Focus On Research
Penn State Intercom......January 25, 2001

Declining birth rates may bring
about stability in sub-Saharan Africa

Recent birth rate declines in sub-Saharan Africa, especially in cities, may signal the first small, faltering steps toward balanced population, adequate food supplies and relative economic stability, a University Park study found.

"Population growth in sub-Saharan Africa is currently about 3 percent per year," said David Shapiro, professor of economics, demography and women's studies. "This is expected to decline as fertility falls, but recent U.N. projections suggest that by the year 2050, the population of the region will increase from its current level of about 650 million to somewhere between 1.5 and 2 billion. The level of fertility that we see in the coming years will have crucial repercussions not just for the African, but also for the global economy."

Until the late 1980s, Africa south of the Sahara Desert -- including such countries as Uganda, Rwanda, Ethiopia and Nigeria -- was the only major world region where fertility rates remained high and showed no signs of falling. In terms of human fertility, sub-Saharan Africa was then at a stage similar to that of most of Europe a century ago, with a wide gap between declining death rates and persistently high birth rates, according to Shapiro, also a research associate with the University's Population Research Institute. However, the gap was distinctly wider for sub-Saharan Africa, translating into much more rapid population growth. During the past decade, this situation has changed significantly, with fertility rates decreasing throughout much of sub-Saharan Africa, especially urban areas. The causes, all facilitated by urbanization, are fourfold: declining infant and child mortality, higher educational levels, delayed marriage or cohabitation and increased use of contraceptives, Shapiro said.

The slowing of population growth should facilitate economic development, making for better use of the region's human and natural resources, he added. This has implications worldwide, meaning that sub-Saharan Africa can start to become a full-fledged economic bloc in its own right, providing mass markets for U.S. goods and requiring less aid from the industrialized powers. Shapiro co-authored a paper on the subject with B. Oleko Tambashe, research associate professor of international health and development at Tulane University

"A fertility rate of about 2.7 children per family is necessary to maintain the population at a zero growth rate in sub-Saharan Africa," Shapiro said. "Among the 25 sub-Saharan countries where demographic and health surveys have been taken, totals from all surveys reveal an average fertility rate of 6.6 children per family in rural districts and 4.8 children in urban districts. This is still very far from reaching population stability."

During the 1990s, however, fertility rates began an unprecedented decline. In Kenya, the fertility rate nationwide fell from 6.7 children per family in 1989 to 4.7 in 1998. Other sub-Saharan countries showed drops, too.

Shapiro noted that the fertility rate decline was most pronounced in urban areas. "This was particularly true in capital cities, where fertility rates in Kenya and Togo are in fact approaching the replacement level. Birth rates are beginning to fall even in rural areas for a number of sub-Saharan countries," he said.

The researcher predicted the trend likely would be permanent. He traced it to urbanization and related socioeconomic changes.

"The levels of education in sub-Saharan Africa have improved for urban and rural dwellers alike, but particularly for city residents," Shapiro said. "Because education is more accessible in the cities, urban dwellers often make the decision to have fewer children but provide the children they have with more schooling."

ALS patients' quality of life
not related to physical strength

Researchers from The College of Medicine at Hershey report that quality of life (QOL) assessments in patients with amyotrophic lateral sclerosis reveal that quality of life does not correlate with physical function, but rather appears to depend on psychological factors, spiritual factors and support systems.

"It was clear from the responses that patients' quality of life depended on things like the perception of purpose and the meaning of life," said Zachary Simmons, associate professor of medicine and orthopedics and rehabilitation at The College of Medicine and director of the ALS Clinic at The Milton S. Hershey Medical Center. "This is a strong message to all of us that we should not assume that these patients have a poor (quality of life) simply because they are physically debilitated."

This was a prospective study of consecutive patients seen at the Hershey Medical Center ALS clinic. Ninety-six patients were enrolled in the study with patients ranging in age from 23 to 80.

ALS is also known as Lou Gehrig's disease and is named after the baseball player who died of it. It is a neurologic disorder that affects about 30,000 people in the United States. Its cause remains unknown and there is no cure.

Simmons and his team used a variety of standardized testing for muscle strength and physical function as well as QOL questionnaires. The average patient rated QOL as greater than 7 on a scale of 1 to 10. Fifty-three percent of patients rated QOL as 8 or greater, this despite muscle strength and function ratings that were often quite low.

"The generally high patient assessment of QOL was striking, despite the presence of a terminal illness and decreased measures of strength and function in many patients," Simmons reported.

Clinical trial at College of Medicine tests
new drug therapy for hepatitis C patients

Researchers at The Milton S. Hershey Medical Center are involved in a clinical trial that will test a new therapy for patients with hepatitis C.

"The standard treatment for hepatitis C is three injections per week with Interferon and, by mouth, the drug Ribavirin. This new investigational drug is essentially a long-lasting form of Interferon that will require only one injection per week," explained principal investigator Thomas J. McGarrity, professor of medicine at The College of Medicine and a gastroenterologist at The Milton S. Hershey Medical Center. "We believe this new form of Interferon stays in the blood longer at a high steady level which will be more effective."

About 200 patients will be enrolled. Including Hershey, there are seven Pennsylvania sites testing the drug.

"We think the virus might actually have a chance to recover with several shots per week," McGarrity said. "With this long-lasting therapy, there will be fewer peaks and valleys and hopefully no time for the virus to recover. The treatment will last for one year."

Patients will undergo a blood test six months following completion of the treatment. If they are free of virus at that time, McGarrity said it is very unlikely the virus would return at all.

It is estimated that 4 million people in the United States may have hepatitis C. Many are baby boomers who experimented with drug use in the '60s.

"We know that intravenous drug use and having a blood transfusion prior to 1990 are two of the main causes of the disease," McGarrity said. "People who were infected 20 or 30 years ago are the patients we are seeing today. The disease is very hard to detect because often there are no symptoms for decades."

Hepatitis is an inflammation of the liver, the organ that eliminates toxins and is important in metabolism. Hepatitis C is now the No. 1 reason people need a liver transplant. The disease also can cause liver cancer. Many in the health-care field have termed the situation an epidemic because hepatitis C is expected to kill more Americans in the next 20 or 30 years than AIDS.

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