GLOBAL BURDEN OF DISEASES

INTRODUCTION
 TEN THREATS TO GLOBAL
HEALTH IN 2019
• Here are 10 of the many issues that will demand attention from WHO and health partners in
2019.
AIR POLLUTION AND CLIMATE
CHANGE
 NON COMMUNICABLE DISEASE

• Non communicable diseases, such as diabetes, cancer and heart disease, are collectively
responsible for over 70% of all deaths worldwide, or 41 million people. This includes 15
million people dying prematurely, aged between 30 and 69.
 GLOBAL INFLUENZA PANDEMIC

• WHO is constantly monitoring the circulation of influenza viruses to detect potential

pandemic strains: 153 institutions in 114 countries are involved in global surveillance and
response.
 FRAGILE AND VULNERABLE
SETTINGS
• More than 1.6 billion people (22% of the global population) live in places where protracted
crises (through a combination of challenges such as drought, famine, conflict, and
population displacement) and weak health services leave them without access to basic care
 ANTIMICROBIAL RESISTANCE

• In 2017, around 600 000 cases of tuberculosis were resistant to rifampicin – the most
effective first-line drug – and 82% of these people had multidrug-resistant tuberculosis.
 EBOLA AND OTHER HIGH-THREAT
PATHOGENS
• In 2018, the Democratic Republic of the Congo saw two separate Ebola outbreaks, both of
which spread to cities of more than 1 million people.
 WEAK PRIMARY HEALTH CARE
• Primary health care is usually the first point of contact people have with their health care
system, and ideally should provide comprehensive, affordable, community-based care
throughout life
 VACCINE HESITANCY

• Measles, for example, has seen a 30% increase in cases globally.

• a vaccines advisory group to WHO identified complacency, inconvenience in accessing
vaccines, and lack of confidence are key reasons underlying hesitancy
 DENGUE

• An estimated 40% of the world is at risk of dengue fever, and there are around 390 million
infections a year. WHO’s Dengue control strategy aims to reduce deaths by 50% by 2020.
 HIV/AIDS

• However, the epidemic continues to rage with nearly a million people every year dying of
HIV/AIDS
• Today, around 37 million worldwide live with HIV.
8 MAJOR HEALTH PROBLEMS IN THE WORLD
TODAY:
1. HEART DISEASES
2. CANCER
 3.DIABETES
• Diabetes is a chronic condition associated with abnormally high blood glucose levels:
fasting blood sugar level greater than 110mg/ dl, random blood glucose level greater than
200 mg/ dl.
• 4. Kidney disease
• 5. Alzheimer’s disease
• 6. Influenza
• 7. Stroke
 8. AIDS
• About 40 million people are living with HIV AIDS
• 95% of whom are in developing countries
• 17 million unaware of the fact that they have the virus in their body.
• Sub-Saharan Africa is the most affected region with 25.8 million
victims.
• More than 12 million Africans have died of AIDS, and many millions
orphaned as a result.
The Global Burden of Disease Study (GBD) is a comprehensive
regional and global research program of disease burden that assesses 
mortality and disability from major diseases, injuries, and risk factors
 AIMS

• The GBD has three specific aims:

• To systematically incorporate information on non-fatal outcomes into the assessment
of the health status

• To ensure that all estimates and projections were derived on the basis of objective
epidemiological and demographic methods, which were not influenced by advocates.

• To measure the burden of disease using a metric that could also be used to assess the
cost-effectiveness of interventions. The metric chosen was the DALY .The burden of
disease can be viewed as the gap between current health status and an ideal situation
in which everyone lives into old age free of disease and disability.
 METRICS

Disability- Population
Adjusted Life Year GBD Attributable
(DALY) Fraction (PAF)
 DEFINITION (DALY )

• Quantifying the Burden of Disease from mortality and morbidity

• One DALY can be thought of as one lost year of "healthy" life. The sum of these
DALYs across the population, or the burden of disease, can be thought of as a
measurement of the gap between current health status and an ideal health situation
where the entire population lives to an advanced age, free of disease and disability.

