Matching action to need: an analysis of Global Burden of Disease 2017 and population health data to focus adolescent health policy and actions in Myanmar

Abstract

Background: Myanmar is a country undergoing rapid transitions in health. Its national strategic policy for young people's health is being revised but there is a paucity of population data to inform local priorities and needs. Objective: In this paper we describe a comprehensive profile of adolescent health in Myanmar to focus policy and health actions. Methods: We used available primary data, and modelled estimates from the GBD 2017, to describe health outcomes (mortality and morbidity), health risks and determinants for adolescents in Myanmar between 1990-2017. A governance group of key stakeholders guided the framing of the study, interpretation of findings, and recommendations. Results: Overall health has improved for adolescents in Myanmar since 1990, however adolescent mortality remains high, particularly so for older adolescent males; all-cause mortality rate for 10-24 years was 70 per 100,000 for females and 149 per 100,000 for males (16,095 adolescent deaths in 2017). Overall, the dominant health problems were injuries for males and non-communicable disease for females in a context of ongoing burden of communicable and nutritional diseases for both sexes, and reproductive health needs for females. Health risks relating to undernutrition (thinness and anaemia) remain prevalent, with other health risks (overweight, binge alcohol use, and substance use) relatively low by global and regional standards but increasing. Gains have been made in social determinants such as adolescent fertility and modern contraception use; however, advances have been more limited in secondary education completion and engagement in employment and post education training. Conclusions: These results highlight the need to focus current efforts on addressing disease and mortality experienced by adolescents in Myanmar, with a specific focus on injury, mental health and non-communicable disease.

Keywords: Adolescent health; Myanmar; morbidity; mortality; policy.

Figure 1.

Observed Years of Life Lost and Years Lost to Disability (rate per 100,000) for 10–24-year-olds in Myanmar across 9 categories, by age and sex. Data are from 1990 to 2017 and show overall trends using 5-year slices (the 2008 disaster is not shown). Dotted line indicates all-cause expected YLLs and YLDs. GBD (2017)

Figure 2.

Causes of Disability Adjusted Life Years in 10–24-year-olds by sex in 2017. Each coloured box represents a disaggregated cause, the size of the box is proportional to the DALY rate per 100,000 for that cause. GBD (2017)

Figure 3.

Selected health risks. (a) Prevalence of overweight/obesity among 10–19-year-olds (%) (BMI >+1 SD above the median), WHO (2016). (b) Prevalence of thinness among 10–19-year-olds (%) (BMI <-2 SD below the median), WHO (2016). (c) Prevalence of anaemia among 10–24-year-olds (%), GBD (2017). (d) Comprehensive knowledge of HIV, 15–24-year-olds. DHS (2016). (e) Prevalence of an episode of binge drinking (alcohol >48 g females, >60 g males), 10–24-year-olds, in the past 12mths (%), GBD (2016). (f) Prevalence of tobacco smoking among 10–24-year-olds (%), GBD (2017). (g) DALYs (per 100,000) due to drug use in 10–24-year-olds. GBD (2017)

Figure 4.

Selected social determinants of health. (a) Mean years of education in 10–24-year-olds, GBD 2017. (b) Educational attainment, 20–24-year-olds (%), DHS 2016. (c) Literacy, 15–24-year-olds (%), UNESCO 2019. (d) Not in education, employment or training, 15–24-years (%), ILO 2019. (e) 20–24-year-olds married before 15 years or 18 years (%), DHS 2016. (f) Live births per 1,000 females, 10–24-years, GBD 2017 & DHS 2016. (g) Demand for modern contraception satisfied, females 15–24-years (%), GBD 2016