhp 
    For the background see: Weiss, D. J., Lucas, T. C. D., Nguyen, M., Nandi, A. K., Bisanzio, D., Battle, K. E., Cameron, E., Twohig, K. A., Pfeffer, D. A., Rozier, J. A., Gibson, H. S., Rao, P. C., Casey, D., Bertozzi-Villa, A., Collins, E. L., Dalrymple, U., Gray, N., Harris, J. R., Howes, R. E., … Gething, P. W. (2019) – Mapping the global prevalence, incidence, and mortality of Plasmodium falciparum, 2000–17: A spatial and temporal modelling study. In The Lancet, 394(10195), 322–331. https://doi.org/10.1016/S0140-6736(19)31097-9

70. The latest data for Sub-Saharan Africa (from 2013) – where more than 90% of all malaria deaths occur – shows that fewer than half of all children under five sleep under an insecticide treated bed-nets. See the chart here: https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart

71. World Health Organization (WHO) ‘Mother-to-child transmission of HIV’ [accessed November 2019]

72. 1,860,000 children die every year. An average year has 365 days. This means than on every average day 1,860,000 / 365 = 5,096 children die.

73. Oza, S., Cousens, S. N., & Lawn, J. E. (2014). Estimation of daily risk of neonatal death, including the day of birth, in 186 countries in 2013: a vital-registration and modelling-based study.The Lancet Global health, 2(11), e635-e644.

74. What this also means is that the share of child deaths from older or younger children also depends on how much progress countries have made on vaccine coverage and other interventions. If you click on the ‘Relative” toggle in the chart and change the country using the “Change country” to Sub-Saharan Africa, where child mortality rates are the highest, you’ll see that the share of children dying after the neonatal period is higher than in the rest of the world. There, neonatal deaths account for only 37% of under-5 deaths, whereas in most Asian, European and American countries this share is 50% or higher. This is because many countries across Sub-Saharan Africa still have significant progress to make in the prevention of vaccine-preventable diseases.  

    What this data tells us is – when countries make progress against child mortality, the share of child deaths in the earliest stages of life increases.

75. Bhutta, Z. A., Das, J. K., Bahl, R., Lawn, J. E., Salam, R. A., Paul, V. K., … & Walker, N. (2014). Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?. The Lancet, 384(9940), 347-370.

76. https://www.who.int/news-room/fact-sheets/detail/preterm-birth

77. Spontaneous preterm births include those that occur as a result of spontaneous preterm labour (40-45%) and those that occur as a result of preterm premature rupture of the membranes (30-35%). The non-spontaneous preterm births are provider initiated (e.g. cesarean sections).

    Goldenberg, R. L., Culhane, J. F., Iams, J. D., & Romero, R. (2008). Epidemiology and causes of preterm birth.The Lancet, 371(9606), 75-84

78.  A list of factors associated with preterm birth is long; for many of these factors we don’t have a generalizable effect size. A non-exhaustive list includes, external factors such as maternal nutrition, smoking, drug use, air-pollution, infection with HIV, chlamydia, malaria, hepatitis C or syphilis; as well as innate factors such as gestational diabetes, short cervical length, pre-eclampsia, maternal anemia, genetic predisposition. Ethnicity, socioeconomic status, and the number of previous pregnancies are also important.

79. Medley, N., Vogel, J. P., Care, A., & Alfirevic, Z. (2018). Interventions during pregnancy to prevent preterm birth: an overview of Cochrane systematic reviews. Cochrane Database of Systematic Reviews, (11).

    Delnord, M., & Zeitlin, J. (2019, February). Epidemiology of late preterm and early term births–An international perspective. In Seminars in Fetal and Neonatal Medicine (Vol. 24, No. 1, pp. 3-10). WB Saunders.

    Adams, M. M., Elam-Evans, L. D., Wilson, H. G., & Gilbertz, D. A. (2000). Rates of and factors associated with recurrence of preterm delivery. Jama, 283(12), 1591-1596.

