Conclusions
Previous assessments of the global burden of disease have not included stillbirths or sufficiently emphasized the important causes of neonatal death. This was understandable given the intended focus of these studies. In addition, the inclusion of stillbirths would have highlighted issues about how to weight deaths at different ages that would have been difficult to incorporate into the DALY metrics being used to assess the global burden of disease.
Data on the numbers of stillbirths and neonatal deaths have improved, and a recent major effort by CHERG now provides a much better picture than before of the causes of neonatal death. (Annex C describes the CHERG effort and compares its results with estimates that result from fitting the CHERG estimates into the overall death envelope of chapter 3.) This chapter proposes an approach that incorporates modeling ALP, which allows flexibility in assessing how to weight stillbirths and other early deaths in constructing aggregate measures of the disease burden. This chapter combines new information and new methods into a reassessment of the global burden of disease that is based closely on, but goes beyond, what is reported in chapter 3.
We draw the following conclusions from this exercise:
-
The numbers of stillbirths and of neonatal deaths are large. This underscores the importance of implementing tools and policies for addressing them. A number of recent publications point to directions for policy (for example, Darmstadt and others 2005; Institute of Medicine 2003; Lawn and others 2006; Martines and others 2005; Stoll and Measham 2001; Tinker and others 2005; WHO 2005b; Zupan 2005).
-
The inclusion of stillbirths within the standard GBD framework is now feasible, and future assessments of the global burden of disease could consider doing so.
-
The GBD cause structure would need relatively minor modifications to incorporate deaths at early ages. Birth asphyxia and preterm births could be separate subcategories and sepsis and pneumonia could also be included as a separate category. Rather than reporting a single burden estimate for the under five age group, the more fine-grained age breakdown of table 6.4 could be used.
-
The databases on numbers and causes of stillbirths and neonatal deaths require major investments so they can be improved. Undertaking a CHERG type of review of the existing literature to gain a better understanding of the causes of stillbirths is also a priority.
-
The selection of a generally appropriate ALP function requires more data on preferences or trade-offs concerning deaths at different ages.
