DESK REVIEWS | 01.02. Epidemiological situation

DESK REVIEW | 01.02. Epidemiological situation

Kenya still experiences epidemiological and demographic challenges which affect the health of its population thus increasing mortality rates.

Global Burden of disease in Mexico

In the recent decades, Mexico has experienced an epidemiological transition, while common infections, in particular respiratory and intestinal tracts, are the most frequent causes of morbidity, chronic degenerative diseases such as diabetes and hypertension are reasons for seeking attention, especially in older ages.

Table 2 presents the first ten causes of disease in Mexico by age group in 2017, reported by the General Directorate of Epidemiology (DGE) agency of the Secretary of Health. The most frequent causes are acute respiratory infections, followed by intestinal infections, especially in the young population (>1-24 years of age) (DGE, 2018).

Table 2. Ten main causes of morbidity by age group. Mexico 2017.

<1 year 1-4 years 5-9 years 10-14 years 15-19 years 20-24 years 25-44 years 45-49 years 50-59 years 60-64 years ≥65 years
Acute respiratory infections (1)

830.9

(1)

53771.9

(1)

363.2

(1)

19752.2

(1)

14 382.3

(1)

15349.5

(1)

12822.2

(1)

20061.5

(1)

18268.7

(1)

24231.3

(1)

17 895.5

Intestinal infections by other organisms and poorly defined (2)

123.6

(2)

9987.2

(2)

5685.0

(2)

4146.7

(2)

3589.1

(2)

4591.4

(3)

3368.9

(3)

4896.8

(3)

3998.5

(3)

5300.0

(3)

3997.5

Conjunctivitis (3)

30.7

(3)

1752.1

(4)

1253.6

(4)

935.7

(6)

770.7

(6)

1107.8

(5)

1033.0

(6)

1245.7

(6)

1112.9

(7)

1348.5

(7)

1156.8

Urinary tract infection (5)

8.2

(4)

1487.1

(3)

1705.6

(3) 1455.8 (3)

3097.0

(3)

4568.4

(2)

3700.0

(2)

5 431.2

(2)

5020.1

(2)

6596.8

(2)

6 002.8

Acute otitis media (4)

8.3

(5)

1198.4

(5)

1 168.2

(5)

834.5

(7)

679.4

(8)

721.5

(9)

452.0

(10) 539.6
Pneumonia and bronchopneumonia (6)

7.7

Asthma (6)

517.8

(8)

422.9

(10) 270.2
Chickenpox (10)

3.2

(7)

479.5

(6)

467.4

Intestinal amebiasis (9)

3.4

(8)

442.2

(9)

318.4

Pharyngitis and streptococcal tonsillitis (8)

4.4

(9)

416.1

(10) 298.2
Mild malnutrition (7)

6.7

(10) 363.2
Gingivitis and periodontal disease (7)

448.8

(7)

600.6

(5)

963.8

(5)

1266.4

(6)

985.9

(5)

1439.6

(5)

1313.1

(5)

1766.1

(6)

1179.5

Ulcers, gastritis and duodenitis (6)

735.3

(4)

1143.1

(4)

1569.6

(4)

1267.2

(4)

2326.3

(4)

1840.8

(4)

2527.9

(4)

1760.7

Obesity (8)

299.4

(9)

319.4

(9)

490.6

(8)

726.4

(7)

1139.9

(9)

927.3

(9)

930.7

Scorpion sting poisoning (9)

270.2

(10) 297.5
Vulvovaginitis (8)

553.5

(7)

1039.0

(7)

793.3

(9)

926.2

Urogenital candidiasis (10) 323.6
Arterial hypertension (10) 287.8 (8)

966.3

(7)

1072.0

(6)

1569.2

(5)

1340.1

Diabetes (10) 867.3 (8)

1007.1

(8)

1339.0

(8) 910.0
Peripheral venous insufficiency (10) 696.3 (10) 601.8
Hyperplasia of the prostate (9) 650.2

Source: (Dirección General de Epidemiología & Secretaria de Salud, 2018).

(Notes: ICD-10: International Classification of Disease (https://icd.who.int/browse10/2010/en). Data show rates per 100 thousand inhabitants. Numbers in parenthesis in each cell indicate the place in which that specific disease is located within the ten main causes of disease in a specific age group).

In relation to mortality, diabetes, heart and cerebrovascular disease, cirrhosis, and cancer dominate the mortality picture, particularly among adults over the age of 40. In contrast, external injuries are the leading causes of death among young people aged 15-19, with homicides, traffic accidents and suicides being the most prominent (Secretaría de Salud, 2015b).

According to global burden of disease reports, in Mexico, the main causes of death have been remained unchanged between 2007-2017 (ischemic heart disease, chronic kidney disease, and diabetes), while interpersonal violence increased its relevance moving to the fourth cause of death. Relevance of neonatal disorders and road injuries decreased their relevance as main causes of Years of Life Lost (YLLs), while interpersonal violence, moved up and now represents the first cause of YLLs. Diabetes and headache disorders remain unchanged as causes of Years Lived with Disability (YLDs), while low back pain moved up to the third place.

In 2013, updated estimations of Burden of Disease in Mexico were generated by age groups, sex, regions of the country (North, Centre, and South), by major disease group (communicable, non-communicable, and injuries) (Lozano Asencio et al., 2013). Main results show a heterogeneous situation of the GBD in Mexico, divided into health risks and problems by different regions in the country. The Southern states, which lag in social development, show prevailing health problems related to transmissible diseases linked to nutrition, housing, and education disparities, whereas the Northern states of the country present an advanced epidemiological transition accompanied by much higher rates of violence. Table 3 shows the main causes of years of life lost due to premature death for all ages, by region, where it is observed that they are a combination of chronic diseases, infectious diseases, and injuries.

Taking mortality rates into account, regardless of the region of the country, non-communicable diseases predominate, accounting for 63% of health losses due to premature death. However, in relation to communicable diseases, nutrition and reproduction, there are important differences by region, as the risk of dying prematurely from these causes is 36% higher in the South than in the North of the country. In contrast, with intentional and accidental injuries, the risk of premature loss of life is 92% higher (almost double) for people living in the North compared to those living in the South.

Table 3 Main causes of years of life lost to premature death in Mexico by region.

  Centre % North % South %
1 Ischaemic heart disease 7.6 homicides 14.7 Cirrhosis 7.6
2 chronic kidney disease 7.5 Ischaemic heart disease 10.0 Ischaemic heart disease 7.0
3 diabetes mellitus 7.1 diabetes mellitus 5.7 diabetes mellitus 6.8
4 Cirrhosis 6.8 traffic accidents 5.5 chronic kidney disease 5.7
5 traffic accidents 6.6 chronic kidney disease 4.9 Congenital anomalies 4.4
6 acute respiratory infections 5.0 Cirrhosis 3.8 traffic accidents 3.9
7 Congenital anomalies 5.0 cerebrovascular disease 3.6 acute respiratory infections 3.9
8 cerebrovascular disease 4.0 Congenital anomalies 3.4 cerebrovascular disease 3.7
9 preterm new-borns 3.8 preterm new-borns 3.0 homicides 3.5
10 homicides 3.7 acute respiratory infections 2.9 preterm new-borns 3.3
11 chronic obstructive pulmonary disease 2.2 chronic obstructive pulmonary disease 1.6 HIV 2.3
12 neonatal encephalopathy 1.8 suicide 1.5 neonatal encephalopathy 2.2
13 neonatal sepsis 1.6 HIV 1.4 drownings 2.2
14 suicide 1.5 Lung cancer 1.3 chronic obstructive pulmonary disease 1.9
15 alcohol-associated disease 1.2 drownings 1.3 alcohol-associated disease 1.7

Source: (Lozano Asencio et al., 2014, p. 33)

Mexico is therefore a heterogeneous country in relation to its health problems. Three important characteristics (Lozano Asencio et al., 2014) are identified as:

  • A social gap in the South where communicable health problems remain as many are linked to basic deficiencies in housing, nutrition, education, and access to health services.
  • A risk transition process, where non-communicable diseases predominate in any region of the country and in all age groups.
  • A region living in situations of extreme violence, where the risk of intentional and accidental injuries is almost twofold among people living in the North, compared to those living in the South.
References:

Dirección General de Epidemiología, & Secretaria de Salud (DGE). (2018). Anuario de morbilidad 1984-2017.

Lozano Asencio, R., Gómez Dantés, H., Pelcastre Villafuerte, B. E., Montañez, J. C., Campuzano, J. C., Franco, F., & González Vilchis, J. J. (2013). Carga de la Enfermedad en México 1990-2010: Nuevos resultados y desafíos Contenido. 122.

Lozano Asencio, R., Gómez-Dantés, H., Pelcastre, B., Ruelas, M., Montañez, J., Campuzano, J., Franco, F., & González, J. (2014). Carga de la enfermedad en México 1990-2010. Nuevos resultados y desafíos (Vol. 91). Instituto Nacional de Salud Pública, Secretaría de Salud, 2014.

Secretaría de Salud. (2015b). Prontuario de la Salud. Informe sobre la salud de los Mexicanos 2015.

Risk behaviours

In 2017, around 10.1% of the adult population (≥18 years old) smoked tobacco, of which 2.6% were classified as heavy smokers (≥20 cigarettes/per day) and 6.7% were passive smokers in the work environment. Around 54% of people were classified as being overweight (IMC≥35) and 18.9% were obese (≥30). About 14.6% consumed sugary drinks five or more days per week and 19.1% regularly consumed alcohol to excess. Around 13.9% of both men and women (≥18 years old) were physically inactive. There was a greater difference among sex in the age group between 18 and 24 years where 21% of the women and 9% of men were physically inactive. Besides, physical inactivity was increased among people with fewer years of schooling (Brazilian Ministry of Health, 2017b).

Diabetes

The prevalence rate of diabetes in Brazil varied from 8 to 9%, and 8.1% when adjusted by age, according to the Brazilian Society of diabetes in 2017 (Brazilian Society of Diabetes, 2017). Between 2006 and 2016, the number of people with diabetes grew by 61.8%, amounting to 8.9% of the population (9.9% in women and 7.8% in men) (Ministry of Health, 2017). In 2017, estimates from the Brazilian Ministry of Health based on data from 27 large cities (people aged 18+) showed that the prevalence of diabetes in the urban population was 7.6% for both genders. However, this rate tended to increase with age and was higher among those with lower education levels (up to eight years of education) (Brazilian Ministry of Health, 2017b). Estimates from the National Health Research 2013 revealed that the prevalence of diabetes was 4.6% in people aged 18 years and over in the rural population of Brazil (Brazilian Institute of Geography and Statistics, 2020).