80. The review compared different models of care. It found that midwife-led continuous care during pregnancy can reduce preterm birth risk by 24% compared to other types of hospital care. Other models of care include physician-led care or shared care between several healthcare professionals. 

    Sandall  J, Soltani  H, Gates S, Shennan  A, Devane D. Midwife‐led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub5

    
    

81. Screening pregnant women during the first 20 weeks gestation can reduce the risks of preterm birth by 45% compared to the group that receives the screening but is not informed of its results.

    Sangkomkamhang  US, Lumbiganon P, Prasertcharoensuk  W, Laopaiboon M. Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD006178. DOI: 10.1002/14651858.CD006178.pub3.

82. The review study found that zinc supplementation reduces preterm birth risk by 14%.

    Ota  E, Mori  R, Middleton  P, Tobe‐Gai R, Mahomed  K, Miyazaki C, Bhutta ZA. Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD000230. DOI: 10.1002/14651858.CD000230.pub5.

83. High-risk is defined as previous preterm deliveries, short cervix or prior cervical surgery.

    Alfirevic  Z, Stampalija  T, Medley N. Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD008991. DOI: 10.1002/14651858.CD008991.pub3.

84. Data from historical famines also provides valuable case studies on the relationship between maternal nutrition and preterm delivery. For example, during the siege of Leningrad (a blockade of Soviet city of Leningrad by the Nazis between 1941 and 1944, that resulted in prolonged famine in the region) there was a 41% increase in preterm births among mothers who conceived during the famine period.

    A review by Bloomfield (2011) discusses many aspects of maternal nutrition and their relationship to preterm birth. 

    Bloomfield, F. H. (2011). How is maternal nutrition related to preterm birth?. Annual review of nutrition, 31, 235-261.

    Antonov, A. N. (1947). Children born during the siege of Leningrad in 1942. The Journal of pediatrics, 30(3), 250-259.

85. Chawanpaiboon, S., Vogel, J. P., Moller, A. B., Lumbiganon, P., Petzold, M., Hogan, D., … & Lewis, C. (2019). Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis.The Lancet Global Health, 7(1), e37-e46.

86. Of course that means that 42% of deaths from of preterm birth are still left. As discussed previously, we still don’t understand all the causes of preterm birth, which makes it difficult to provide the right interventions. As we learn more about the causes we can provide new and improve the current treatments. The study authors also suggest that we currently don’t have good assessments for a number of interventions that are used to reduce preterm mortality rates. Such interventions were therefore not included in the model used to estimate by how much the preterm complication mortality rates could be reduced. 

    Bhutta, Z. A., Das, J. K., Bahl, R., Lawn, J. E., Salam, R. A., Paul, V. K., … & Walker, N. (2014). Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?. The Lancet, 384(9940), 347-370.

87. Antenatal steroids are given to help the fetal lung development.

88. Conde‐Agudelo  A, Díaz‐Rossello  JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD002771. DOI: 10.1002/14651858.CD002771.pub4.

    Lawn, J. E., Mwansa-Kambafwile, J., Horta, B. L., Barros, F. C., & Cousens, S. (2010). ‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications. International journal of epidemiology, 39(suppl_1), i144-i154.

89. Even though targets for kangaroo care coverage have been proposed, countries do not collect the coverage data and accurate global estimates are not available. Most research literature predicts global coverage to be very low, perhaps as low as 10%.

90. Bhutta, Z. A., Das, J. K., Bahl, R., Lawn, J. E., Salam, R. A., Paul, V. K., … & Walker, N. (2014). Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?. The Lancet, 384(9940), 347-370.

91. Clarke, J., & Price, R. (1786). XVII. Observations on some causes of the excess of the mortality of males above that of females. By Joseph Clarke, MD Physician to the Lying-in Hospital at Dublin. Communicated by the Rev. Richard Price, DDFRS in a letter to Charles Blagden, MD Sec. R. S. Philosophical Transactions of the Royal Society of London, (76), 349-362.

