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Global burden of disease: causes, levels, and intervention strategies 

Global burden of disease: causes, levels, and intervention strategies

Global burden of disease: causes, levels, and intervention strategies

Ramanan Laxminarayan

and Dean Jamison

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date: 30 March 2017

Recent decades have seen remarkable progress in quantifying the burden of disease in low- and middle-income countries and in gathering evidence on the effectiveness and cost-effectiveness of health interventions. This chapter reviews the major sources of death and disability in these countries and draws lessons from recent analytical work on the cost-effectiveness of interventions to address this disease burden. Four essential messages emerge: 1 Life expectancies worldwide improved dramatically from 1960 to 2002, with the largest increases being in low- and middle-income countries. 2 Improvements in immunization coverage, access to basic education, and spread of low-cost but powerful medical technologies—rather than income growth—appear to have been the primary causes of the gains in life expectancy. 3 The decline in childhood infectious disease burden has been partially offset by a dramatic, age-related increase in the incidence of HIV/AIDS and of chronic, noncommunicable diseases (cardiovascular disease, stroke, diabetes, cancer, psychiatric disorders), especially in low- and middle-income countries. 4 Cost-effective interventions can—if selected carefully and adopted widely—address the challenges of lowering under-5 and maternal mortality, and the burden of noncommunicable diseases.

Interventions that in appropriate circumstances can cost less (sometimes much less) than US$100 per disability-adjusted life year (DALY) include: ◆ improving care of children <28 days old ◆ expanded immunization coverage with standard child vaccines ◆ adding vaccines against additional diseases to the standard child immunization program (particularly Haemophilus influenzae B, hepatitis B) ◆ switching to use of combination drugs against malaria (when resistant to previous standard treatments) ◆ some measures to prevent and treat HIV/AIDS ◆ taxing tobacco products ◆ treating acute myocardial infarction with an inexpensive set of drugs ◆ detecting and treating cervical cancer ◆ operating a basic surgical ward at the district hospital level that focuses on trauma, high-risk pregnancy, and other common surgically treatable conditions

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