High Blood Pressure

The prevalence of high blood pressure in the population aged 18 and over is about 24.3%, being higher in women (26.4%) than in men (21.7%). In both genders, prevalence rate tended to increase with age and was higher in those with low levels of education (up to 8 years of education) (Brazilian Ministry of Health, 2017b).

Obesity

The prevalence of being overweight is about 54%, being higher in men (57.3%) than in women (51.2%). Women who were older were more likely to be overweight, while those who were more educated were less likely to be overweight. No specific pattern was observed for men. The prevalence of obesity was 18.9% for men and women. The frequency of obesity was lower among more educated women, but no particular pattern was observed among men (Brazilian Ministry of Health, 2017b).

Mental disorders

Between 1999 and 2016, Alzheimer’s disease was one of the ten leading causes of age-standardised years of life lost (YLL) rate in Brazil. This condition was also among the main causes of years of life lived with disability (YLD) in 2016 together with depressive, bipolar and anxiety disorders (GBD 2016, 2018). According to a WHO report, the prevalence of depressive disorders in Brazil was 5.8% and of anxiety disorders was 9.3% in 2017 (World Health Organization, 2017). We could not find any report document ‘mental disorders’ more generally.

References:

Brazilian Institute of Geography and Statistics. (2020). Tabela 4492: Pessoas de 18 anos ou mais de idade que referem diagnóstico médico de diabetes, total, percentual e coeficiente de variação, por condição em relação à força de trabalho na semana de referência e situação do domicilio. SIDRA. https://sidra.ibge.gov.br/tabela/4492

Brazilian Ministry of Health. (2017b). Ministry of Health Report on Surveillance of Risk Factors.

Brazilian Society of Diabetes. (2017). Atlas da diabetes no Brasil.

GBD 2016. (2018). Burden of disease in Brazil, 1990-2016: A systematic subnational analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, 392. http://dx.doi.org/10.1016/S0140-6736(18)31221-2

Ministry of Health. (2017). Ministry of Health Report on Surveillance of Risk Factors.

World Health Organization. (2017). Depression and Other Common Mental Disorders: Global Health Estimates. https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf;jsessionid=F9B8AE77F2B1D3698E01577B2AFCBC03?sequence=1

The Centre for Health Protection of Hong Kong estimated that 39.6% of persons aged 15 or above reported one or more doctor-diagnosed chronic conditions in year 2014/2015. There were 9 types of significant non-communicable diseases covered in the population health survey conducted by this centre, including hypertension, high blood cholesterol, diabetes mellitus, coronary heart disease, asthma, cancer, stroke, chronic obstructive pulmonary disease, and dementia. Among them, the top 3 most self-reported conditions in 2017 were hypertension (male 17.6%, female 17.9%), high blood cholesterol (male 14.8%, female 14.0%), and diabetes mellitus (male 5.4%, female 5.6%) (Centre for Health Protection, 2017). The next round of population health survey in Hong Kong will be conducted in year 2020.

The Department of Health reported the ten leading causes of death by gender in 2017 (HealthyHK, 2018, July 19). The top 3 leading causes for both genders were: 1. malignant neoplasms, 2. pneumonia, and 3. disease of heart. Dementia was the 8th and 5th leading cause of death for males and females respectively.

References:

Centre for Health Protection. (2017). Report of Population Health Survey 2014/15. Retrieved from https://www.chp.gov.hk/en/static/51256.html

Healthy HK. (2018, July 19). Leading cause of all deaths.

There has been an increase in the burden of non-communicable (NCD) diseases over the past two decades, with NCD burden rising from 30% of total disease burden in 1990 to 55% of total disease burden in 2016 (Indian Council of Medical Research, Public Health Foundation of India and Institute of Health Metrics and Evaluation [ICMR, PHFI and IHME], 2017). The most considerable DALY rate increase (from 1990-2016) was observed for diabetes and ischemic heart disease (IHD) (ICMR, PHFI and IHME, 2017). In addition, there has also been a rise in NCD neurological disorders in India, with their contribution to total DALYs increasing from 4% in 1990 to 8.2% in 2019 (India State-Level Disease Burden Initiative Neurological Disorders Collaborators, 2021). Stroke, headache disorders, and epilepsy contributing most significantly to total neurological disorder DALYs in 2019 (India State-Level Disease Burden Initiative Neurological Disorders Collaborators, 2021).

Moreover, NCDs which typically present over the age of 55 in developed countries are presenting almost a decade earlier (≥45 years of age) in the Indian population (Arokiasamy, 2018). In addition, considering that communicable diseases are also highly prevalent in the country as they contribute to 27.5% of all deaths (Mohan et al., 2019), the Indian public health system faces significant challenges with this double burden of disease (Arokiasamy, 2018).

State wise variations in NCDs:

As per GBD 2019 data, the prevalence of NCDs varies across different across states. In 2019, the lowest prevalence rate was in Arunachal Pradesh, which had a prevalence rate of 91,599.98 prevalent cases per 100,000 people (90,577.05 – 92,577.86) (ICMR, PHFI and IHME, 2019). Whereas, the highest prevalence was in Kerala, with 94,140.27 prevalent cases per 100,000 people (93,473.85 – 94,765.24) (ICMR, PHFI and IHME, 2019). With respect to NCD burden, the number of deaths and Disability Adjusted Life Year’s (DALY’s) are also described. The least number of deaths was in the state of Arunachal Pradesh with 262.98 deaths per 100,000 people (214.73 – 318.26) and the highest number of deaths was in the state of Kerala – 596.35 deaths per 100,000 people (503.58 – 697.71) (ICMR, PHFI and IHME, 2019). In terms of DALY’s – the state of Arunachal Pradesh again had the lowest number of 14,675.94 per 100,000 people (12,212.71 – 17,202.98) and Tamil Nadu had the highest number of DALY’s with 23.406.3 per 100,000 people (19,820.32 – 27,314.47) (ICMR,PHFI and IHME, 2019).

References:

Arokiasamy, P. (2018). India’s escalating burden of non-communicable diseases. The Lancet Global Health, 6, e1262–e1263. https://doi.org/10.1016/S2214-109X(18)30448-0

India State-Level Disease Burden Initiative Neurological Disorders Collaborators (2021). The burden of neurological disorders across the states of India: The Global Burden of Disease Study 1990-2019. The Lancet. Global health, 9(8), e1129–e1144.

Indian Council of Medical Research, Public Health Foundation of India and Institute for Health Metrics and Evaluation (ICMR, PHFI, and IHME). (2017). India: Health of the Nation’s States-The India State-level Disease Burden Initiative, New Delhi: ICMR, PHFI and IHME. Available from: https://www.healthdata.org/sites/default/files/files/policy_report/2017/India_Health_of_the_Nation%27s_States_Report_2017.pdf

Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation (ICMR, PHFI, and IHME). (2019). GBD India Compare Data Visualization. Available from: https://vizhub.healthdata.org/gbd-compare/

Mohan, P., Mohan, S. B., & Dutta, M. (2019). Communicable or noncommunicable diseases? Building strong primary health care systems to address double burden of disease in India. Journal of family medicine and primary care8(2), 326–329. https://doi.org/10.4103/jfmpc.jfmpc_67_19

According to the WHO (2014) non-communicable diseases are now the leading causes of mortality in Indonesia, accounting for an estimated ‘71% of total deaths’ (WHO Noncommunicable Diseases Country Profiles, 2014). NCDs, including cardiovascular diseases (35%), maternal, perinatal and nutritional conditions (21%), cancers (12%), chronic respiratory diseases (6%), injuries (6%), and diabetes (6%) account for a considerable share of mortality (WHO, 2018). Mortality due to diabetes was found to have increased by 63 per cent between 2005 and 2016. This represents the largest increase in mortality among NCDs in Indonesia. Furthermore, ‘hypertension and diabetes are primary risk factors for stroke’. The prevalence of strokes between 2007 and 2013 has increased from 8.3 strokes to 12.3 strokes per 1000 population. In 2014, approximately 15 per cent of mortality was related to strokes, which is ‘among the highest proportion’ worldwide (Agustina et al., 2019, p.82).

The cost of care for people with diabetes and stroke are expected to cause substantial burden on the Indonesian health care system. Agustina and colleagues citing data from a 2014 report by the National Institute of Health Research Development report that the cost burden for diabetes (56%), stroke (57%), hypertension (46%), and heart disease (34%) are expected to increase substantially by 2020. The financial implications have been estimated to amount to $5.80 billion for the health care system as well as increasing out-of-pocket costs (Agustina et al., 2019, p.82)

Furthermore, over the last decade, illnesses such as depression and anxiety disorders have been found to increase by 22 per cent and 18 per cent, respectively (Agustina et al., 2019, p.80). This made depressive disorders the ‘seventh largest contributor to years lived with disability in 2016’. It is reported that in 2013 approximately 400,000 people aged 15 and older lived with severe mental disorders. Despite the banning of restraints in 1977, an estimated 57,200 (14.3%) people were subject to this practice (Agustina et al., 2019, p.83; based on National Institute of Health Research and Development. Basic health research 2013).

Overview of significant NCDs

Most data on NCDs are available from the Riset Kesehatan Dasar (Riskesdas)/Basic Health Survey, conducted every five years by the Ministry of Health. Since 2018, in line with Indonesia’s One Data Policy, Riskesdas was integrated into the Survei Sosial Ekonomi Nasional (Susenas)/National Socioeconomic Survey, which is a household survey managed by Statistics Indonesia (Kementrian PPN/BAPPENAS, 2018).

Diabetes Mellitus

The prevalence of diabetes in people aged 15 or above based on previous diagnosis from healthcare professionals increased from 1.1% in 2007 to 2.1% in 2013 and decreased slightly to 2.0% in 2018 (Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI, 2013; Kementrian Kesehatan Republik Indonesia, 2018). The highest prevalence can be found in the four provinces DKI Jakarta (3.4%), DI Yogyakarta (3.1%), East Kalimantan (3.1%), and North Sulawesi (3.0%) (Kementrian Kesehatan Republik Indonesia, 2018). This is likely linked to stark increase in obesity (10% in 2007 to 21.8% in 2018 and other NCDs) (Agustina et al., 2019, p.75; Kementrian Kesehatan Republik Indonesia, 2018). According to the latest Riskesdas survey, a measurement based of blood glucose level in line with the American Diabetes Association (ADA) and PERKENI 2015 criteria was added to the survey (Kementrian Kesehatan Republik Indonesia, 2018). The national prevalence is much higher (10.9%) when the diagnosis of diabetes is based on this, although this cannot be compared to previous data.

 Hypertension

In 2018, the prevalence of hypertension was 34.11% among the population aged 18 or over (based on blood pressure measurement). This marks as a significant increase from 2013, when prevalence was recorded at 25.8%. However, there had been a 5.9% decrease between the years 2010 to 2013 (Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI, 2013).