92. Bakwin, H. (1929). The sex factor in infant mortality. Human Biology, 1(1), 90.

93. Sawyer, C. C. (2012). Child mortality estimation: estimating sex differences in childhood mortality since the 1970s. PLoS Medicine, 9(8), e1001287.

94. Naeye, R. L., Burt, L. S., Wright, D. L., Blanc, W. A., & Tatter, D. (1971). Neonatal mortality, the male disadvantage. Pediatrics, 48(6), 902-906.

95. This is also the explanation reported by the World Health Organization: “Newborn girls have a biological advantage in survival over newborn boys. They have lesser vulnerability to perinatal conditions (including birth trauma, intrauterine hypoxia and birth asphyxia, prematurity, respiratory distress syndrome and neonatal tetanus), congenital anomalies, and such infectious diseases as intestinal infections and lower respiratory infections.“

96. Peelen, M. J., Kazemier, B. M., Ravelli, A. C., De Groot, C. J., Van Der Post, J. A., Mol, B. W., … & Kok, M. (2016). Impact of fetal gender on the risk of preterm birth, a national cohort study. Acta obstetricia et gynecologica Scandinavica, 95(9), 1034-1041.

97. Zeitlin, J., Saurel-Cubizolles, M. J., de Mouzon, J., Rivera, L., Ancel, P. Y., Blondel, B., & Kaminski, M. (2002). Fetal sex and preterm birth: are males at greater risk?. Human Reproduction, 17(10), 2762-2768.

98. Peacock, J. L., Marston, L., Marlow, N., Calvert, S. A., & Greenough, A. (2012). Neonatal and infant outcome in boys and girls born very prematurely. Pediatric Research, 71(3), 305.

99. Hintz, S. R., Kendrick, D. E., Vohr, B. R., Poole, W. K., Higgins, R. D., & Nichd Neonatal Research Network. (2006). Gender differences in neurodevelopmental outcomes among extremely preterm, extremely‐low‐birthweight infants. Acta Paediatrica, 95(10), 1239-1248.

100. Jones, M., Castile, R., Davis, S., Kisling, J., Filbrun, D., Flucke, R., … & Tepper, R. S. (2000). Forced expiratory flows and volumes in infants: normative data and lung growth. American Journal of Respiratory and Critical Care Medicine, 161(2), 353-359.

101. Hoo, A. F., Henschen, M., Dezateux, C., Costeloe, K., & Stocks, J. (1998). Respiratory function among preterm infants whose mothers smoked during pregnancy. American Journal of Respiratory and Critical Care Medicine, 158(3), 700-705.

102. Fleisher, B., Kulovich, M. V., Hallman, M. I. K. K. O., & Gluck, L. O. U. I. S. (1985). Lung profile: sex differences in normal pregnancy. Obstetrics and Gynecology, 66(3), 327-330.

103. Peacock, J. L., Marston, L., Marlow, N., Calvert, S. A., & Greenough, A. (2012). Neonatal and infant outcome in boys and girls born very prematurely. Pediatric Research, 71(3), 305.

104. DiPietro, J. A., & Voegtline, K. M. (2017). The gestational foundation of sex differences in development and vulnerability. Neuroscience, 342, 4-20.

105. Townsel, C. D., Emmer, S. F., Campbell, W. A., & Hussain, N. (2017). Gender differences in respiratory morbidity and mortality of preterm neonates. Frontiers in Pediatrics, 5, 6.

106. Giefing‐Kröll, C., Berger, P., Lepperdinger, G., & Grubeck‐Loebenstein, B. (2015). How sex and age affect immune responses, susceptibility to infections, and response to vaccination. Aging Cell, 14(3), 309-321.

107. Markle, J. G., & Fish, E. N. (2014). SeXX matters in immunity. Trends in Immunology, 35(3), 97-104.

108. Libert, C., Dejager, L., & Pinheiro, I. (2010). The X chromosome in immune functions: when a chromosome makes the difference. Nature Reviews Immunology, 10(8), 594.

109. Waldron, I. (1983). Sex differences in human mortality: the role of genetic factors. Social Science & Medicine, 17(6), 321-333.

