Infants less than one year old most impacted by famine of the Dutch Hunger Winter with highest mortality rate

During the Dutch Hunger Winter Famine, infants experienced the highest absolute and relative mortality of all children under 14 years of age.

These are the findings from a new study at Columbia University Mailman School of Public Health, Wageningen University & Research and the Netherlands Interdisciplinary Demographic Institute in the Hague, the Netherlands.

In the famine cities, infant mortality increased to 1% or 922 deaths per 10,000 compared to 109 deaths per 10,000 children between the ages of one and four, and 27 deaths per 10,000 deaths at ages five to 14. Over 60% of deaths between the ages 0 to 14 took place in the first year of life. The results are published in the journal Population Studies.

"Our findings show that the impact of the famine was largest among infants less than one year of age, where diseases of the digestive system showed a tenfold mortality increase," said L.H. Lumey, MD, professor of Epidemiology at Columbia Mailman School.

"Most deaths in this category were from enteritis, diarrhea, and ulceration of the intestines, all of which are important complications of famine. We examined absolute and relative mortality changes combined with age-specific causes of death to better understand the impact of a famine at the population level and to identify the most vulnerable populations."

Compared to the pre-war years 1935–1940, infant deaths (<1 year) in the three famine-affected cities show a more than 3-fold increase, deaths between one and four years a four-fold increase, and deaths between five and 14 years a three-fold increase. These increases show the impact of the famine in relative terms but not capture the number of losses at the population level as is needed for targeted interventions.

Lumey and his colleagues—Ingrid de Zwarte and Peter Ekamper—used data from vital statistics reports in the Netherlands for the period 1935–47, to provide a detailed description of the impact of the Dutch Hunger Winter famine on infant and child mortality. They used the monthly CBS statistical bulletins (CBS 1935–47) as the main data source to show the number of deaths in selected age groups (stillbirths, <1 year, one to four years, and five to 14 years) for the entire country, at the regional level (provinces), and for municipalities with 25,000 inhabitants or more.

For each age at death, they compared mortality during the Dutch Hunger Winter with mortality before and after the famine, separately for the three largest famine cities and for the remainder of the country. The famine was most severe in the three largest western cities—Amsterdam, Rotterdam, and The Hague, with a combined population of around 1.8 million.

"Vital statistics registrations in Netherlands largely continued during the famine and provide a unique opportunity to examine in more detail than ever before the absolute and relative vulnerability of infants and children" observed Lumey.

"Infant mortality in our setting was the most sensitive indicator of famine severity, with the largest number of deaths and the most direct link between famine intensity and specific causes of death. Our findings suggest that infant mortality could be the most sensitive marker to track the severity and impact of famine also in other settings and to help relief interventions."