Heart disease

In 2018, the prevalence of all types of heart disease was 1.5%. The four provinces with the highest prevalence of heart disease are North Kalimantan (2.2%), DI Yogyakarta (2.0%), Gorontalo (2.0%), and DKI Jakarta (1.9%) (Kementrian Kesehatan Republik Indonesia, 2018). Previous data in 2013 only reported coronary heart disease (1.5%) and heart failure (0.3%) prevalence in the population (Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI, 2013)

Stroke

In 2018, the prevalence of stroke in Indonesia confirmed by diagnosis was 10.9 per 1,000 people, which presents a decrease from 12.1 per 1,000 people in 2013 (Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI, 2013; Kementrian Kesehatan Republik Indonesia, 2018). To aid interpretation of this data, it is important to point out that stroke is reported as the leading cause of death in Indonesia (CDC, 2020; IHME, 2019), (thus prevalence reported here might indicate the number of survivors). However, prevalence of stroke may be underreported as some patients may not have been able to access appropriate healthcare services or were not aware of their diagnosis. Estimates based on diagnosis and interview of symptoms suggest a prevalence rate of 1.21% in 2013  (Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI, 2013), but results using this method were not reported for 2018 data.

References:

Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Suparmi, Achadi, E. L., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, A. H., Thabrany, H., Susiloretni, K. A., Soewondo, P., Ahmad, S. A., Kurniawan, M., Hidayat, B., Pardede, D., Mundiharno, … Khusun, H. (2019). Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet, 393(10166), 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7

Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI. (2013). Riset Kesehatan Dasar 2013 (Vol. 6). https://doi.org/1 Desember 2013

CDC. (2020). CDC in Indonesia (Issue Cdc).

IHME. (2019). Indonesia. http://www.healthdata.org/indonesia

Kementrian Kesehatan Republik Indonesia. (2018). Riset Kesehatan Dasar 2018. https://doi.org/1 Desember 2013

Kementrian PPN/BAPPENAS. (2018). Revolusi Kebijakan One Data, Riskesdas 2018 Tampil Beda. Berita Pembangunan. https://www.bappenas.go.id/id/berita-dan-siaran-pers/revolusi-kebijakan-one-data-riskesdas-2018-tampil-beda/

National Institute of Health Research and Development. (2013). Basic health research 2013. Report: Ministry of Health Republic of Indonesia, Jakarta, 2013.

WHO. (2014). Noncommunicable Diseases Country Profiles, 2014. https://apps.who.int/iris/bitstream/handle/10665/128038/9789241507509_eng.pdf;jsessionid=26014D4B19896037A6A9EE830F4A33C4?sequence=1

WHO. (2018). NCDs Country Profiles 2018 WHO. 224. https://www.who.int/nmh/publications/ncd-profiles-2018/en/

Non-communicable diseases (NCDs) account for more than 50 to 70% of hospital admissions and 55% of hospital deaths in Kenya (MoH-Kenya, KNBS, & WHO, 2015). The greatest burden on the healthcare system is attributable to four major NCDs: cardiovascular diseases, diabetes mellitus, cancer, and chronic respiratory illnesses. According to the 2015 NCDs surveillance using the STEPS (STEPwise approach to surveillance), a standardized protocol involving three levels of gathering data on demographics and risk factors from nationally representative populations, articles revealed the following rates (Wamai, Kengne, & Levitt, 2018):

Hypertension: The age-standardized prevalence for hypertension in Kenya was 24.5% with 15.6% of them being aware of their elevated blood pressure of which 26.9% were on treatment and only half were able to achieve their blood pressure control.

Diabetes: The age-standardized prevalence for pre-diabetes and diabetes mellitus was 3.1% and 2.4% respectively, with 43.7% being aware of having pre-diabetes or diabetes of whom 20% were on treatment and only 7% were able to achieve glycaemic control.

Cervical cancer: Out of 1180 women who were interviewed, 16.4% had screened for cervical cancer despite high awareness.

NCDs common risk factors: Three-quarters of individuals who had participated in the STEPS study had four to six risk factors for NCDs while 10% were exposed to more than six risk factors. The most universal risk factor was inadequate fruit intake (99.8%), and majority had high dietary salt consumption (89.5%) and insufficient physical activity (80.3%). Other modifiable risk factors associated with these four NCDs are tobacco use, excessive alcohol consumption, air pollution, environmental degradation, climate change and psychological stress. Additional significant contributors to the burden of disease are violence, injuries, haemoglobinopathies, mental disorders, oral, eye and dental diseases.

 

References:

MoH-Kenya, KNBS, & WHO. (2015). Kenya STEPwise Survey for Non Communicable Diseases Risk Factors 2015 Report. MoH-Kenya. https://www.health.go.ke/wp-content/uploads/2016/04/Executive-summary-6-2.pdf

Wamai, R. G., Kengne, A. P., & Levitt, N. (2018). Non-communicable diseases surveillance: Overview of magnitude and determinants in Kenya from STEPwise approach survey of 2015. BMC Public Health, 18(Suppl 3), 1–8. http://doi.org/10.1186/s12889-018-6051-z

Diabetes

The main non-communicable diseases in Mexico are diabetes, hypertension, and obesity. The prevalence of diabetes reached very high levels at the beginning of this century and has been steadily increasing. In 2000, 6.5% of the population aged 20 or over was diagnosed as diabetic, rising to 7.5% in 2006 and to 9.4% in 2016 (Rojas-Martínez et al., 2017).

In an actualisation of the GBD reported in 2016, in Mexico diabetes was the first cause of YLDs, similar to other countries in Latin America like Barbados, Jamaica, Puerto Rico, Saint Vincent and the Grenadines, Trinidad and Tobago, and the Virgin Islands (Vos et al., 2016). This emphasises the necessity of intensive long-term management to prevent fatal and disabling complications in those countries.

The National Health and Nutrition Survey (ENSANUT), a national probabilistic survey, reported in 2016 that 9.4% of the adults interviewed (10.3% of women and 8.4% of men), reported a diagnosis of diabetes by a physician or other health professionals (Table 4), a slight increase from ENSANUT 2012’s reported prevalence of 9.2%, and 7.25% in ENSANUT 2006. The majority (87.8%) reported receiving medical treatment to control their illness. Most people with a previous medical diagnosis of diabetes were between 60 and 70 years of age (INSP & Secretaría de Salud, 2016).

Table 4. Percentage of adults who reported having received a prior medical diagnosis of diabetes

  Men   Women   Total  
Age group Number (Thousands) % Number (Thousands) % Number (Thousands) %
20-29 23.2 0.3 153.1 1.6 176.3 1.0
30-39 70.0 0.9 275.6 3.1 345.6 2.1
40-49 543.6 9.4 582.6 8.2 1126.2 8.7
50-59 743.9 17.7 872.1 17.2 1616 17.4
60-69 951.8 27.7 1,228.4 32.7 2,180.2 30.3
70-79 280.1 19.3 500.5 29.8 780.5 24.9
80 and more 80.6 12.5 159.3 21.8 239.9 17.5
Total 2,693.2 8.4 3,771.6 10.3 6,464.8 9.4

(Source: ENSANUT MC, 2016)

The report of diabetes by previous medical diagnosis was higher among women than among men, both nationally (10.3% vs 8.4%), in urban (10.5% vs 8.2%) or rural (9.5% vs 8.9%) localities (INSP & Secretaría de Salud, 2016).

Hypertension

According to ENSANUT 2016 (Campos-nonato et al., 2018), current prevalence of hypertension[1] is 25.5%, although 40.0% of these did not know they had hypertension before the survey. Of the total adults 20 years and older with a previous diagnosis of hypertension who were receiving treatment, only 45.6% had controlled or normal hypertension (SBP≤140mmHg; DBP≤90mmHg) when measured at the time of the survey. By sex, 26.1% of men and 24.9% of women reported having hypertension. The prevalence was highest among people aged 70 to 79 years. In ENSANUT 2016, no statistically significant differences were observed in the prevalence of arterial hypertension between geographic regions, nor between rural and urban localities (INSP & Secretaría de Salud, 2016).

Table 5. Prevalence of hypertension, by sex and age group. Mexico 2015

Hypertension Detected at survey Previous diagnosis
% (CI 95%) n % (CI 95%) n % (CI 95%) n
Total 25.5 23.3-27.8 2204 10.2 8.9-11.7 839 15.3 13.4-17.5 1365
Women 26.1 23.5-28.9 1426 7.7 6.5-9.1 447 18.4 16.0-21.2 979
Men 24.9 21.6-28.5 778 12.8 10.9-15.0 392 12.1 9.4-15.5 386
Age Group
20-29 8.3 6.1-11.2 96 5.4 3.6-8.0 54 2.9 1.8-4.7 42
30-39 13.1 8.8-19.2 198 5.6 3.8-8.1 104 7.6 3.8-14.6 94
40-49 24.2 20.9-27.9 388 10.6 8.3-13.6 164 13.6 11.3-16.2 224
50-59 39.8 35.3-44.5 489 13.3 10.4-16.9 157 26.5 22.1-31.4 332
60-69 56.0 50.6-61.2 529 19.6 14.4-26.2 178 36.3 30.2-43.0 351
70-79 66.3 60.0-72.1 367 23.9 17.9-31.2 129 42.4 36.0-49.1 238
≥80 59.4 49.1-69.0 137 22.1 14.7-31.9 53 37.3 27.5-48.3 84

Source: (Campos-nonato et al., 2018)

Obesity

In Mexico it is considered that there is an epidemic of being overweight and obesity, which began in the 90’s and has presented a growing trend, especially in children under 20 (Secretaría de Salud, 2015b). By sex, the prevalence of obesity (BMI ≥30 kg/m2) is higher in females (38.6%, 95% CI 36.1, 41.2) than males (27.7%, 95% CI 23.7, 32.1) (Secretaría de Salud, 2015b).

The prevalence of abdominal obesity (defined as having a waist circumference in men ≥90 cm and in women ≥80 cm) in adults 20 years of age or older is 76.6%. Prevalence is higher for women than for men and increases with age, except for the very old (INSP & Secretaría de Salud, 2016).

Table 6. Prevalence of abdominal obesity* in adults 20 years of age or older, categorised by sex and age groups

Age Group Waist Perimeter Abdominal obesity
  Men Women Men Women
20-29 49.0 24.7 51.0 75.3
30-39 32.2 10.2 67.8 89.8
40-49 29.8 8.4 70.2 91.6
50-59 27.8 5.3 72.2 94.7
60-69 25.9 6.1 74.1 93.9
70-79 20.0 13.7 80.0 86.3
≥80 33.2 14.7 66.8 85.3
Total 34.6 12.3 65.4 87.7

Source: (Secretaría de Salud, 2015b)

According to national data, the combined prevalence of being overweight and obese in the school-age population in 2016 was 33.2%. The prevalence of being overweight was 17.9% and obesity 15.3%. In contrast with the adult population, a higher prevalence of obesity was observed in boys 18.3%, compared to girls 12.2% (INSP & Secretaría de Salud, 2016).

