GBD PROFILE: SWAZILAND

1 GLOBAL BURDEN OF DISEASES, INJURIES, AND RISK FACTORS STUDY 2010 The Global Burden of Disease Study 2010 (GBD 2010) is a collaborative project of nearly 500 researchers in 50 countries led by theInstitute for Health Metrics and Evaluation (IHME) at the University of Washington. It is the largest systematic scientific effort in history toquantify levels and trends of health loss due to diseases, injuries, and risk factors. GBD serves as a global public good to informevidence-based policymaking and health systems OVERVIEWlIn terms of the number of years of life lost (YLLs) due topremature death in SWAZILAND , HIV/AIDS, diarrheal diseases, andlower respiratory infections were the highest ranking causes the 25 most important causes of burden, as measured bydisability-adjusted life years (DALYs), lower respiratoryinfections showed the largest decrease, falling by 9% from 1990to leading risk factor in SWAZILAND is suboptimal MORTALITY RATElThis chart shows the change in mortality rate at every agerange.

2 The points above 0 on the chart indicate positive declinesin the all-cause mortality rate, while points below 0 indicate anincrease in mortality rate between 1990 and greatest reductions in all-cause mortality rate wereexperienced by females aged 1-4 years (8%). Females aged25-29 years saw the largest increase in mortality rate (585%).Percent decline in age-specific mortality rate by sex from 1990-2010 in SwazilandCAUSES OF PREMATURE DEATHY ears of life lost (YLLs) quantify premature mortality by weighting younger deaths more than older chart shows thechange in the top 25causes of YLLs due topremature mortalityfrom 1990 to lines indicate acause has moved up inrank or stayed thesame. Broken linesindicate a cause hasmoved down in causes are colorcoded by blue fornon-communicablediseases, green forinjuries, and red forcommunicable,maternal, neonatal, andnutritional causes PROFILE: | GBD | page 1 600 3000 Percent decline in age specific mortality rate 1 45 910 1415 1920 2425 2930 3435 3940 4445 4950 5455 5960 6465 6970 7475 7980+Age groupMalesFemales# YLLs in thousands(% of total)Rank and disorder 1990 Rank and disorder 2010# YLLs in thousands(% of total)% change3 ( )22 COPD3 ( )25 Cardiomyopathy10 ( )10 Congenital anomalies4 ( )17 Diabetes69 ( )1 Diarrheal diseases4 ( )21 Fire20 ( )3 HIV/AIDS3 ( )24 Hypertensive heart disease11 ( )6 Interpersonal violence5 ( )13 Ischemic heart disease54 ( )2 Lower respiratory infections15 ( )8 Malaria5 ( )15 Maternal disorders4 ( )20 Measles43 Measles6 ( )12 Mechanical forces5 ( )14 Meningitis10 ( )9 Neonatal encephalopathy5 ( )16 Neonatal sepsis17 ( )4 Preterm birth complications4 ( )18 Protein-energy malnutrition35 Protein-energy malnutrition3 ( )23 Road injury9 ( )11 Stroke11 ( )7 Syphilis30 Syphilis15 ( )5 Tuberculosis5 ( )19 Typhoid fevers26 Typhoid fevers7 ( )17 COPD1285 ( )22 Cardiomyopathy845 ( )

