GBD PROFILE: ZAMBIA

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 ZAMBIA , HIV/AIDS, malaria, and lowerrespiratory infections were the highest ranking causes in the 25 most important causes of burden, as measured bydisability-adjusted life years (DALYs), diarrheal diseases showedthe largest decrease, falling by 32% from 1990 to leading risk factor in ZAMBIA is childhood 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 (55%). Males aged 60-64years saw the largest increase in mortality rate (5%).Percent decline in age-specific mortality rate by sex from 1990-2010 in ZambiaCAUSES 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.

3 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 1015304560 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)% change46 ( )23 Cirrhosis89 ( )14 Congenital anomalies756 ( )4 Diarrheal diseases65 ( )18 Drowning50 ( )22 Epilepsy56 ( )20 Falls99 ( )13 Fire1,067 ( )1 HIV/AIDS38 ( )24 Interpersonal violence54 ( )21 Ischemic heart disease818 ( )3 Lower respiratory infections1,097 ( )2 Malaria69 ( )16 Maternal disorders73 ( )17 Measles26 Measles351 ( )6 Meningitis177 ( )

4 8 Neonatal encephalopathy121 ( )12 Neonatal sepsis64 ( )19 Poisonings134 ( )10 Preterm birth complications583 ( )5 Protein-energy malnutrition129 ( )11 Road injury33 ( )25 Self-harm79 ( )15 Stroke177 ( )9 Syphilis184 ( )7 Tuberculosis68 ( )22 Cirrhosis4884 ( )17 Congenital anomalies-748 ( )25 Diabetes7926 Diabetes500 ( )4 Diarrheal diseases-3477 ( )18 Drowning2075 ( )19 Epilepsy5098 ( )15 Falls69105 ( )14 Fire71,745 ( )1 HIV/AIDS6475 ( )20 Interpersonal violence9881 ( )16 Ischemic heart disease50688 ( )3 Lower respiratory infections-161,155 ( )2 Malaria576 ( )21 Maternal disorders-5403 ( )6 Meningitis13279 ( )7 Neonatal encephalopathy55210 ( )10 Neonatal sepsis7760 ( )23 Poisonings-7194 ( )11 Preterm birth complications46474 ( )5 Protein-energy malnutrition-21146 ( )12 Road injury1454 ( )24 Self-harm64128 ( )13 Stroke60269 ( )8 Syphilis52247 ( )

5 9 Tuberculosis33 Ranks for top 25 causes of YLLs 1990-2010, ZambiaCCCommuni cabl e, maternal , neonatal , and nutri ti onalCCNon-communi cabl eCCInj uri es050,000100,000150,000 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 &

6 TuberculosisHIV/AIDSMALARIALOWER RESPIRATORY INFECTIONSDIARRHEAL DISEASESPROTEIN-ENERGY MALNUTRITIONMENINGITISNEONATAL ENCEPHALOPATHYTUBERCULOSISSYPHILISPRETER M BIRTH COMPLICATIONSNEONATAL SEPSISROAD INJURYIRON-DEFICIENCY ANEMIASTROKEMAJOR DEPRESSIVE DISORDEREPILEPSYFIREFALLSCONGENITAL ANOMALIESISCHEMIC HEART DISEASEMATERNAL DISORDERSLOW BACK PAINDROWNINGINTERPERSONAL VIOLENCECOPD1 23 4 56 7 8 9 10 11 12 13 14 15 16 17 181920 21 22 23 24 25-100-80-60-40-20020406080100 | 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.

7 The top five leadingcauses of YLDs in ZAMBIA are iron-deficiency anemia, major depressive disorder, HIV/AIDS, low back pain, and chronic obstructivepulmonary 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 ZAMBIA , the topthree causes of DALYs in 2010 were HIV/AIDS, malaria, and lower respiratory infections.

8 The only cause to appear in the 10 leading causesof DALYs in 2010 and not 1990 was preterm birth 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 3012345678% DALYs attributable to risk factorsHigh body mass indexUnimproved waterZinc deficiencySanitationHigh fasting plasma glucoseVitamin A deficiencyOccupational risksAlcohol useSmokingIron deficiencyDietary risksHigh blood pressureSuboptimal breastfeedingHousehold air pollutionChildhood underweightWar & disasterIntentional injuriesUnintentional injuriesTransport injuriesOther non communicableMusculoskeletal disordersDiabetes/urogen/blood/endoMenta l & behavioral disordersNeurological disordersDigestive

9 DiseasesCirrhosisChronic respiratory diseasesCardio & circulatory diseasesCancerOther communicableNutritional deficienciesNeonatal disordersMaternal disordersNTD & malariaDiarrhea/LRI/other infectiousHIV/AIDS & tuberculosisAge-standardized death rates, YLL rates, YLD rates, 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 RankKenya1,092 21,013 5 39,731 2 36,153 6 13,184 3 12,884 ,22348724 45,244 4 26,770 4 14,698 8 13,715 ,508 11 1,389 11 67,610 12 58,839 12 15,080 13 14,364 13 ,3127 1,080 7 58,713 10 38,726 7 15,237 14 13,830 ,185 3 1,0306 45,628 5 35,128 5 14.

10 555 7 13,298 ,29568643 49,258 6 26,361 3 14,743 9 13,206 ,31682,130 14 43,569 3 85,888 14 13,503 4 15,483 14 14 Zambia1,722 15 1,533 13 73,053 14 57,620 11 15,030 11 13,732 14 11 14 11 North Korea89518322 25,915 1 21,755 1 10,569 1 10,347 ,717 14 3,321 15 61,823 11 137,295 15 15,059 12 16,428 15 ,35791,1378 55,603 9 43,461 9 14,553 6 14,177 12 ,285 58321 49,745 7 26,361 2 13,660 5 12,959 ,439 10 1,2239 52,340 8 38,959 8 13,050 2 12,879 Faso1,521 12 1,396 12 68,852 13 59,507 13 14,862 10 13,409 ,658 13 1,290 10 75,253 15 45,587 10 15,596 15 13,882 11 15 10 RISK FACTORSO verall, the three risk factors that account for the most disease burden in ZAMBIA are childhood underweight, household air pollutionfrom solid fuels, and suboptimal breastfeeding.