[1] Hypertension is classified as those who reported have been previously given a diagnosis of hypertension by a health professional or that presented, when interviewed, measures of systolic blood pressure (SBP) ≥140mmHg and diastolic blood pressure ≥90mmHg.

References:

Campos-nonato, I., Hernández-Barrera, L., Pedroza-Tobías, A., Medina, C., & Barquera, S. (2018). Hipertensión arterial en adultos mexicanos: prevalencia, diagnóstico y tipo de tratamiento. Ensanut MC 2016. Salud Publica de Mexico, 60(3), 233–243. https://doi.org/10.21149/8813

INSP, & Secretaría de Salud. (2016). Encuesta Nacional de Salud y Nutrición de Medio Camino, 2016 (Vol. 2016). https://doi.org/10.1111/acem.12546

Rojas-Martínez, R., Basto-Abreu, A., Aguilar-Salinas, C. A., Zárate-Rojas, E., Villalpando, S., & Barrientos-Gutiérrez, T. (2017). Prevalencia de diabetes por diagnóstico médico previo en México. Salud Pública de México, 60(3). https://doi.org/10.21149/8566

Secretaría de Salud. (2015b). Prontuario de la Salud. Informe sobre la salud de los Mexicanos 2015.

Vos, T., Allen, C., Arora, M., Barber, R. M., Brown, A., Carter, A., Casey, D. C., Charlson, F. J., Chen, A. Z., Coggeshall, M., Cornaby, L., Dandona, L., Dicker, D. J., Dilegge, T., Erskine, H. E., Ferrari, A. J., Fitzmaurice, C., Fleming, T., Forouzanfar, M. H., … Zuhlke, L. J. (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1545–1602. https://doi.org/10.1016/S0140-6736(16)31678-6

The World Health Organisation estimates that for the year 2016, NCDs account for 51% of all deaths in South Africa (WHO, 2018). Communicable, maternal, perinatal, and nutritional conditions account for 40% of mortality, followed by cardiovascular diseases (19%), cancers (10%), injuries (9%), diabetes (7%), and chronic respiratory diseases (4%) (WHO, 2018). For the same year men were more at risk for premature deaths from NCDs – 32% compared to 21% of their female counterparts (WHO, 2018).

Data from 2015 ranked cerebral-vascular disease fourth on the top ten causes of years of life lost (YLLs) (Groenewald et al., 2017).

References:

Groenewald, P., Bradshaw, D., Day, C., & Laubscher, R. (2017). 14 Burden of disease. October 2012, 206–226. Available from: https://www.hst.org.za/publications/District%20Health%20Barometers/14%20(Section%20A)%20Burden%20of%20Disease.pdf

WHO. (2018). Non-communicable diseases (NCD) Country Profiles:South Africa. Available from: https://apps.who.int/iris/handle/10665/274512

HIV/AIDS

From 1980 to June 2018, 926,742 HIV positive cases were identified in Brazil, with an annual record of 40,000 new cases. In 2012, detection rate was 21.7 cases per 100 thousand inhabitants, whereas in 2017, detection rate was 18.3, representing a decrease of 15.7%. In four years, there was also a decrease of 16.5% in the mortality rate from the disease, from 5.7 per 100 thousand inhabitants in 2014 to 4.8 deaths in 2017.  Around 73% of new HIV infections occur among males, 70% of whom are aged between 15 and 39 years (Brazilian Ministry of Health, 2018f). Such decline might be related to more accessible treatment for all, better diagnosis rates, reduced time between diagnosis and start of treatment, and better access to testing (Brazilian Ministry of Health, 2018f).

Tuberculosis

In 2017, 69,569 new cases of tuberculosis were reported in Brazil. Incidence rate equalled 33.5 cases per 100 thousand inhabitants. From 2008 to 2017, this coefficient showed an annual average decrease of 1.6%. In 2016, 4,426 deaths from tuberculosis were recorded, resulting in a mortality rate equal to 2.1 deaths per 100 thousand inhabitants, reflecting an annual average decrease of 2.0% from 2007 to 2016. The distribution of both indicators was heterogeneous by regions, states, and capitals. However, the tuberculosis situation in the capitals of the country requires attention, since 70.4% of them (19 capitals) had an incidence rate higher than that recorded in the entire country. The highest mortality rates in 2016 were recorded in the north and northeast cities -in Recife (6.4 per 100 thousand inhabitants), Belém (5.3 per 100 thousand inhabitants) and Manaus (4.7 per 100 thousand inhabitants) (Brazilian Ministry of Health, 2018c), possibly given to lower socioeconomic status in these cities. In 2017, 13.347 relapse cases/treatment were registered in the country, equivalent to 16.1% of total cases reported in the period. The states with the highest proportion of retreatments were Rio Grande do Sul (23.3%), Rondônia (19.9%) and Paraíba (19.5%). This result is similar to that observed in the capitals, among which the highest proportion of retreatment was recorded in Porto Alegre (31.2%), Campo Grande (25.8%), João Pessoa (23.8%) and Porto Velho (23.3%) (Brazilian Ministry of Health, 2018c).

Dengue /Zika Virus/ Chikungunya

Brazil faces epidemic levels of mosquitoes-transmissible diseases (e.g. Aedes aegypti), such as dengue, zika virus, yellow fever and chikungunya, all of which take a great proportion of financial and human resources in the primary, secondary and tertiary care sectors in Brazil, in both private and public health services. According to a report published in March 2019 by the Ministry of Health comparing the epidemiological situation of dengue, chikungunya and zika in 2018 and in 2019, the number of cases with such diseases has increased considerably, as per information below (Brazilian Ministry of Health, 2019f).

Dengue: In 2019 (up to week 11), there were 229,064 probable cases of dengue in the country, with an incidence rate of 109.9 cases per 100 thousand inhabitants. In the same period of 2018, there were 62,904 probable cases. The South-Eastern region had the highest number of probable cases (149,804 cases, 65.4%) in relation to the country rates, followed by the Midwest (40,336 cases, 17.6%), the North (15,183 cases, 6.6%), the Northeast (17,137 cases, 7.5%) and the South (6,604 cases, 2.9%). The incidence rate of probable dengue cases (per 100 thousand inhabitants) up to week 11 of 2019 shows that the Centre-West and Southeast regions had the highest incidence rates: 250.8 cases per 100 thousand inhabitants and 170.8 cases per 100 thousand inhabitants, respectively (Brazilian Ministry of Health, 2019f).

Chikungunya: In 2019 (until week 11), there were 12,942 probable cases of chikungunya in the country, with an incidence rate of 6.2 cases per 100 thousand inhabitants. At the same week of 2018, 23,484 probable cases were registered. In 2019, the Southeast region had the highest number of probable cases of chikungunya (8,536 cases, 66.0%) in relation to the total of the country. The North (2,139 cases, 16.5%), the Northeast (1,786 cases, 13.8%), the Central Region (293 cases, 2.3%) and the South (188 cases, 1.5%). The incidence rate of probable cases of chikungunya in 2019 shows that the North and the Southeast regions had the highest incidence rates: 11.8 cases per 100 thousand inhabitants and 9.7 cases per 100,000 inhabitants, respectively (Brazilian Ministry of Health, 2019f).

Zika virus: In 2019 (until September 9), 2,062 probable cases of Zika were registered in the country, representing an incidence rate of 1 case per 100 thousand people. During the same period of 2018, 1,908 probable cases had been registered. In 2019, the northern region has had the highest number of probable cases (912 cases, 44.2%) in relation to the country’s total figures – the Southeast: 584 cases, 28.3%; the Midwest: 176 cases, 8.5%; the Northeast: 343 cases, 16.6%; the South: 47 cases, 2,3 %. The incidence rate of probable Zika cases shows that the Northern region has had the highest incidence rate: 5 cases per 100 thousand inhabitants. Among the UFs, Tocantins (47 cases per 100 thousand inhabitants) and Acre (9.5 cases per 100 thousand inhabitants) have had the highest numbers (Brazilian Ministry of Health, 2019f).

Yellow fever: With regards to yellow fever, between January and May 2019, 68 cases were confirmed in the state of São Paulo, 12 in Paraná and one case in Santa Catarina (total=81 cases). The majority of the cases were among rural workers and/or among people with higher exposure to the mosquitos, of which 72 (88.9%) were males, aged between eight and 87 years. Among the confirmed cases, 14 led to death (17.3%). The total number of human cases recorded in the same period of 2018 was 1,309, showing an important decrease in the number of cases in the country (Brazilian Ministry of Health, 2018d).

Influenza: Brazil has also epidemic periods of influenza, which the country has been trying to control through vaccination and education (e.g. hand washing). It affects mostly vulnerable populations such as babies, pregnant women, older adults, health professionals, carers, bed-bound people, and people with potentially compromised immune systems – HIV, cancer, lupus, etc.). Brazil has a national online system for compulsory registration of Influenza cases (SINAN, 2019).

References:

Brazilian Ministry of Health. (2016b). Panorama da tuberculose no Brasil: A mortalidade em números.

Brazilian Ministry of Health. (2018c). Implantação do Plano Nacional pelo Fim da Tuberculose como Problema de Saúde Pública no Brasil: Primeiros passos rumo ao alcance das metas (Vol. 49).

Brazilian Ministry of Health. (2018d). Monitoramento do Período Sazonal da Febre Amarela Brasil – 2017/2018 (Issue Figura 1).

Brazilian Ministry of Health. (2018f). Pará está entre os estados com redução de óbitos por AIDS. Ministério Da Saúde.

Brazilian Ministry of Health. (2019f). Monitoramento dos casos de arboviroses urbanas transmitidas pelo Aedes (dengue, chikungunya e Zika) até a Semana Epidemiológica 11 de 2019 (Vol. 50, Issue Tabela 1).

SINAN. (2019). Sistema de Informação de Agravos de Notificação. http://www.portalsinan.saude.gov.br/

HIV and AIDS

In 2018, there were 624 HIV reports and 139 AIDS report in Hong Kong. A cumulative total of 9,715 reports of HIV infection and 1,996 AIDS cases was identified under the voluntary and anonymous HIV/AIDS reporting system of the Department of Health launched since 1985. In 2018, 1 in every 9,850 new blood donors, 1 in every 264 attendees in Sexually Transmitted Diseases (STD) Clinics, and 1 in every 110 users in methadone clinics were tested HIV positive. Most of the HIV reports were male (85%) and Chinese (72%). Most infected people (78%) were diagnosed at the age between 20 and 49. People infected with HIV progress to AIDS when they suffer from clinical complications of severe immunodeficiency due to HIV. The most common illnesses presenting at AIDS were pneumocystis pneumonia and tuberculosis.