3 23 Chronic kidney disease23133 Chronic kidney disease8 ( )16 Cirrhosis24429 Cirrhosis12 ( )10 Congenital anomalies2311 ( )9 Diabetes16166 ( )2 Diarrheal diseases-55 ( )24 Epilepsy8527 Epilepsy6 ( )20 Fire70341 ( )1 HIV/AIDS1,6256 ( )19 Hypertensive heart disease11635 ( )4 Interpersonal violence15210 ( )12 Ischemic heart disease9950 ( )3 Lower respiratory infections-916 ( )13 Malaria09 ( )15 Maternal disorders10614 ( )8 Mechanical forces1567 ( )18 Meningitis3410 ( )14 Neonatal encephalopathy-15 ( )25 Neonatal sepsis-417 ( )7 Preterm birth complications-411 ( )11 Road injury3036 ( )21 Self-harm35035 Self-harm17 ( )6 Stroke9427 ( )5 Tuberculosis79 Ranks for top 25 causes of YLLs 1990-2010, SwazilandCCCommuni cabl e, maternal , neonatal , and nutri ti onalCCNon-communi cabl eCCInj uri es05,00010,00015,00020,000 YLDs0 6 days7 27 days28 364 days1 4 years5 9 years10 14 years15 19 years20 24 years25 29 years30 34 years35 39 years40 44 years45 49 years50 54 years55 59 years60 64 years65 69 years70 74 years75 79 years80+ yearsWar & disasterIntentional injuriesUnintentional injuriesTransport injuriesOther non communicableMusculoskeletal disordersDiabetes/urogen/blood/endoMenta l & behavioral disordersNeurological disordersDigestive diseasesCirrhosisChronic respiratory diseasesCardio & circulatory diseasesCancerOther communicableNutritional deficienciesNeonatal disordersMaternal disordersNTD & malariaDiarrhea/LRI/other infectiousHIV/AIDS & tuberculosisHIV/AIDSDIARRHEAL DISEASESLOWER RESPIRATORY INFECTIONSINTERPERSONAL VIOLENCETUBERCULOSISSTROKEPRETERM BIRTH COMPLICATIONSCOPDMECHANICAL FORCESDIABETESROAD INJURYCONGENITAL ANOMALIESMAJOR DEPRESSIVE DISORDERASTHMAISCHEMIC HEART DISEASENEONATAL ENCEPHALOPATHYMALARIAMATERNAL DISORDERSIRON-DEFICIENCY ANEMIACIRRHOSISMENINGITISEPILEPSYLOW BACK

4 PAINHYPERTENSIVE HEART DISEASEFIRE12 34 5 678 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25-200-150-100-50050100150200 | GBD | page 2 Percent change 1990-2010 YEARS LIVED WITH DISABILITY (YLDs)Years lived with disability (YLDs) are estimated by weighting the prevalence of different conditions based on severity. The top five leadingcauses of YLDs in SWAZILAND are HIV/AIDS, major depressive disorder, asthma, iron-deficiency anemia, and low back size of the coloredportion in each barrepresents the number ofYLDs attributable to eachcause. The height of each barshows which age groups hadthe most YLDs in 2010. Thecauses are aggregated. Forexample, musculoskeletaldisorders include low backpain and neck YLDs by cause and age 2010 DISABILITY-ADJUSTED LIFE YEARS (DALYs)Disability-adjusted life years (DALYs) quantify both premature mortality (YLLs) and disability (YLDs) within a population. In SWAZILAND , thetop three causes of DALYs in 2010 were HIV/AIDS, diarrheal diseases, and lower respiratory infections.

5 The causes that were in the 10leading causes of DALYs in 2010 and not 1990 were cerebrovascular disease, chronic obstructive pulmonary disease, exposure tomechanical forces, and diabetes top 25 causes of DALY sare ranked from left to rightin order of the number ofDALYs they contributed in2010. Bars going up show thepercent by which DALYs haveincreased since 1990. Barsgoing down show the percentby which DALYs havedecreased. Globally,non-communicable diseasesand injuries are generally onthe rise, while communicable,maternal, neonatal, andnutritional causes of DALY sare generally on the causes of DALYs and percent change 1990 to 2010 for | GBD | page 3 1012345% DALYs attributable to risk factorsVitamin A deficiencyUnimproved waterSanitationOccupational risksPhysical inactivityIron deficiencyChildhood underweightHigh fasting plasma glucoseSmokingHigh body mass indexDietary risksHousehold air pollutionHigh blood pressureAlcohol useSuboptimal breastfeedingWar & disasterIntentional injuriesUnintentional injuriesTransport injuriesOther non communicableMusculoskeletal disordersDiabetes/urogen/blood/endoMenta l & behavioral disordersNeurological disordersDigestive diseasesCirrhosisChronic respiratory diseasesCardio & circulatory diseasesCancerOther communicableNutritional deficienciesNeonatal disordersMaternal disordersNTD & malariaDiarrhea/LRI/other infectiousHIV/AIDS & tuberculosisAge-standardized death rates, YLL rates, YLD rates.

