|
|
| |
Levels of anchorage
to local data and NBD Results:
|
| |
| |
|
|
| |
|
|
| |
Periodontal disease shows up
as the leading cause of burden in case of
the local HSV-VAS anchored estimate. It
goes to the second position, in case of
the HSV-Torrance-TTO anchored estimate.
The problem of protein energy
malnutrition is highlighted by the two
HSV anchored estimates. However,
considering the present mortality level
in the state, ranking of these
disabilities as the top two causes of
disease burden may meet with popular
rejection. For example, tuberculosis is
viewed as a serious public health problem
in the state. The National Tuberculosis
Control Program is being implemented in
the state from 1962 (Mahapatra and
Ramana, 1994). The Tuberculosis control
program has continuously received
political and professional support in
view of the widely shared concern about
the adverse public health impact of the
disease. A School Health Project was
started in the state in 1993, with
assistance from the British Overseas
Development Agency (ODA). Dental health
of school children was a major component
of this project which was subsequently
discontinued in 1999. The British ODA did
not renew funding, in view of
less-than-expected project performance.
Although many factors would have
contributed to discontinuation of the
School Health Program, the limited
inference I draw from a comparative
review of support for the two programs
described above is that the popular
concern for tuberculosis control is much
more sustained and stronger compared to a
program with dental health as a major
component. Based on this experience, my
conjecture is that people will be quick
to point out that the two HSV anchored
estimate puts the estimate of
tuberculosis at the lower end of the ten
leading causes of burden and highlights
periodontal disease as the fore most
cause of burden. This is not to deny the
importance of disease burden due to
periodontal disease and protein energy
malnutrition. The argument here is about
choice of the primary NBD estimate. The
two HSV anchored estimate can be used to
demonstrate sensitivity of disease burden
estimates to an alternate health state
valuation. |
|
| |
|
|
| |
We have compared disease
burden estimates from two versions of
minimally anchored estimates (WDR93 and
GBD96) and three intermediately anchored
estimates (COD, HSV-VAS, and
HSV-Torrance-TTO), with local data on
causes of death and health state
valuation. It would have been useful to
look at changes in burden of disease
estimates with local data on descriptive
epidemiological parameters namely,
incidence, age at onset, and duration of
different diseases. Unfortunately
descriptive epidemiological data are hard
to come by. It needs co-ordinated efforts
on the part of many epidemiologists to
build up the descriptive epidemiological
profile of a population. As and when such
data are available, it will be useful to
examine, how NBD estimates change with
incorporation of local data on disease
incidence and prevalence. |
|
| |
|
|
| |
However, on the basis of
limited comparisons made above, certain
inferences can be made. Firstly, Murray
and Lopez have made substantive revisions
between the GBD estimates published in
WDR 1993 and the final version published
in 1996. As we have seen here, the
revisions for the India estimates were in
the desirable direction tending to match
local mortality levels and cause of death
patterns. The cause of death anchored
estimates are only marginally different
from the GBD96 estimates, mainly because
the later had already incorporated local
data on urban cause of death and had
gained some insights from the pilot study
on rural cause of death. Hence it would
be wrong to infer that collection of
local cause of death would not improve a
NBD estimate over the GBD estimate for
the corresponding region. Rather the
opposite inference is due. Recall the
substantial difference between the WDR93
and the GBD96 estimates for India. The
improvement can be attributed to
availability of local cause of death
information to the GBD96 team. |
|
| |
|
|
|
< Previous Next >
|
| |
|
