Incorporating Deaths Near the Time of Birth into Estimates of the Global Burden of Disease

Excerpt

The purpose of this chapter is to explore the sensitivity of results within the Global Burden of Disease (GBD) framework to alternative approaches to encompassing the large number of deaths that occur near the time of birth, namely almost 4 million neonatal deaths and 3.3 million stillbirths. The sensitivity analyses in this chapter thus complement those of chapter 5, which explore the effect of variations in discount rates, age weights, and disability weights. Chapter 3 in this volume describes the GBD framework and provides estimates of deaths and DALYs by cause for 2001 using the World Bank regional grouping of countries. (Map 1, inside the front cover of this volume, shows the World Bank regional groupings used throughout this book.) This chapter uses the same framework and numbers to the extent possible, but with the following exceptions:

1. We divide the newborn through age 4 category into neonatal (newborn through 27 days), postneonatal (28 days to less than 1 year), and child (1 through 4 years).

2. We aggregate the 136 causes noted in chapter 3 into 35 causes.

3. We allocate the substantial number of neonatal deaths attributed to pneumonia or sepsis to the chapter 3 category of respiratory infections.

4. We explore the sensitivity of the results in chapter 3 to adding stillbirths as a new age category.

5. We explore the sensitivity of the results to alternative ways of assigning YLL to deaths under the age of five.

The first section of this chapter deals with mortality: all-cause and cause specific. It uses the results presented in chapter 3, but adds to them estimates of the level of stillbirths and of the level and causes of neonatal mortality. The second section deals with estimation of the burden of disease in DALYs. The inclusion of stillbirths in the analysis highlights the more general issue of how to deal appropriately with deaths at different ages in constructing a measure of YLL.