6 And life expectancy at birth and health-adjusted life expectancy at birth for 1990 and 2010, both sexes combinedCountryAge-standardized death rate(per 100,000)Age-standardized YLL rate(per 100,000)Age-standardized YLD rate(per 100,000)Life expectancy at birthHealth-adjusted lifeexpectancy at birth19902010199020101990201019902010199 02010 Rate Rank Rate Rank Rate Rank Rate Rank Rate Rank Rate Rank LE Rank LE Rank HALE Rank HALE RankEgypt1,065 984410 35,058 9 22,148 8 12,868 7 11,979 10 Guatemala1,061 87878 36,242 11 24,337 9 12,800 6 11,705 24,125 5 17,197 5 11,778 2 11,588 21,127 3 14,448 3 12,452 5 12,527 11 ,507 14 1,291 14 41,590 13 34,595 13 13,346 11 12,65712 34,466 8 11,060 1 13,138 9 11,281 ,995 15 1,257 13 82,686 15 44,380 14 15,039 15 13,712 13 14 15 ,239 12 2,186 15 39,973 12 80,065 15 13,819 14 15,781 15 12 155312 15 Fiji1,184 10 1,068 11 32,309 7 28,494 11 13,180 10 12.

7 351 24,291 6 19,529 7 11,437 1 11,256 21,457 4 12,094 2 13,133 8 12,031 ,284 138229 49,438 14 26,020 10 13,781 13 12,113 105014 18,868 1 18,059 6 12,337 4 12,006 Lanka71226204 20,846 2 14,898 4 12,231 3 11,452 ,199 11 1,124 12 35,469 10 31,305 12 13,663 12 14,024 14 105513 RISK FACTORSO verall, the three risk factors that account for the most disease burden in SWAZILAND are suboptimal breastfeeding, alcohol use, and highblood pressure. The leading risk factors for children under 5 and adults aged 15-49 years were suboptimal breastfeeding and alcohol use,respectively, in graph shows the top 15risk factors for colored portion of eachbar represents the specificdiseases attributable to thatrisk factor while bar sizerepresents the percentage ofDALYs linked to specific of disease attributable to 15 leading risk factors in 2010, expressed as a percentage of SWAZILAND DALYsCOUNTRY BENCHMARKING OF BURDEN OF DISEASEU nderstanding the relative performance of SWAZILAND against other comparator countries provides key insight into public healthsuccesses and areas where SWAZILAND might be falling behind.

8 The table identifies SWAZILAND 's rank across 14 other comparator countries,selected and ordered by income per capita, for five metrics of interest, with 1 indicating the best rank and 15 indicating the worst rates are used to make meaningful comparisons across time by adjusting for changes in population size and expectancy incorporates mortality, and health-adjusted life expectancy further incorporates years lived in less than ideal 2010, SWAZILAND ranked 15th for age-standardized death rate and 15th for age-standardized YLL | GBD | page 4 Ranking of leading age-standardized rates of disability-adjusted life years (DALYs) relative to comparator countries in 1990 CountryEgypt12 12 4 12 3 1 1 3 10 6 11 9 5 11 9 3 4 9 8 9 14 6 10 2 9 Guatemala14 14 10 13 10 15 3 8 4 10 1 13 3 5 12 10 3 3 4 10 11 11 13 13 7 Armenia7 6 9 5 2 8 12 4 9 5 5 2 2 8 3 12 7 12 10 2 8 1 3 4 2 Jordan1 2 5 9 1 5 2 2 13 1 7 3 8 9 13 6 1 10 11 8 13 8 2 3 8 Vanuatu9 10 1 4 12 9 4 11 2 12 13 6 15 13 1 7 14 8 14 11 9 10 12 12 4 Maldives6 9 11 6 11 11 13 6 15 2 4 12 10 10 14 2 13 1 6 13 5 4 11 11 15 Angola15 15 14 11 15 6 8 15 12 15 10 14 12 14 10 15 15 6 7 15 6 12 15 14 11 Swaziland11 11 15 7 14 14 10 12 7 14 9 8 14 12 6