Tuberculosis

Tuberculosis (TB) is an important infectious disease in Hong Kong. In 2018, there was a total of 4,326 TB notifications with male to female ratio of 1.7:1 (Centre for Health Protection, 2019, February 4a). It was rare in children under 15 years old but more common among old people. The total number of deaths caused by TB was 179 (132 male and 47 female) (Centre for Health Protection, 2019, February 4b) respectively.

Seasonal influenza

Seasonal influenza is a common respiratory tract infection caused by human seasonal influenza viruses. In Hong Kong, it is more common in periods from January to April and from July to August (Centre for Health Protection, 2020a). Centre for Health Protection has been closely monitoring the weekly numbers of institutional influenza-like illness outbreaks and influenza-associated admission rate in public hospitals (Centre for Health Protection, 2020a). In 2019, there were 24,215 positive detections of seasonal influenza viruses under laboratory surveillance (Centre for Health Protection, 2020c).  In 2018/2019 winter, it caused 5,217 cases of adult ICU admission and 2,942 cases of adult death with laboratory confirmation (Centre for Health Protection, 2020b).

References:

Centre for Health Protection. (2019, February 4a). Notification & death rate of tuberculosis (all forms), 1947-2018. Retrieved from https://www.chp.gov.hk/en/statistics/data/10/26/43/88.html

Centre for Health Protection. (2019, February 4b). Tuberculosis notifications (all forms) and rate by age group and sex, 2018 (Provisional). Retrieved from https://www.chp.gov.hk/en/statistics/data/10/26/43/6825.html

Centre for Health Protection. (2020a). Explanatory notes on the intensity levels for seasonal influenza in Hong Kong. Retrieved from https://www.chp.gov.hk/files/pdf/explanatory_note_for_flux_mem_eng.pdf

Centre for Health Protection. (2020b). Flu Express. Retrieved from: https://www.chp.gov.hk/files/xls/flux_data.xlsx

Centre for Health Protection. (2020c). Flu Express-Weekly surveillance data Retrieved from: https://www.chp.gov.hk/files/xls/flux_data.xlsx

Virtual AIDS Office of Hong Kong. (2019, May). HIV/AIDS Situation in Hong Kong [2018]. Hong Kong Retrieved from https://www.aids.gov.hk/english/surveillance/sur_report/hiv_fc2018e.pdf.

HIV/AIDS

Using state level survey data, the National Aids Control Organization and Indian Council of Medical Research-National Institute of Medical Sciences (NACO and ICMR-NIMS, 2019) report estimated that the adult (15–49 years) HIV prevalence was 0.22% (0.17-0.29%) in 2019. The report found that rates differed by gender, with prevalence being higher among males at 0.24% (0.18-0.32%) compared to 0.20% (0.15-0.26%) among females. There is also a wide variation in the prevalence of HIV by State/UTs. As per the NACO and ICMR-NIMS 2019 report, the highest young adult HIV prevalence rate was reported in Mizoram, [2.32%, [1.85–2.84%]), followed by Nagaland (1.45% [1.15–1.78%]), and Manipur (1.18% [0.97–1.46%]). The lowest prevalence rates were found in Arunachal Pradesh (0.06%), Jammu and Kashmir (0.06%), and Sikkim (0.07%).

TB

According to the Global TB Report (WHO,2019a), 10 million people are infected with TB globally in 2018. India accounts for 27% of the global tuberculosis cases (WHO, 2019a).

State variations in TB:

As per GBD 2019 data, the prevalence of TB in India varies across the states. In 2019, the lowest prevalence rate was in Goa, which has a prevalence rate of 14,835.37 cases per 100,000 people (13,185.25 – 16,832.76) and the highest being in West Bengal with 37,351.82 prevalent cases per 100,000 people (33,258.47 – 41,758.29) (ICMR, PHFI and IHME, 2019). In terms of burden, the measures of the number of deaths and DALY’s are described. The least number of deaths was in Kerala 10.53 deaths per 100,000 people (8.2 – 13.15) and the highest number of deaths was in Uttar Pradesh with 45.24 deaths per 100,000 people (37.23 – 55.08 (ICMR, PHFI and IHME, 2019). With respect to DALY’s (Disability Adjusted Life years), Kerala again had the lowest number of DALY’s per 100,000 people 333.92 (268.22 – 407.48) and Uttar Pradesh had the highest number of DALY’s with 1,744.52 per 100,000 people (1,461.91– 2,074.18) (ICMR, PHFI and IHME, 2019).

According to the Burden of Disease report (National Commission on Macroeconomics and Health (NCMH), 2005), the Health and Development Initiative states that those at the greatest risk of TB are those from a lower socioeconomic status, since the disease spreads in crowded places such as schools, marketplaces, households etc. Moreover, there are also several social and economic costs of being diagnosed with TB. According to the Burden of Disease report (NCMH, 2005), if an adult is diagnosed with TB, on average, they lose 3–4 months of work time, which results in a 20%–30% loss in annual household income (NCMH, 2005). This is of significant concern as the portion of the population which is most affected by TB in India is of working age, with 89% of cases occurring amongst those 15-69 years of age (Central TB Division, 2019). This loss of household income due to illness along with paying for the costs associated with treatment could lead many households to experience catastrophic health expenditures.

 Malaria

There were approximately 228 million cases of malaria reported globally in 2019 (WHO, 2019b). Out of the 15 countries that contribute to the global malaria burden, India accounts for 3% of global malaria burden (WHO, 2019b). However, with national programs and other interventions, the country has reported a decline in malaria, with its incidence having decreased by 24% in 2017 in comparison to the previous year (WHO, 2019b).

State wise variations in Malaria:

As per GBD 2019 data, prevalence of malaria varies across the states in India. In 2019, the lowest prevalence rate was in Sikkim, which had a prevalence rate of 48.82 cases per 100,000 people (37.82 – 63.49) and the highest being in Chattisgarh with 1745 prevalent cases per 100,000 people (905.05– 3389.51) (ICMR, PHFI and IHME, 2019). With respect to burden, the number of deaths and DALYs associated with malaria are also described. The least number of deaths was in Sikkim with 0.0018 deaths per 100,000 people (0.00045 – 0.0075) and the highest number of deaths was in Odisha with 23.51 deaths per 100,000 people (8.1 – 58.11) (ICMR, PHFI and IHME, 2019). In terms of DALYs– Sikkim had the lowest number of 2.55 DALYs per 100,000 people (1.94 – 3.3) and Odisha had the highest number of DALYs with 1,455.04 per 100,000 people (540.73 – 3,375.05) (ICMR, PHFI and IHME, 2019).

Other communicable diseases

Apart from these, emergence of new forms of infections and re-emergence of several infectious diseases, mainly due to viruses are a matter of concern for India. Respiratory viral infections (e.g., H1N1, Avian influenza, H5N1, and Covid-19), arboviral infections (e.g., Chikungunya, Japanese encephalitis, and Kyasanur forest disease [KFD]) and bat-borne viral infections (e.g., Nipah viral disease and severe fever with thrombocytopenia virus [SFTV]) are the three major categories of emerging viral infections in India (Mourya et al., 2019).

The Integrated Disease Surveillance Programme (IDSP) in their 2017 surveillance report stated that a total of 1683 outbreaks were due to epidemic prone diseases (Mourya et al., 2019). Of these, 71% were caused due to viral pathogens (Mourya et al., 2019).

COVID-19:

The COVID-19 pandemic has caused unprecedented challenges to the Indian health system. While the first case in the country was confirmed on January 30th in 2020, there has been a significant rise in cases with a total of 43 million cases and 521,691 total deaths confirmed in the country as of 30th April 2022 (Johns Hopkins University, 2022). People with co-morbidities and the elderly have been the most affected (MoHFW, 2020; Press Information Bureau, 2020). The government has taken multiple measures to protect vulnerable populations and reduce disease spread including a complete nationwide lockdown from March 25th to May 31st in 2020. The government also introduced a mass vaccination campaign in phases and 633 million doses have been provided as of 30th August 2021 (MoHFW, 2021).

References:

Central TB Division. (2019). Revised National TB Control Programme, Annual Report. Available from https://tbcindia.gov.in/WriteReadData/India%20TB%20Report%202019.pdf

Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation (ICMR, PHFI and IHME). (2019). GBD India Compare Data Visualization. Available from: https://vizhub.healthdata.org/gbd-compare/

Johns Hopkins University (2022). Coronavirus Resource Centre. Available from: https://coronavirus.jhu.edu/map.html

Ministry of Health and Family Welfare (2020a). It is more important now to follow COVID Appropriate Behaviours because of the upcoming festival season, arrival of winter, opening up of economy: Dr. V.K. Paul [Press Information Bureau Website]. Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=1664105

Ministry of Health and Family Welfare. (2021). Ministry of Health and Family Welfare. Available from: from https://mohfw.gov.in/

Mourya, D., Yadav, P., Ullas, P., Bhardwaj, S., Sahay, R., Chadha, M., …& Singh, S. (2019). Emerging/re-emerging viral diseases & new viruses on the Indian horizon. Indian Journal of Medical Research, 149(4), 447. https://doi.org/10.4103/ijmr.ijmr_1239_18

National Aids Control Organization and Indian Council for Medical Research-National Institute of Medical Science. (2019). India HIV Estimates 2019. Available from: http://naco.gov.in/sites/default/files/INDIA%20HIV%20ESTIMATES.pdf

National Commission on Macroeconomics and Health, Ministry of health & Family Welfare, Government of India. (2005). Burden of disease in the India: Background Papers, NCMH. Indian Journal of Medical Research, 124(3), 235–244.

Press Information Bureau (2020). India’s case fatality rate is 1.53% compared to 17.9% with comorbid people and 1.2% for people without comorbidities: Secretary [PIB Twitter].  Available from: https://twitter.com/pib_india/status/1315978147792211970

World Health Organization (2019a). Global Tuberculosis Report. Available from: https://www.who.int/publications/i/item/9789241565714

World Health Organization (2019b). World Malaria Report. Available from: https://www.who.int/india/health-topics/malaria#:~:text=According%20to%20the%20WMR%202019,of%2050.5%25%20compared%20with%202017.

The prevalence and burden of communicable diseases, particularly that of HIV/AIDS and TB, are considerable in Indonesia.

