Title: Estimating District Specific Dengue burden in Kerala using Disability Adjusted Life Years (DALY)
Authors: Zinia T. Nujum, Vijayakumar K., Meenakshy V., Saboora Beegum M.
DOI: https://dx.doi.org/10.18535/jmscr/v6i1.68
Abstract
Introduction: Kerala is hyperendemic for dengue. Determining State and district specific DALY are crucial in prioritizing, implementing and evaluating actions, but are seldom done. The objective of this study was to compute and compare the DALY due to Dengue in the districts of Kerala for 2014 and 2015.
Methods: DALY was computed using the DALY package, accessible in the R statistical program. The parameters that were inputed are incidence/1000, mortality rate, mean age of mortality, disability weights, proportion of cases treated. Reported incidence/1000 and mortality rates were calculated using the reported cases and deaths from the state surveillance unit. Estimates of dengue incidence/1000 were made using the fever surveillance and sentinel surveillance data. DALY was computed based on reported and estimated dengue burden. Absolute DALY (AD) and Relative DALY (RD) with their 95% CI were computed.
Results: AD and RD was high for some districts and low for others. Thrissur, had the highest in 2014 (AD- 840, RD-26.91/lakh population [95%CI: 11.50-39.60]) and Kasargode (AD-2601; RD-198.95/lakh [95%CI: 85.67-291.42]) in 2015.Thiruvananthapuram recorded the second highest DALY consistently for both years (AD- 801; RD-24.26/lakh [95% CI: 11.27-35.04] and AD-2312; RD- 70.03[95% CI: 30.68-102.71]). Districts with highest incidence were not the same as those with highest DALY.
Conclusion: There is gross inequity in the burden of Dengue in the districts of Kerala. Estimated DALY in some districts are very much higher than the global estimates. Prioritization for action can be misleading if incidence is used as measure of burden.
Keywords: Dengue, DALY, Kerala, Districts, Burden of disease.
References
- Gubler, D.J. and Kuno, G. Dengue and Dengue Haemorrhagic Fever. CABI Publishing, New York, p.1,1978
- Lall, R. and Dhanda, V. Dengue haemorrahagic fever and the dengue shock syndrome in India. Natl Med J India 9: 20, 1996.
- Kadar A., Kandasamy, M.S., Appavoo, P. and Anuradha, C.N. Outbreak and control of dengue in a village of Dharmapuri, Tamil Nadu. J Commun Dis 29: 69, 1997.
- State Bulletin, Thiruvananthapuram. Integrated Disease Surveillance Project, State Surveillance Unit, Directorate of Health Services, Government of Kerala, 2010.
- Murray CJL. Rethinking DALYs. In: Murray CJL, Lopez AD, editors. The Global Burden of Disease. Vol 1 of Global Burden of Disease and Injury Series. Cambridge, MA: Harvard School of Public Health; 1996. pp. 1–98.
- The Global Burden of Disease: 2004 Update. WHO. [Accessed 2009 Feb 4]. Available from:http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html
- Indian Council of Medical Research, Public Health Foundation of India and
Institute for Health Metrics and Evaluation. India: Health of the Nation’s States- The India State-Level Disease Burden Initiative. New Delhi:ICMR, PHFI, and IHME; 2017. - R Core Team (2016). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/.
- Brecht Devleesschauwer, Scott McDonald, Juanita Haagsma, Nicolas Praet, Arie Havelaar and Niko Speybroeck (2016). DALY: The DALY Calculator - Graphical User Interface for Probabilistic DALY calculation in R. R package version 1.5.0. https://cran.r-project.org/package=DALY
- Office of the Registrar General and Census Commisioner, India. Ministry of Home Affairs, Government of India, Census Digital Library and Sample Registration System Publications. Available at http://censusindia.gov.in/2011-common/censusdataonline.html. Accessed on 15-06-2017.
- Zinia T Nujum, Achu Thomas, Vijayakumar K , Thomas Mathew, Saran S Pillai. Estimation of Burden Using Active Dengue Sentinel Surveillance and Fever Surveillance. Dengue Bulletin Volume 39-December 2016; pages 78-68.
- Cecilia D. Current status of dengue and chikungunya in India. WHO South-East Asia J Public Health 2014; 3(1): 22–27.
- Shepard DS, Undurraga EA, Halasa YA (2013) Economic and Disease Burden of Dengue in Southeast Asia. PLoSNegl Trop Dis 7(2): e2055. https://doi.org/10.1371/journal.pntd.0002055.
- Beauté and Vong: Cost and disease burden of Dengue in Cambodia. BMC Public Health 2010 10:521.
- Srinivasa Rao Mutheneni, Andrew P Morse, Cyril Caminade and Suryanaryana Murty Upadhyayula. Dengue burden in India: recent trends and importance of climatic parameters. Emerging Microbes & Infections (2017) 6, e70; doi:10.1038/emi.2017.57. Available at https://www.nature.com/articles/emi201757.pdf, accessed on 7/01/2018