Abstract

PIP: In a large data-synthesis project, the Global Burden of Disease (GBD) Study has provided summaries of fatal and nonfatal diseases worldwide. However, the GBD investigators' estimates for sub-Saharan Africa do not help to define the burden of disease for the region and provide no real contrast with developed countries. It is even doubtful that the study results could serve as the basis for public health policy. Throughout sub-Saharan Africa, except in South Africa, births and deaths are not necessarily recorded and a formal system of medical care is unavailable to most of the population. Even population denominators cannot be specified and basic health indices such as death rates or causes of death are not known. The statistics which appear in national ministries and international agencies are merely guesstimates formed from models, extrapolations, and common sense, constrained largely by the need to avoid deviating too far from previous estimates. In the absence of vital records, local community studies are often used to obtain information about population dynamics, but it is more difficult to assess the status of adult health. The GBD study is being heralded as the reference standard. However, if the GBD data are wrong, the consequences will likely by most damaging to the populations which were underrepresented in the fact-gathering process. The GBD projections from sub-Saharan Africa should not be used until data are available which correspond with modelled estimates.