• CALCULATION: DALY = YLL+ YLD

YLL = N ×L
YLD = I×DW×L
• PREVALENCE YLD Y L D = P×DW
 POPULATION ATTRIBUTABLE FRACTION (PAF)

• Definition : Quantifying the contribution of risk factors to the Burden of Disease

• . PAF is the proportional reduction in population disease or mortality that would

occur if exposure to a risk factor were reduced to an alternative ideal exposure
scenario (eg. no tobacco use). Many diseases are caused by multiple risk factors, and
individual risk factors may interact in their impact on overall risk of disease. As a
result, PAFs for individual risk factors often overlap and add up to more than 100
percent.
•
GLOBAL HEALTH OBSERVATORY (GHO) DATA
GLOBAL BURDEN OF DISEASES
 MATERNAL HEALTH

• Maternal mortality: 
• Every day in 2015, about 830 women died due to
complications of pregnancy and child birth
• The primary causes of death are haemorrhage, hypertension,
infections, and indirect causes, mostly due to interaction
between pre-existing medical conditions and pregnancy.
• The risk of a woman in a developing country dying from a
maternal-related cause during her lifetime is about 33 times
higher compared to a woman living in a developed country.
• Maternal mortality :303 000 women died of maternal causes in 2015
• Antenatal : 75%of pregnant women (in 83 countries) had at least 4 antenatal care visits
• Family planning :77%of women of reproductive
age who are married or in-union have their
need for family planning met with a modern method
 CHILD HEALTH
• Trends in child mortality:
•  The global under-five mortality rate declined by 56% from 93 deaths per 1000 live births in
1990 to 39 in 2017.
• . About 73% of under-five deaths occurred in two regions in 2017, WHO Africa (49%) and
WHO South-East Asia (24%).
• The highest under-five mortality rate remains in the WHO African Region (74 per 1000 live
births), 8 times
higher than that in the WHO European Region (9 per 1000 live births).
• Mortality : 5.4 million children under age five died in 2017
• Causes of death :1 million children under 5 died due to prematurity in 2016
• Approx. 60%of children under five with symptoms of pneumonia are taken to an
appropriate health provider
 Causes of child mortality, 2017
• Neonatal deaths accounted for 47% of
under-five deaths in 2017.
• Preventing child deaths
• Care seeking for pneumonia
In countries with available data, approximately 60% of children under
five with symptoms of pneumonia are taken to an appropriate health
provider
• Diarrhoea treatment
In the majority of countries with available data, less than half of
children under five receive ORS treatment for diarrhoea
• Infants under six months of age exclusively breastfed
An estimated 41% of infants less than six months of age are exclusively
breastfed in 2017
• Measles immunization coverage at one year
• 5.4 million children under age five died in 2017
 2. COMMUNICABLE DISEASES
• HIV/AIDS
• more than 70 million people have been infected with the HIV virus and about 35 million people
have died of HIV.
• Globally, 36.9 million [31.1–43.9 million] people were living with HIV at the end of 2017.
• An estimated 0.8% [0.6-0.9%] of adults aged 15–49 years worldwide are living with HIV,
• . The WHO African region remains most severely affected, with nearly 1 in every 25 adults
(4.1%) living with HIV and accounting for nearly two-thirds of the people living with HIV
worldwide.
• Number of people newly infected with HIV:1.8 [1.4−2.4] million people were newly infected
worldwide in 2017
• Mortality :940 000people died of HIV-related illnesses worldwide in 2017
• Prevention : 129 low- and middle-income countries reported a total of 150 million
people tested in 2014

• Antiretroviral therapy coverage among all age groups :As of December 2017, an
estimated 21.7 million people globally were receiving antiretroviral therapy
 