HIV/AIDS

Indonesia experiences the ‘fastest growing HIV epidemic’ among southeast Asian countries  (Agustina et al., 2019, p. 83). According to UNAIDS, approximately 630,000 (lower to upper estimates 540,000-740,000) people lived with HIV in 2016. By 2018, this number was estimated to have reached 640,000 (550,000-750,000). The majority of people living with HIV were aged 15 or over (620,000). Among these, an estimated 17% (15%-20%) accessed antiretroviral therapy. Furthermore, there were an estimated 48,000 (43,000-52,000) new HIV infections and 38,000 (34,000-43,000) AIDS-related deaths in Indonesia (UNAIDS, 2018).

By December 2019, cases of HIV/AIDS have been reported in 93.2% of districts and in 34 provinces across Indonesia. The provinces with the highest number of HIV infections were DKI Jakarta (65,578), followed by East Java (57,176), West Java (40,215), Papua (36,382), and Central Java (33,322) (Ditjen P2P Kementerian Kesehatan RI, 2020).

TB

According to WHO, Indonesia is ranked among the countries with the highest burden of tuberculosis (WHO, 2019) . It is estimated that there are about 1 million new cases of TB per year and prevalence is estimated to be at almost 400 cases per 100,000 people (Agustina et al., 2019, p.83; WHO, 2017, p.1). According to the WHO TB report 2019, notifications of TB in Indonesia increased from ‘from 331 703 in 2015 to 563 879 in 2018 (+70%), including an increase of 121 707 (+28%) between 2017 and 2018’ (WHO, 2019, p.2).

Mortality of TB was substantial, as Indonesia was estimated to be among the group of five countries where 40 or more deaths per 100,000 population were associated with TB (WHO, 2017, p.35). This is paired with low levels of TB treatment. The WHO reports that Indonesia belongs to the group of countries with 50 per cent of less treatment coverage in 2016 (WHO, 2017, p.78). Furthermore, ‘high levels of underreporting of detected TB cases’ was found following the 2013-2014 national TB prevalence survey with Indonesia ranging among the top three countries (16% gap between TB incidence and reported cases) (WHO, 2017, pp.180).

The WHO report further shows a substantial gap between the funding required for prevention, diagnosis, and treatment and the actual funds available. In Indonesia this funding gap is estimated to amount to US $98 million (WHO, 2017, p.115). Of the available funds, 61 per cent were provided from domestic sources and 39 per cent by donors (WHO, 2017, p.117).

The previously reported growing burden of HIV/AIDS together with the high burden of TB further complicates the situation in Indonesia. In combination with the described underreporting, this leads to a situation where only 14% of people with TB had a reported HIV status and ‘less than 50% of HIV patients were started [on the recommended] ART’ treatment in 2016 (WHO, 2017). In 2019, Indonesia remained among the 20 high TB/HIV burden countries as well as among the ‘20 countries with highest estimated numbers of incident [multi-drug resistant TB] (MDR-TB) cases’ (WHO, 2017). Despite low reporting and high burden, it is reported that Indonesia had an ‘85 per cent treatment success among people with new and relapse TB’ and ’60 percent treatment success among people with new and relapse HIV-positive TB’ in 2015 as well as ’51 per cent treatment success among people with rifampicin-resistant TB in 2014’ (WHO, 2017, pp. 88,90).

Other relevant infectious diseases are malaria, with approximately 40,000 death per annum as well as arboviruses, dengue fever, chikungunya, nipa, avian influenza, and Zika (Agustina et al., 2019, pp.83).

References:

Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Suparmi, Achadi, E. L., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, A. H., Thabrany, H., Susiloretni, K. A., Soewondo, P., Ahmad, S. A., Kurniawan, M., Hidayat, B., Pardede, D., Mundiharno, … Khusun, H. (2019). Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet, 393(10166), 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7

Ditjen P2P Kementerian Kesehatan RI. (2020). Laporan Perkembangan HIV AIDS & Penyakit Infeksi Menular Seksual (PIMS) Triwulan IV Tahun 2019.

UNAIDS. (2018). Country factsheets: Indonesia. https://www.unaids.org/en/regionscountries/countries/indonesia

WHO. (2017). Global Tuberculosis Report 2017.

WHO. (2019). Global Tuberculosis Report 2019. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf?ua=1

 

HIV/AIDS, neonatal disorders, diarrheal diseases, lower respiratory infections, congenital defects, tuberculosis, stroke, ischemic heart disease, meningitis, cirrhosis were the top 10 causes of death and disability-adjusted life years (DALYs) combined in 2017 in Kenya (all ages and sexes combined) (Institute for Health Metrics and Evaluation, 2017)

Although HIV prevalence in Kenya reduced from 7.2% (excluding North-Eastern region) in 2007 to 5.6% and an incidence of 0.5% in 2012 with similar decline across males and females, it continues to be a public health concern due to the annual transmission rate of 8.9 per 100 HIV-infected persons. In 2012, HIV prevalence peaked (9.8%)  among those aged 45-49 while in 2007 the highest prevalence (11.9%) was seen among those aged 30-34 (Kimanga et al., 2016).

Kenya was also hit by the global pandemic of corona virus disease (COVID-19) which was first detected in China on 31st December 2019. In March 2020, the first case was confirmed. Older people have experienced a double blow during the pandemic as they are at a higher risk of developing dementia and are vulnerable to frailty and comorbid conditions. By 12th April 2020, 7% of COVID-19 cases (out of 197) were aged 60 years. In addition, most deaths across the globe were older adults with underlying health issues (Lloyd-Sherlock et al., 2020).  Unfortunately, non-governmental organizations (NGOs) offering support to persons with dementia and their caregivers remain scarce in  Kenya, yet that is the only face-to-face and practical option for the increasing cases of dementia (Comas-Herrera et al., 2020).

The World Health Organization (WHO) and the government of Kenya has continuously put in strict safety measures to reduce further infection of COVID-19 such as physical distancing, wearing masks, hand washing and other sanitization procedures. In some countries like Kenya, measures to reduce public gatherings and crowds included government curfew and minimal movement outside major counties affected by COVID-19. Some of the measures may pose difficulties for persons with dementia such as remembering these instructions since decline in memory is a key presentation for dementia. As a result, persons with dementia may be predisposed to infection (Wang et al., 2020) or experience legal consequences because there have not been exceptions or guidelines that have been put in place for persons with disability such as dementia.

References:

Comas-Herrera, A., Lorenz-Dant, K., Ferri, C., Govia, I., Sani, T., Jacobs, R., … The STRiDE Team. (2020). Supporting people living with dementia and their carers in low- and middle-income countries during COVID-19. LTCcovid.Org, International Long-Term Care Policy Network, CPEC-LSE, April, 7–10. https://ltccovid.org/2020/04/10/supporting-people-living-with-dementia-and-their-carers-in-low-and-middle-income-countries-during-covid-19/

Institute for Health Metrics and Evaluation. (2017). Country profiles: Kenya – What causes the most death and disability combined? https://www.healthdata.org/kenya

Kimanga, D., Ogola, S., & Umuro, M. (2016). Prevalence and Incidence of HIV Infection, Trends, and Risk Factors Among Persons Aged 15–64 Years in Kenya: Results From a Nationally Representative Study. Journal of Acquired Immune Deficiency Syndromes, 1999(66(Suppl 1)), 13–26. https://doi.org/10.1097/QAI.0000000000000124

Lloyd-Sherlock, P., Ebrahim, S., Geffen, L., & McKee, M. (2020). Bearing the brunt of covid-19: older people in low and middle income countries. BMJ, 368, 1–2. https://doi.org/10.1136/bmj.m1052

Wang, H., Li, T., Barbarino, P., Gauthier, S., Brodaty, H., Molinuevo, J. L., … Tang, Y. (2020). Dementia care during COVID-19. Lancet (London, England), 395(10231), 1190. https://doi.org/10.1016/S0140-6736(20)30755-8

Infectious diseases continue to represent a Public Health problem in Mexico, because of emerging and re-emerging infections, due to increased population mobility, overcrowding, inadequate basic sanitation, social marginalization, modification in the composition or behaviour of some infectious agents, drug resistance, and comorbidity, particularly acute respiratory, intestinal, and urinary tract infection (Soto-Estrada et al., 2016). Communicable diseases are major causes of premature death such as acute respiratory infections, and in some age groups, AIDS and tuberculosis appear as relevant causes along with Chagas disease, which stands out as a major cause of disability in older adults (Lozano Asencio et al., 2014).

HIV

Mexico has a National AIDS Cases Registry, which is the main tool for monitoring this epidemic in the country, which has led to an improvement in the registration of cases, as well as greater access to antiretroviral treatments, which in turn have been improving, giving people with HIV/AIDS a greater opportunity to live longer (Secretaría de Salud, 2015b).

The most recent epidemiologic data on HIV comes from the ENSANUT 2012 where in addition to survey questions, spot-blood tests for HIV (Western-blot) were taken from a sample of population 15-49. A prevalence of 0.15% was identified (95% CI 0.09-0.21); 0.07% (95% CI 0.03-0.11) in women, and 0.24% (95% CI 0.11-0.36) in men. The HIV positive population are more likely to be young men, with a higher socioeconomic level in relation to the general population and are also more likely to be covered by social security (49.9% in HIV positive versus 34.5% in non-positive) (Gutiérrez et al. 2014).

It was estimated that approximately 104,000 people 15 to 49 years were living with HIV in Mexico in 2012, and of these, 75% are men. Of those tested, 50.6% did not know their serological status before being tested as part of the survey. The estimated prevalence among individuals 15 to 49 years was adjusted both for selection bias correction and the usual difficulty to capture some population groups, which resulted in a slightly higher HIV serology of 0.23% and an estimated number of people with HIV of 140,000 (Gutiérrez et al., 2014).

Table 7. Serology prevalence of HIV, in population 15 to 49 years. Mexico, 2012

Age group Men %

(95% CI)

Woman %

(95% CI)

Total %

(95% CI)

15-49 0.24 (0.11-0.36) 0.07 (0.03-0.11) 0.15 (0.09-0.21)
15-19 0.21 (<0.00-0.44) Not estimable 1.10 (<0.00-0.21)
20-49 0.24 (0.10-0.39) 0.09 (0.10-0.39) 0.16 (0.09-0.23)

Source: ENSANUT, 2012

Tuberculosis and other infectious diseases

In Mexico, the Ministry of Health estimates that there are at least 2,000 to 2,500 deaths per year due to tuberculosis, as well as more than 19,000 new cases annually. Tuberculosis affects groups of all ages, but it predominates in young people and in mid-life. Not all treated cases of tuberculosis should be considered officially reported, because mistakes in clinical records should be considered, such as mix the prevalent cases (therapeutic failures, relapses, and chronic or multi-drug resistant cases) with the incidents, so it continues to be a major public health problem (Báez-saldaña et al., 2003).

