Intro
Many of the diseases and health conditions that account for a large part of the disease burden in low- and middle-income countries are far less common in high-income countries. These burdens are primarily associated with infectious diseases, reproductive health, and childhood illnesses. Just eight diseases and conditions account for 29 percent of all deaths in low- and middle-income countries: TB, HIV/AIDS, diarrheal diseases, vaccine-preventable diseases of childhood, malaria, respiratory infections, maternal conditions, and neonatal deaths.
Approximately 17.6 million people in low- and middle-income countries die each year from communicable diseases and maternal and neonatal conditions. Both the occurrence of and the death rates from such diseases and conditions are far lower in all high-income countries. This is due in part to greater wealth, better general living conditions, and different climatic and environmental factors, but also to the use of cost-effective health interventions. Many of the diseases that account for the largest differences in health status between low- and middle-income countries and high-income countries are also diseases for which cost-effective strategies are known, available, and feasible.
If low- and middle-income countries achieved the same rates of death from these diseases as high-income countries, the number of deaths would fall from 17.6 million to 3.0 million per year. The difference, some 14 million deaths, represents a measure of the excess burden of ill-health in low- and middle-income countries. Applying known and cost-effective measures to these diseases could substantially reduce many needless deaths.
A number of cost-effective measures for addressing communicable diseases and maternal and neonatal conditions were already known when the first edition of Disease Control Priorities in Developing Countries (Jamison and others 1993) was published. ORT had been proven cost-effective for reducing case fatalities associated with childhood diarrhea. Prenatal care and skilled birth attendance, immunization against tetanus and hygienic care of a newborn's umbilical cord, immunization against childhood illnesses, and the DOTS strategy for controlling TB were also known, cost-effective measures for addressing this excess burden of disease. DCP2 presents information confirming many of these earlier findings, but also surveys new evidence concerning, for example, the emergence of drug-resistant strains of malaria, TB, and HIV and the large concentration of childhood deaths that occur in the first 28 days of life.
This chapter can discuss only a selection of the diseases covered in DCP2 that constitute the excess disease burden in low- and middle-income countries. (For a complete list of communicable diseases and maternal and neonatal conditions that are covered in DCP2 see chapter 1, box 1.1, and the appendix.) Moreover, the following accounts can highlight only a few of the findings for each of the diseases included. For a fuller and more complete account, refer to the associated DCP2 chapters as referenced in this chapter.
[Box 4.1]