• Prevention of mother-to-child transmission :Globally, there were still more than
1.4 million [1.1–1.7 million] pregnant women with HIV in 2017, of which an
estimated 80% [61–>95%] received antiretroviral drugs to prevent mother-to-child
transmission
Sexually Transmitted Infections (STIs)
• Syphilis testing in pregnancy : ≥95%of antenatal care attendees were tested for
syphilis in 26 of 84 countries reporting for 2017
• Syphilis in sex workers : 5%of sex workers are infected with syphilis in 18 of 31
reporting countries for 2017
• Sexually transmitted infections : 1 million pregnant women had active syphilis
infection in 2016 and were at risk for adverse pregnancy outcomes such as stillbirth
and neonatal death due to congenital syphilis
TUBERCULOSIS (TB)
• Incidence :10 million new TB cases in 2017
• Lives saved :54 million through effective diagnosis and treatment between 2000 and
2017
How many TB cases and deaths are there?
• Estimated: 10.0 million (range: 9.0–11.1 million) new TB cases.
• Estimated: 1.3 million (range: 1.2–1.4 million) HIV-negative people died from TB
and 0.30 million (range: 0.27–0.34 million) HIV-positive
people died from TB.
• Notified: 6.4 million new TB cases were officially notified to
national authorities and then reported to WHO.
Diagnosis and treatment of TB, HIV-associated TB and drug-resistant TB
• In 2017, 6.4 million new cases of TB were reported, equivalent to 64% of the
estimated incidence of 10 million.
• There were 0.46 million reported cases of HIV-positive TB (51% of the estimated
incidence), of whom 84% were on antiretroviral therapy.
• 139 thousand people were started on treatment for drug-resistant TB (25% of the
estimated incidence).

Treatment outcomes of patients notified in 2016 (excluding patients moved to

second-line treatment)
• 82% of new and relapse TB patients were successfully treated.
• 68% of previously treated (excluding relapse) TB patients were successfully
treated.
• 77% of HIV-positive TB patients were successfully treated.
 NONCOMMUNICABLE DISEASES (NCD)
• Total NCD mortality :40 million of the 56 million global deaths in 2015 were
due to NCDs
• Premature NCD mortality :48%of NCD deaths in low- and middle income
countries in 2015 occurred before the age of 70
• Risk factors :80%of premature heart disease, stroke and diabetes can be
prevented.
• Deaths from NCDs
• Of the 56.9 million global deaths in 2016, 40.5 million, or 71%, were due to
noncommunicable diseases
Premature NCD deaths
• In low- and middle income countries, about 46% of deaths occurred before the age
of 70 in 2016
 STROKE: A GLOBAL RESPONSE IS NEEDED
• Globally, 70% of strokes and 87% of both stroke-related deaths and disability-
adjusted life years occur in low- and middle-income countries.
•  Over the last four decades, the stroke incidence in low- and middle-income
countries has more than doubled. During these decades stroke incidence has declined
by 42% in high-income countries.
 
• CARDIOVASCULAR DISEASES
• RAISED BLOOD PRESSURE
• Worldwide, raised blood pressure is estimated to cause 7.5 million deaths, about 12.8% of the total of all
deaths. This accounts for 57 million disability adjusted life years (DALYS) or 3.7% of total DALYS.
• Globally, the overall prevalence of raised blood pressure
in adults aged 25 and over was around 40% in 2008
• the number of people with uncontrolled hypertension
rose from 600 million in 1980 to nearly 1 billion in 2008.
BURDEN OF COPD
• currently 64 million people have COPD and 3 million people died of COPD. WHO predicts
that COPD will become the third leading cause of death worldwide by 2030.
• Estimates show that COPD becomes in 2030 the third leading cause of death worldwide.
• In 2002 COPD was the fifth leading cause of death
DIABETES MELLITES
• From 108 million in 1980 to 422 million in 2014.
• Adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014 .
• In 2016, an estimated 1.6 million deaths were directly caused by diabetes. Another 2.2 million
deaths were attributable to high blood glucose in 2012.
• Almost half of all deaths attributable to high blood glucose occur before the age of 70 years. WHO
estimates that diabetes was the seventh leading cause of death in 2016.
• In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2016, diabetes was the direct
cause of 1.6 million deaths and in 2012 high blood glucose was the cause of another 2.2 million
deaths.
 BURDEN OF MENTAL ILLNESS

Untreated mental Mental illness

disorders : 13% among homeless:
>50%
Severe mental
disorders recieve no
treatment : 76-85%

prevalence : depression -17% Severe mental

Post traumatic stress illnessassociated with
disorder-15% unemployment : 90%
 ROAD TRAFFIC INJURY