Other relevant diseases are rotavirus, which is a virus that causes diarrheal disease, especially in infants between 6 and 24 months of age. Since 2006, children in Mexico have free access to rotavirus vaccine because it has been included in the basic vaccination table. Pneumonia causes bacterial meningitis in adults and is the second most common cause of meningitis in children over 2 years of age.

Vector-borne diseases

It is estimated that close to 60% of the national territory presents favourable conditions for the proliferation of insects that transmit pathogens. Malaria is about to be eradicated, dengue persists, while chikungunya and zika have recently appeared. In relation to dengue fever, it has increased in the last years in 30 states of the country. Finally, the Chagas disease, a condition caused by the protozoan parasite Trypanosoma cruzi, is among the top ten causes of life years associated with disability in older adults (Lozano Asencio et al., 2013).

References:

Báez-saldaña, A. R., Cm, M., Pérez-padilla, J. R., Salazar-lezama, M. A., Ar, B., Jr, P., & Ma, S. (2003). Discrepancias entre los datos ofrecidos por la Secretaría de Salud y la Organización Mundial de la Salud sobre tuberculosis en México , 1981-1998. 45(2).

Gutiérrez, J. P., Sucilla-Pérez, H., Conde-González, C. J., Izazola, J. A., Romero-Martínez, M., & Hernández-ávila, M. (2014). Seroprevalencia de VIH en población mexicana de entre 15 y 49 años: Resultados de la Ensanut 2012. Salud Publica de Mexico, 56(4), 323–332. https://saludpublica.mx/index.php/spm/article/view/7352/10303

Lozano Asencio, R., Gómez Dantés, H., Pelcastre Villafuerte, B. E., Montañez, J. C., Campuzano, J. C., Franco, F., & González Vilchis, J. J. (2013). Carga de la Enfermedad en México 1990-2010: Nuevos resultados y desafíos Contenido. 122.

Lozano Asencio, R., Gómez-Dantés, H., Pelcastre, B., Ruelas, M., Montañez, J., Campuzano, J., Franco, F., & González, J. (2014). Carga de la enfermedad en México 1990-2010. Nuevos resultados y desafíos (Vol. 91). Instituto Nacional de Salud Pública, Secretaría de Salud, 2014.

Secretaría de Salud. (2015b). Prontuario de la Salud. Informe sobre la salud de los Mexicanos 2015.

Soto-Estrada, G., Moreno-Altamirano, L., Pahua Díaz, D., Soto-Estrada, G., Moreno-Altamirano, L., & Pahua Díaz, D. (2016). Panorama epidemiológico de México, principales causas de morbilidad y mortalidad. Revista de La Facultad de Medicina (México), 59(6), 8–22. http://www.scielo.org.mx/pdf/facmed/v59n6/2448-4865-facmed-59-06-8.pdf

In 2018 an estimated 7.52 million people were living with HIV in South Africa, with 18.99% of adults between the ages of 15 and 49 being infected, and 22.32% of women (StatsSA, 2018d).

In 2015, HIV/AIDS (1 365 000) and TB (849 000) were identified as the country’s two leading causes of YLLs to premature mortality (Groenewald et al., 2017). The table below ranks the top ten causes of YLLs, including both communicable and non-communicable diseases or conditions:

Table 5: Top ten causes of years of life lost (YLLs) for South Africa, 2015

Rank Cause of death Total (in thousands)
1 HIV/AIDS 1,365
2 TB 846
3 Lower respiratory infections 581
4 Cerebrovascular disease 442
5 Ischaemic heart disease 333
6 Diarrhoeal diseases 306
7 Diabetes mellitus 272
8 Interpersonal violence 266
9 Road injuries 228
10 Accidental gunshot 221

Source: Adapted from Groenewald et al., (2017), p.214

South Africa has seen an increase in the burden of HIV/AIDS and TB and other communicable diseases, perinatal, maternal and nutritional conditions (i.e., comm/mat/peri/nutr) from 37.8% in 1997 to 62.1% in 2006 (Groenewald et al., 2017). However, for 2015 there has been a decline (45.4%) in HIV/AIDS, TB and Comm/mat/peri/nutr and this is attributed largely to an increase in the burden of non-communicable diseases (i.e., from 29% in 2006 to 40% in 2015). Despite these gains, the increase of cases of multiple drug resistant, TB (MDR-TB) has placed strain on the health system to cope, with rates for TB alone increasing from 3.2% total DALYs in 2010 to 3.7% in 2015 (EMERALD, 2017).

References:

EMERALD. (2017). Moving towards Universal Health Coverage for Mental Disorders in South Africa.

Groenewald, P., Bradshaw, D., Day, C., & Laubscher, R. (2017). 14 Burden of disease. October 2012, 206–226. Availabe from: https://www.hst.org.za/publications/District%20Health%20Barometers/14%20(Section%20A)%20Burden%20of%20Disease.pdf

StatsSA. (2018d). Quarterly Labour Force Survey. Available from: https://www.statssa.gov.za/?p=11882

According to a map of violence produced by the Institute for Applied Economic Research (IPEA) and the Brazilian Forum of Public Security (FBSP), the homicide rate in Brazil was 30 times higher than that in Europe in 2016 (62,517 murders). Considering only the last decade, 553,000 Brazilians lost their lives through violent death (153 deaths per day). Such deaths represent almost 10% of all deaths in the country and affect mainly young men: 56.5% of the deaths of Brazilians aged between 15 and 19 are from violent deaths. Young victims represent 53.7% of the total number of deaths in the country (that is, 33,590 deaths), 94.6% of whom are males. The number of violent deaths also reflects great racial inequality: 71.5% of the people murdered are black or mixed race (Institute for Applied Economic Research, 2018).

Despite the alarming numbers at the national level, the disparity between the Federation Units draws attention. There was a reduction of homicide rates in the last decade in states such as São Paulo (-46.7%), Espírito Santo (-37.2%) and Rio de Janeiro (-23.4%), and a growth in others, such as Rio Grande do Norte (256.9%), Acre (93.2%), Rio Grande do Sul (58.8%) and Maranhão (121.0%). By 2016, the homicide rate per 100,000 inhabitants had reached almost 45 in the states of the Northeast and the North. In the Southeast, on the other hand, the value was in the 20’s, slightly below the 25 reached by the Southern states (Institute for Applied Economic Research, 2018).

Most homicides in Brazil are caused by fire guns: from 1980 to 2016, almost one million Brazilians lost their lives because of fire guns. A total of 71.1% of homicides was committed with the use of fire guns (a rate that grew for decades until 2003, the year of the creation of the disarmament statute) (Institute for Applied Economic Research, 2018). Currently the Brazilian new government is starting to allow more sectors of the population to have a fire gun.

References:

Institute for Applied Economic Research. (2018). Atlas da violência.

 

According to the Injury Survey 2008 conducted by the Centre for Health Protection, 6.2% of the Hong Kong population (415,200 persons) reported at least one unintentional injury that limited their normal activities in the past 12 months. The prevalence rate was similar for both genders and was found to be highest for those aged 75 and over (8.9%). The most common causes of injury episodes were falls (32.2%), sprain (25.8%) and sports (14.1%). Falls were found to be most common cause of injury episodes in females (40.8%) and among those aged 75 and over (74.3%) (Centre for Health Protection, 2010). The average cost of the total medical expenses incurred in each injury episode was HK$1,929 (median HK$300). The total cost incurred as a result of injuries was estimated at HK$838.6 million (95% CI HK$473.9 million to HK$1,203.4 million) in 2008. The cost was increasing with age and the highest in persons aged 65 and over (median for those aged 65 and over: HK$500). More than half of the injury episodes (51.3%) sustained by employed persons caused them to be absent from work temporarily for an average of 19.8 days (median 7.0 days). The mean and median of paid sick leaves taken were 13.5 and 5.0 days respectively. About 36.2% of the injury episodes caused the victims to change their normal daily activities and 1.4% caused them to develop residual disabilities for 6 months or longer. 13.0% of the injury episodes were reported to cause a decline in usual household income (Centre for Health Protection, 2010; 2015). The next round of such survey, namely Unintentional Injury Survey 2018, was conducted by the Centre for Health Protection and completed in 2019. Survey results are yet to be released.

In 2013, there were 1,860 registered deaths related to injuries, which made injuries the 5th leading cause of death in Hong Kong. Among the deaths related to injuries, the top 3 leading causes were intentional self-harm (53.7%), falls (12.5%) and transport accidents (7.5%). For the potential years of life lost at age 75, injuries ranked second among all causes of death (after cancer) and accounted for 15.7% of the total potential year lost  (Centre for Health Protection, 2015).

References:

Centre for Health Protection. (2010). Injury Survey 2008. Hong Kong Retrieved from https://www.chp.gov.hk/files/pdf/injury_survey_eng.pdf

Centre for Health Protection. (2015). Action Plan to Strengthen Prevention of Unintentional Injuries in Hong Kong. Hong Kong: Department of Health, HKSAR. Retrieved from https://www.change4health.gov.hk/filemanager/common/image/strategic_framework/injuries_action_plan/injuries_action_plan_e.pdf

As per the National Crime Records Bureau’s Accidental Deaths and Suicides report (National Crime Records Bureau [NCRB], 2020a) there were 3,74,397 accidental deaths and 1,53,052 deaths from suicide reported in 2020. The Crime in India report (NCRB, 2020b) states that there were 29,193 cases of violence related deaths (homicide) in 2020.

State wise variations in injuries:

As per GBD 2019 data, the prevalence of injuries of various types varies across the states. In 2019, the lowest prevalence rate was in Meghalaya, which had a prevalence rate of 16,545.72 cases per 100,000 people (15,672.39 – 17,471.5) and the highest was in Tamil Nadu with 29,116.16 prevalent cases per 100,000 people (27,570.69 – 30,738.74) (ICMR, PHFI and IHME, 2019). In terms of burden, the number of deaths and DALYs are described. The least number of deaths was in Meghalaya with 30.62 deaths per 100,000 people (22.93 – 43.12) and the highest number of deaths was in Tamil Nadu with 99.41 deaths per 100,000 people (70.01-121.01) (ICMR, PHFI and IHME, 2019). With respect to DALYs, Meghalaya had the lowest number of DALYs with 2,057.27 per 100,000 people (1664.38 – 2618.95) and Tamil Nadu had the highest number of DALYs with 5,055.08 per 100,000 people (4,054.81 – 5,944.4) (ICMR, PHFI and IHME, 2019).

References:

Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation (ICMR, PHFI and IHME). (2019). GBD India Compare Data Visualization. Available from: https://vizhub.healthdata.org/gbd-compare/

National Crime Records Bureau. (2020a). Accidental Deaths and Suicides in India.

