Infants are enchanting all over the world, as the new movie 'Babies' shows. But their standards of hygiene sure vary.
The film captures the first year of life for four diverse babies. In a nomadic family in Namibia, Ponijao drinks from muddy streams, chews on dry bones and uses her many siblings' body parts as toys.
On a small family farm in Mongolia, a rooster struts around little Bayar's bed, a goat drinks from his bathwater and livestock serve as babysitters.
By contrast, Mari, growing up in high-rise, high-tech Tokyo, and Hattie, whose doting parents live a 'green' lifestyle in San Francisco, both have modern conveniences and sanitation.
Statistically, Mari and Hattie are healthier. Some 42 out of 1,000 children in Namibia, and 41 out of 1,000 in Mongolia die before their 5th birthday; compared with only 8 in 1,000 in the U.S. and only 4 in Japan.
Yet the upscale urban infants are at higher risk for some health problems -- including allergies, asthma and autoimmune diseases like Type 1 diabetes, multiple sclerosis and inflammatory bowel disease -- than the babies in the rural developing world.
While the film makes no mention of hygiene in any of the countries, its images evoke an intriguing medical controversy: Are we too clean, with our preoccupation for hand-sanitizers, disinfectants and anti-microbial products? Now, there's research that suggests there may be a way to get the best of both worlds.
According to the 'hygiene hypothesis,' first proposed in 1989, exposure to a variety of bacteria, viruses and parasitic worms early in life helps prime a child's immune system, much like sensory experiences program his brain. Without such early instruction, the immune system may go haywire and overreact with allergies to foods, pollen and pet dander or turn on the body's own tissue, setting off autoimmune disorders.
Many of these microorganisms evolved symbiotically with humans over millions of years -- the so-called 'old friends' theory. But where they've been eradicated, a key part of human development has been thrown off.
'The vast majority of microbes are harmless. There are only a few dozen that can cause lethal infections,' says Thomas McDade, director of the Laboratory for Human Biology Research at Northwestern University.
In 1998, about 1 in 5 children in industrialized countries suffered from allergic diseases such as asthma, allergies and rashes, according to the International Study of Asthma and Allergies in Childhood, a global research initiative. The incidence of peanut allergy in the U.S. tripled between 1997 and 2008, according to a report from Mount Sinai School of Medicine in New York.
But such diseases are still relatively rare in Africa and rural Asia, as are Type 1 diabetes and multiple sclerosis.
'The geographical distribution of allergic and autoimmune diseases is a mirror image of the geographical distribution of various infections diseases,' says a report by French researchers in a March issue of the journal Clinical & Experimental Immunology devoted to the hygiene hypothesis.
Exposure to immune-stimulating germs may also lower the risk of heart disease, according to Dr. McDade. In a study of 1,700 Filipinos followed from birth to age 21 published this year in the journal Proceedings of the Royal Society, those who grew up around chicken, pigs and dogs and had bouts of diarrhea in childhood had lower rates of C-reactive protein, an inflammation marker that has been linked to cardiovascular disease, as young adults.
There are other dangers lurking in muddy water and animal feces. Nearly 70% of the 8.8 million deaths of children under age 5 world-wide in 2008 were caused by infectious diseases, most frequently pneumonia, diarrhea and malaria, according to an analysis in the Lancet last week.
Even though rural Africa and Asia have made enormous strides in public health in the past decade, infant mortality stands at 31 per 1,000 in Namibia and 34 per 1,000 in Mongolia, compared to 7 per 1,000 in the U.S. and 3 per 1,000 in Japan.
Scientists are still working on ways to separate good germs from bad ones; in the meantime, they have a few insights: Studies have shown that children who grow up with household pets have fewer allergies and less asthma than those who don't.
Michael Bell, an infectious disease specialist and deputy director of Healthcare Quality Promotion at the Centers for Disease Control and Prevention, says that people should be vigilant about wound care since bacteria can cause problems if they get into the blood stream, and he still advocates hand-washing. 'If you're not doing it 10 times a day, you're probably not doing it enough,' he says. But he and other experts say that regular soap and water are fine in most cases. Sterilizing hands is critical mainly for health-care workers and in hospitals, where disease-causing germs are prevalent and can easily spread.
Many experts advise common sense. 'We don't want to say to children, 'OK, play by the dirty river bank and catch whatever you can,'' says Dr. Weinstock. 'But we can say there's nothing wrong with kids playing in the dirt. They don't have to live in total sanitation, and they won't die from eating something off the floor. It's probably more healthy than not.'