Road traffic deaths :1.25 million

people die each year

Vulnerable road users : Almost

50%of those dying on the world’s
roads

Legislation : 17 countries have

amended their laws
NUMBER OF REGISTERED VEHICLES
 PUBLIC HEALTH AND ENVIRONMENT

Mortality and Household Ambient

burden of air air
disease from
pollution : pollution :
unhealthy
environments 3.8 million 4.2 million
: 12.6 million deaths deaths
(23%) every year every year
MORTALITY – HOUSEHOLD AIR POLLUTION
 MEDICINES AND IMMUNIZATIONS

Avail Price of essential

ability of essenti medicines Medical equipment
al medicines

Health technology pol

icy Procurement Lists of medical devic
es
IMMUNIZATION COVERAGE
WATER AND SANITATION

Sanitation :
39% (2.3
billion people )
Drinking
water :71%(5.2
billion)

Hygiene :
15%of people
CLEAN CITIES –URBAN HEALTH

Universal Health Coverage

Nutrition

Access to safe water

Access to piped water

Urban population growth

 HEALTH OUTCOMES IN URBAN POPULATIONS

Under-fiv
e mortalit
y

Infant m HIV/AIDS
ortality prevalence
VIOLENCE
VIOLENCE AGAINST WOMEN
 THE GLOBAL HEALTH COUNCIL
• Established in 1972
• Supporting and connecting advocates,
implementers and stakeholders.
• The organization is the collaborative voice
of the global health community on global
health issues.
• Fact-based platform for a shared voice on cross-
cutting global health issues.
• Promotes and catalyzes an inclusive community
• Connects visionaries and implementers, and calls
for action with global and local impact.
• Result-oriented, measureable, person-centered
solutions
• Promotes collaborative action
 Emerging issues in global health
• “Dual burden” of disease:
• To prevent and control infectious diseases, while also
addressing the health threats from non-communicable
diseases and environmental health risks.
• Social and economic conditions in developing countries
change and their health systems and surveillance.
• Expanding international trade introduces new health risks.
 HEALTH INTERVENTION
• Promotion of breastfeeding, zinc supplementation,
• Vitamin A fortification
• Salt iodization
• Hygiene interventions
• Vaccinations
• Treatments of severe acute malnutrition
• Outcome gap
• lack of Sustainable infrastructure
• To promote
• Physical activity
• Avoiding alcohol and tobacco
• Diet
• Resources
 TRENDS IN HEALTH INEQUALITY
• WHO World Health Statistics 2013 examined the health gaps between
high-resourced and low-resourced countries.

• Health inequalities decreasing in terms of reproductive, maternal and

child health intervention coverage, and child mortality.

• Trends in child malnutrition inequalities are mixed, with no overall

increase or reduction at the global level.
 ROLES OF THE HEALTH SECTOR

• Initiate actions;
• Join up to initiatives developed by the head of
government or new integrated government entities;
• Partner with authorities outside health that are leading
on an issue
• Ensure linkages between national authorities and local
government to support community action.
 JOURNAL PRESENTATION

• TITLE : Global Burden of Diseases, Injuries, and Risk Factors Study (GBD)- The
Vision Loss Group: Methodology and Results of Systematic Review
• 
• 
• Purpose: : The new GBD Study is the first major effort since the original 1990 study
was completed to carry out a complete systematic assessment of population data on
all diseases and injuries to produce estimates of their burden for 1990 and 2005. The
Vision Loss group is responsible for estimating the burden of visual impairment (VI).
• Results: : The search strategy yielded 10,871 articles. The breakdown
by global region was as follows: Europe (33%), North America
(25%), Asia (21%), Africa (12%), Australasia and Oceania (5%),
Latin America (3%), Caribbean (1%). Further results will be available in
Spring 2009.
• Conclusions: : We aim to improve the accuracy of the global visual
burden estimate by incorporating a wealth of recent population-based
studies, incorporating new methods of estimating disease burden,
reducing the threshold of VI to 6/12, reporting on presenting VA
rather than best-corrected visual acuity, and involving estimates of near VI
for the first time.
ANY QUSTIONS?
THANK YOU