9 13 10 4 12 12 2 9 5 15 14 Fiji4 7 8 10 9 4 7 10 3 7 15 1 13 7 2 11 12 13 15 4 7 7 7 10 3 Georgia3 8 7 3 6 7 15 5 5 4 12 5 1 2 5 8 8 14 1 1 1 5 1 5 1 Syria2 3 6 2 5 2 6 9 14 8 8 7 6 6 15 1 2 15 3 5 12 3 6 1 10 Bhutan13 13 3 15 13 3 14 14 11 13 2 10 11 15 4 14 11 2 5 14 15 15 14 9 13 Paraguay8 4 12 8 4 10 9 13 6 3 6 4 4 1 11 5 6 5 9 7 10 13 4 7 5 Sri Lanka5 1 2 1 8 13 5 1 1 9 3 11 7 4 7 4 9 7 2 3 3 2 9 6 12 Guyana10 5 13 14 7 12 11 7 8 11 14 15 9 3 8 9 5 11 13 6 4 14 8 8 6 Ranking of leading age-standardized rates of disability-adjusted life years (DALYs)

10 Relative to comparator countries in 2010 CountryEgypt4 9 8 2 3 11 7 10 3 2 10 14 9 4 12 1 2 6 11 15 4 3 12 13 1 Guatemala12 13 14 15 9 1 10 2 5 10 1 2 10 3 2 4 10 11 14 14 7 13 11 2 6 Armenia9 5 4 4 5 6 2 8 14 8 9 9 7 1 11 10 4 3 2 7 3 6 6 7 2 Jordan3 4 3 9 1 5 6 5 6 11 8 15 15 8 7 2 3 7 4 3 1 2 14 12 8 Vanuatu1 12 12 10 13 15 9 12 8 14 11 5 3 15 9 8 13 13 3 11 14 12 10 6 12 Maldives5 2 2 7 4 2 4 6 2 1 2 3 8 7 1 11 7 4 12 1 5 5 5 1 5 Angola14 14 13 8 14 9 12 13 12 5 15 13 6 11 6 9 15 15 13 10 15 14 7 10 13 Swaziland15 15 15 14 15 13 11 14 15 12 13 10 11 14 4 12 14 14 8 13 13 15 2 15 14 Fiji7 8 10 6 7 10 13 7 13 15 4 7 1 13 15 7 8 8 1 5 12 11 9 3 11 Georgia8 1 6 5 10 12 5 9 9 3 6 4 5 2 14 15 6 1 9 8 6 4 1 11 9 Syria2 3 1 1 2 7 3 4 1 4 3 8 14 5 13 5 1 2 6 2 2 1 13 5 4 Bhutan10 10 11 3 12 3 15 15 11 6 7 11 2 9 3 14 12 12 7 9 10 7 15 8 15 Paraguay11 7 7 12 8 8 8 3 4 9 12 6 13 6 5 6 5 9 5 4 8 8 8 9 3 Sri Lanka6 6 5 11 6 4 1 11 10 7 5 1 4 12 8 3 9 5 10 6 11 10 3 4 7 Guyana13 11 9 13 11 14 14 1 7 13 14 12 12 10 10 13 11 10 15 12 9 9 4 14 10 Ranking Legend1 - 34 - 78 - 1112 - 15 Diarrheal diseasesLower respiratory