Due to Indonesia’s location on the Pacific Ring of Fire, the country experiences natural disasters in relatively high frequency. These include tsunamis, earthquakes, and volcanic eruptions (Agustina et al., 2019, p.77; International Organization for Migration, 2018). In 2004, natural disasters including ‘294 floods, 54 landslides, 11 earthquakes, two tsunamis, and five volcanic eruptions’ were accountable of 10.2 per cent of total mortality and the leading cause of injury and disability. In 2018, two earthquakes led to more than 2,000 deaths over 1,000 missing people, more than 4,000 injured people, over 223,000 displaced people as well as the destruction or damage of approximately 50 health centres. The implications of natural disasters on health infrastructure is substantial. More than 4,500 health facilities were damaged between 1990 and 2015 (Agustina et al., 2019, p.80). In addition, Indonesia has experienced several acts of terrorism over the last two decades (Agustina et al., 2019, p.78). Finally, road injuries accounted as the main cause of death among the populated aged 10 to 25 years (Agustina et al., 2019, p.80).

References:

Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Suparmi, Achadi, E. L., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, A. H., Thabrany, H., Susiloretni, K. A., Soewondo, P., Ahmad, S. A., Kurniawan, M., Hidayat, B., Pardede, D., Mundiharno, … Khusun, H. (2019). Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet, 393(10166), 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7

International Organization for Migration. (2018). Indonesia 2018. Humanitarian Compendium. https://humanitariancompendium.iom.int/appeals/indonesia-2018

In Kenya, the leading causes of injury include assault (42%), road traffic accidents (28%), unspecified soft tissue injury (11%), and less than 10% for cut-wounds and dog-bites, falls and burn and poisoning each (MoH-Kenya et al., 2015). According to the Kenya Health and Demographic survey 2008/9, 39% and 20.6% of women have experienced physical and sexual violence, respectively (Kenya National Bureau of Statistics (KNBS); ORC Macro, 2010). There has been an increase in transport injuries with pedestrians comprising 43% of fatalities (Kenya National Bureau of Statistics (KNBS); ORC Macro, 2010). Other vulnerable road users include motorcyclists and cyclists. More than 75% of deaths on the roads are males and about 50% of the total deaths are children or young adults. The major killer has been consistently identified as speed and lack of use of safety equipment such as helmets, seat-belts and child-restraints (World Health Organization (WHO), 2010).

References:

Kenya National Bureau of Statistics (KNBS); ORC Macro. (2010). Kenya Demographic and Health Survey 2008-09. Health (San Francisco), 1–314. https://dhsprogram.com/pubs/pdf/fr229/fr229.pdf

MoH-Kenya, KNBS, & WHO. (2015). Kenya STEPwise Survey for Non Communicable Diseases Risk Factors 2015 Report. MoH-Kenya. https://www.health.go.ke/wp-content/uploads/2016/04/Executive-summary-6-2.pdf

World Health Organization (WHO). (2010). Road Safety in Ten Countries: Kenya. Nairobi, Kenya. https://www.who.int/violence_injury_prevention/road_traffic/countrywork/rs10_kenya_en.pdf

Accidents and violence

In 2013, there was a reported rate of 13 deaths due to traffic accidents and 18.3 homicide deaths, both per 100 inhabitants. Types of vehicles studied in traffic accidents are bicycles, motorcycles, and motor vehicles. Also included are hit-and-run vehicles, which account for 41% of the load associated with all traffic accidents.

The risk of premature loss of life from intentional and accidental injury is 92% (almost double) higher for people living in the north than those living in the south (Soto-Estrada et al., 2016).

According to data reported by ENSANUT 2012, from a survey among adolescents (10-19 years) and young adults (20-29 years), 4% reported health damages or health issues due to interpersonal violence. This would represent approximately 1,712,485 cases at national level. The prevalence of interpersonal violence is higher among men (5.0%) than women (3.3%) and the most vulnerable age group is that of men aged 20 to 29 years. For women, the household is still the space where one of the highest proportions of violence is suffered, with one in four women (24.5%) reporting violent incidents in their own home (Valdez-Santiago et al., 2013).

Table 8. Prevalence of young people who suffered damage to their health due to interpersonal violence

Age group Men %

(95% CI)

Woman %

(95% CI)

Total %

(95% CI)

Adolescents

(10-19 years)

4.4 (3.8-5.1) 3.4 (2.8-4.0) 3.9 (3.5-4.3)
Young adults (20-29 years) 5.7 (4.4-7.2) 3.1 (2.4-4.2) 4.4 (3.6-5.3)

Source: Own estimates from ENSANUT 2012 data

Disability and Disability-free life expectancy

Indicators of healthy life expectancy are useful to monitor effectively whether the years of life gained with the increase in life expectancy are spent in a good state of health or not. In Mexico there are a few sources of data in older adults: the 10/66 study, the Mexican Health, the Aging Survey (MHAS), and SAGE.

The healthy life expectancy is the estimate expected years of life in good health for persons at a given age. In 2010-2015 life expectancy was 74 years for men, but healthy life expectancy was 65 years, while for women was 78.9 and 69 respectively, which means that there are almost 10 years with disease. This may be related to two factors: the decrease in premature mortality, which has an important effect on improving life expectancy at birth, and the increase in people with disabling sequelae. In other words, there are fewer premature deaths but more disability.

The 10/66 study is a large cohort study, examining health, social, and biological characteristics of older adults living in eight countries (China, Cuba, Dominical Republic, India, Mexico, Peru, Puerto Rico, and Venezuela). In this study, disability was assessed using the more than 15 disability days in the past (assessed through WHODAS 2.0 (WHO, 2010)) month criteria, and dependence was assessed by needing some or much care (Prina et al., 2019). Table 9 reports the prevalence of disability and dependence in the total sample (n=2002), both increased with older age, and women had higher prevalence in the oldest age group.

 Table 9. Prevalence of disability and dependence, stratified by age group and sex.

  Disability Dependence
Age group Male Female Male Female
65-69 8.1 7.1 3.7 5.0
70-74 5.9 5.9 7.7 6.9
75-79 9.8 15.2 8.4 11.2
80-84 14.9 15.9 11.6 14.9
85+ 17.2 20.4 20.0 31.5

Source: (Prina et al., 2019)

Table 10 reports estimated disability-free life expectancy, which gradually declines with increasing age. Women tend to spend a longer period of time with disability and the proportion of remaining life spent disability-free is lower than among men. In the same way, dependence-free life expectancy, which is fundamental to achieve active life expectancy, also declined with increasing age, women had longer periods of dependence.

Table 10. Disability free life expectancy and proportion of remaining life spent in disability and dependence free, by age group and sex

  Disability free life expectancy Dependence-free life expectancy
Age Male % Female % Male % Female %
65 15.4 89.9 16.5 88.1 15.6 91.0 16.4 87.5
70 12.3 89.1 13.1 86.4 12.3 89.0 12.8 84.9
75 9.3 86.6 9.8 83.0 9.4 87.3 9.6 81.2
80 6.8 84.0 7.3 81.8 6.8 84.3 6.8 76.4
85 5.0 83.1 5.4 79.8 4.9 80.3 4.6 68.6

Source: (Prina et al., 2019)

While in the 10/66 study, Mexico reports the highest disability free life expectancy at age 65 (compared with China, Cuba, the Dominican Republic, India, Peru, Puerto Rico, and Venezuela).

In 2018, Payne reported estimations of the rates of transitions between life without disability, life with disability, and death with data from longitudinal surveys of older adult populations in Costa Rica, Mexico, Puerto Rico, and the United States populations, and he reported that the growing older adult populations in Costa Rica, Puerto Rico, and Mexico are not experiencing a substantially higher burden of disability than the disability experienced by people of the same age in the United States (Payne, 2018).

For all these reasons, Mexico must direct its efforts to address the problems associated with the gap that still exists in relation to infectious diseases, the increase in chronic degenerative diseases and those related to injuries and violence, as well as disability and dependence that arise from all of them.

References:

Payne, C. F. (2018). Aging in the Americas: Disability-free Life Expectancy among Adults Aged 65 and Older in the United States, Costa Rica, Mexico, and Puerto Rico. Journals of Gerontology – Series B Psychological Sciences and Social Sciences, 73(2), 337–348. https://doi.org/10.1093/geronb/gbv076

Prina, A., Wu, Y., Kralj, C., Acosta, D., Acosta, I., Guerra, M., Huang, Y., Amuthavalli, T., Jimenez-Velazquez, I., Liu, Z., Llibre Rodriguez, J., Salas, A., Sosa, A., & Prince, M. (2019). Dependence- and Disability-Free Life Expectancy Across Eight Low- and Middle-Income Countries: A 10/66 Study. Journal of Aging and Health. https://doi.org/10.1093/geronb/gbv076

Soto-Estrada, G., Moreno-Altamirano, L., Pahua Díaz, D., Soto-Estrada, G., Moreno-Altamirano, L., & Pahua Díaz, D. (2016). Panorama epidemiológico de México, principales causas de morbilidad y mortalidad. Revista de La Facultad de Medicina (México), 59(6), 8–22. http://www.scielo.org.mx/pdf/facmed/v59n6/2448-4865-facmed-59-06-8.pdf

Valdez-Santiago, R., Hidalgo-Solórzano, E., Mojarro-íñiguez, M., Rivera-Rivera, L., & Ramos-Lira, L. (2013). Violencia interpersonal en jóvenes mexicanos y oportunidades de prevención. Salud Publica de Mexico, 55(SUPPL.2), 259–266. http://www.scielo.org.mx/pdf/spm/v55s2/v55s2a24.pdf

WHO. (2010). WHODAS 2.0 12-item version, interviewer-administered.

South Africa’s injury burden, particularly homicide, is reportedly 6 times higher than the global average (Jabar & Matzopoulos, 2017). Interpersonal violence ranked 8th on the top ten causes of premature death in South Africa in 2015, followed by road injuries and accidental gunshots (Groenewald et al., 2017). Injury related deaths moderately increased from 11% in 2006 to 14.6% in 2015 (Groenewald et al., 2017).

References:

Groenewald, P., Bradshaw, D., Day, C., & Laubscher, R. (2017). 14 Burden of disease. October 2012, 206–226. Availabe from: https://www.hst.org.za/publications/District%20Health%20Barometers/14%20(Section%20A)%20Burden%20of%20Disease.pdf

Jabar, A., & Matzopoulos, R. (2017). Violence and injury observatories Reducing the burden of injury in high-risk communities. SA Crime Quarterly, 59(59), 47–57. https://doi.org/10.17159/2413-3108/2017/v0n59a1547