Applying burden of disease methods in developing countries: a case study from Pakistan

Am J Public Health. 2000 Aug;90(8):1235-40. doi: 10.2105/ajph.90.8.1235.


Objectives: Disability-adjusted life-year (DALY) and healthy life-year (HeaLY) are composite indicators of disease burden that combine mortality and morbidity into a single measurement. This study examined the application of these methods in a developing country to assess the loss of healthy life from prevalent conditions and their use in resource-poor national contexts.

Methods: A data set for Pakistan was constructed on the basis of 180 sources for population and disease parameters. The HeaLY approach was used to generate data on loss of healthy life from premature mortality and disability in 1990, categorized by 58 conditions.

Results: Childhood and infectious diseases were responsible for two thirds of the burden of disease in Pakistan. Condition-specific analysis revealed that chronic diseases and injuries were among the top 10 causes of HeaLY loss. Comparison with regional estimates demonstrates consistency of disease trends in both communicable and chronic diseases.

Conclusions: The burden of disease in countries such as Pakistan can be assessed by using composite indicators. The HeaLY method provides an explicit framework for national health information assessment. Obtaining disease- and population-based data of good quality is the main challenge for any method in the developing world.

MeSH terms

  • Cost of Illness
  • Developing Countries
  • Disabled Persons / statistics & numerical data*
  • Epidemiologic Methods
  • Female
  • Health Status
  • Humans
  • Male
  • Morbidity*
  • Mortality*
  • Pakistan / epidemiology