Adult Disease Induction and Life Course Events: Some Perspectives from a Resource-Compromised Economy

By Eregie, Charles Osayande | Forum on Public Policy: A Journal of the Oxford Round Table, Spring 2008 | Go to article overview

Adult Disease Induction and Life Course Events: Some Perspectives from a Resource-Compromised Economy


Eregie, Charles Osayande, Forum on Public Policy: A Journal of the Oxford Round Table


Introduction

The Nigerian newborn infant is faced with 'Quadruple-barrel Survival Tragedy'. Born in a country with a low-birthweight rate of 16% (UNICEF 2005), Neonatal Mortality Rate (NMR) averaging 50/ 1000 live-births and Maternal Mortality Ratio (MMR) over 1000/ 100,000 births (UNICEF 2005), the newborn is off to a bad head start coupled with low exclusive breastfeeding rate (Eregie 1997a). Emerging from this, the newborn advances into the survival tragedy of early childhood laden with a 'morbidity-trap' of prevalent diseases including: diarrhoeal disorders, acute respiratory infections, malaria, measles and malnutrition among others with resultant gory childhood mortality statistics: Infant Mortality Rate (IMR) of 100/ 1000 live-births and Under-Fives Mortality Rate (U5MR) of over 200/ 1000 live-births (UNICEF 2006). Surviving early childhood, the next tragedy is a challenging adolescence and adulthood with emerging prevalent non-communicable morbidities: Obesity 12%, Hypertension 10%, Diabetes Mellitus 8% (with 50% complicated by the Metabolic Syndrome) and Coronary Heart Disease among others (Akinkugbe and Akinyanju 1997). The final tragedy, a consequence of the preceding ones, is a compromised Quality of Life (QOL) with the resultant unacceptable Life Expectancy estimated at 52 years (UNICEF 2006).

This gory picture of the postnatal difficulties of the Nigerian challenges our clinical practice, public health policy and preparedness/ capacity to make a difference. A proper understanding of the foetal origins of adult disease induction and the nexus with life course events is a sine qua non for the formulation of interventions that will reflect desirable shifts in policy and practice.

Life Course/ Life Course Events

'Life Course' defines the span from conception to death ('Womb to Tomb'). Growth, prenatal to postnatal trajectory, is approximately a continuous process and 'Birth' is only an event within the 'continuum'. The first event in the life course is conception though pre -conceptional factors may contribute to determining subsequent life course events and outcomes. Foetal growth defines intrauterine life and bio-physical changes which culminate in the birth process and associated parameters. The pattern of changes in body dimensions, proportions and compositions after birth reflects the event of early postnatal growth. Early child feeding/ diet, another life course event, influences postnatal growth trajectory. Adolescence, with the attendant pubertal changes, presents a unique event in the life course. Life-style, as a conceptual event, reflects the way of life of a person: active/ ambulant or sedentary, dietary habits, exercise routine, work pattern and social habits including smoking and drinking among others. Infections and several diseases/ disorders may also be events in the life course. Death, the physical end of life, marks the end of life course concluding the 'Womb to Tomb' transition.

An appreciation of the various events in the life course is essential for an in-depth discourse of their contributions to adult disease induction and possible strategies for prevention and control. Foetal growth, early postnatal growth and early child nutrition are regarded by some authors as offering a 'Critical Window' for interventions concerning policy and practice (McCance and Widdowson 1974).

Life Course Events And Adult Disease Induction: The Nexus

There are several reports which suggest linkage of adult disease induction with life course events. A correlation was reported within different areas in Norway between coronary heart disease and infant mortality some 70 years earlier and this was thought to be due to poverty and nutritional deficit resulting in life-long predisposition to more affluent life-style in adulthood (Forsdahl 1977). Adult blood pressure was reported to be inversely related to birthweights of persons born in 1946 in the United Kingdom (Wadsworth et al 1985). …

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