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Burden of disease:

Burden of disease:. Concepts and applications. Session Aims. to introduce the concept “burden of disease” to examine patterns and trends in mortality in Southern African settings to discuss and evaluate the concept of “health transition”

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Burden of disease:

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  1. Burden of disease: Concepts and applications

  2. Session Aims • to introduce the concept “burden of disease” • to examine patterns and trends in mortality in Southern African settings • to discuss and evaluate the concept of “health transition” • to introduce the concept of “priority setting” and its relation to burden of disease studies • to examine the implications of South African mortality patterns for the provision of health care in the country.

  3. Data to measure burden of disease • Industrialised versus developing settings • National data • eg census, vital registration • Health facilities • Surveys • eg household surveys: DHS • Sentinel site data • eg India, China, HDSS, verbal autopsy • Models

  4. The disability-adjusted life year (DALY) • A single measure of disease burden • Expresses years of life lost due to premature death and years lived with a disability (ie years of healthy life lost due to poor health)

  5. DALY: Values and methods • How “long” should people live? • Is a year of healthy life now worth more than in 30 years’ time? • Are we – all people – equal? • How to compare years of life lost due to premature death, and years lived with disabilities of differing severities?

  6. Trends in life expectancyAgincourt 1992-2003

  7. Relative increase in mortality, Agincourt 2002-2003 compared to baseline 1992-1993

  8. Trends in under-five mortality

  9. Trends in adult mortality Age 20-34

  10. Trends in cause specific mortality:Infectious & parasitic disease

  11. Trends in adult mortality Age 50-64

  12. Trends in cause specific mortality:Women 50-64, broad categories

  13. Age-standardised death rates, broad cause and broad health care categories, Agincourt 1992-2005

  14. Top five causes of death, 50-64 years Agincourt 1992-2005

  15. Top five causes of death, children and older adults, Agincourt 1992-2005

  16. Prevalence of stroke survivors:South Africa, Tanzania, New Zealand

  17. Managing chronic NCDs in Agincourt Sub-district services based on network of clinics • staffed by primary care nurses with limited support • drug supply irregular • medical supervision sporadic Poor capacity to manage chronic illness • No functional system secondary prevention • 103 stroke survivors – only 1 on aspirin • 85 hypertensives – 8 on treatment; only 1 controlled • General pop ≥ 35 – 43% hypertension; 24% of these treated in past week; half with BP controlled • Missed diagnoses • Majority of deaths with active TB had previously presented to clinic • 2/3 TB patients seen at a clinic self-referred to hospital Care-seeking pluralistic – allopathic, traditional, faith-based • most first visits to local clinics = pivotal role

  18. Age-standardised death rates by health care categories, Agincourt sub-district 1992-2005

  19. PHC in Practice: Integrating HAART & chronic NCD care

  20. Age-specific death rates by nationality of household head

  21. Reasons given for non-consultation: no money, ineffective care 26% 7% 18% 25% Household survey data No money

  22. Implications of mortality patterns for health system • Shift orientation of service provision: chronic, long-term care as well as acute, episodic care • Tackle (prevent/control) increasing burden of non-communicable disease and risk • Strengthen HIV/AIDS (and TB) prevention, treatment and care • Simultaneously maintain and improve on gains in child and maternal health • Strengthen primary care provision + referral system • Address differential access to care

  23. Epidemiological Transition • Epidemiologic transition theory: 3 stages • Pestilence and famine • Receding pandemics • Man-made or degenerative disease • Critique • Not same direction: reversals in mortality “counter transition” • Not sequential: stages may overlap, co-existence different diseases “prolonged/protracted transition” • Too general: insufficient attention to subgroup differences “epidemiologic polarisation”

  24. Rethinking epidemiologic transition: mortality patterns in rural South Africa • Counter transition • Mortality increasing in children and young adults • Protracted or prolonged transition • Simultaneous emergence of HIV/AIDS together with increasing non-communicable disease • Epidemiologic polarisation • Poorest experience highest burden of mortality

  25. Why is burden of disease information necessary? • “priority setting” and its relation to burden of disease • Programme planning • Programme evaluation

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