110. Libert, C., Dejager, L., & Pinheiro, I. (2010). The X chromosome in immune functions: when a chromosome makes the difference. Nature Reviews Immunology, 10(8), 594.

111. Fischer, J., Jung, N., Robinson, N., & Lehmann, C. (2015). Sex differences in immune responses to infectious diseases. Infection, 43(4), 399-403.

112. For the source see the next citation.

113. The data is taken from Table 4.3 of Roderick Floud, Robert W. Fogel, Bernard Harris, Sok Chul Hong (2011) – The Changing Body Health, Nutrition, and Human Development in the Western World Since 1700. Cambridge University Press. The book’s website is here. The original sources cited by my source are 1930–32, 1949–53, 1970–72: Townsend, Davidson, and Whitehead 1988, pp. 40, 63. 1993–95: Botting 1997, p. 86. 2001: Rowan 2003, p. 38. After 1970-72, the “skilled” group splits into two different groups, which are not labeled on the graph: “skilled manual” (blue), and “skilled non-manual” (dark orange).

114. Mondal, M. N. I., Hossain, M. K., & Ali, M. K. (2009). Factors influencing infant and child mortality: A case study of Rajshahi District, Bangladesh. Journal of Human Ecology, 26(1), 31-39.

115. Angela W. Browne & Hazel R. Barrett (1991) Female Education in Sub‐Saharan Africa: the key to development?, Comparative Education, 27:3, 275-285, DOI: 10.1080/0305006910270303.

116. Finlay, J. E., Özaltin, E., & Canning, D. (2011). The association of maternal age with infant mortality, child anthropometric failure, diarrhoea and anaemia for first births: evidence from 55 low-and middle-income countries. BMJ Open, 1(2), e000226.

117. Finlay, J. E., Özaltin, E., & Canning, D. (2011). The association of maternal age with infant mortality, child anthropometric failure, diarrhoea and anaemia for first births: evidence from 55 low-and middle-income countries. BMJ Open, 1(2), e000226.

118. Emmanuela Gakidou, Krycia Cowling, Rafael Lozano, Christopher JL Murray (2010) – Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis, The Lancet, Volume 376, Issue 9745, 18–24 September 2010, Pages 959-974, ISSN 0140-6736, http://dx.doi.org/10.1016/S0140-6736(10)61257-3.

119. The source is UNESCO (2011) EFA Global Monitoring Report – The hidden crisis: Armed conflict and education.

120. The source is UNESCO (2011) EFA Global Monitoring Report – The hidden crisis: Armed conflict and education. Note: Data are for the most recent year available during the period specified. The UNESCO’s original source is ICF Macro (2010).

121. Gruber, Jonathan, Nathaniel Hendren, and Robert M. Townsend (2014) – “The Great Equalizer: Health Care Access and Infant Mortality in Thailand.” American Economic Journal: Applied Economics, 6(1): 91-107.

122. The data is taken from the International Historical Statistics (IHS), edited by Palgrave Macmillan Ltd. (April 2013). The online version is available here. As a printed version it is published by Palgrave.
     The child survival rate is calculated using the IHS Data ‘Deaths Of Infants Under One Year Old Per 1,000 Live Births’.

123. Adam Storeygard, Deborah Balk, Marc Levy and Glenn Deane (2008) – The global distribution of infant mortality: a subnational spatial view. Population, Space and Place, Volume 14, Issue 3, pages 209–229, May/June 2008. Online here.

124. This visualization is taken from Adam Storeygard, Deborah Balk, Marc Levy and Glenn Deane (2008) – The global distribution of infant mortality: a subnational spatial view. Population, Space and Place, Volume 14, Issue 3, pages 209–229, May/June 2008. Online here.

125. This visualization is taken from Adam Storeygard, Deborah Balk, Marc Levy and Glenn Deane (2008) – The global distribution of infant mortality: a subnational spatial view. Population, Space and Place, Volume 14, Issue 3, pages 209–229, May/June 2008. Online here.

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