Incorporating deaths near the time of birth into estimates of the global burden of disease.

Many countries, including all high-income ones, maintain vital registration systems that provide data on the number of deaths by cause, sex, and age. Some countries also report years of life lost because of premature mortality (YLL) due to each cause, a number that depends on the age of death and on the choice of an algorithm for how YLL should depend on the age of death. The tracking of stillbirths, however, is often incomplete and variable. As of the early 1990s, no estimates of YLL were available for many developing countries or for regional groupings of such countries. The World Bank (1993), as part of the preparation for its World Development Report 1993: Investing in Health, initiated an effort to provide estimates of deaths by age and cause, and hence YLL, for around 100 conditions for eight regional groupings, including all lowand middle-income countries. By adding years of healthy life lost as a result of disability (YLD) to YLL, the World Bank was able to generate estimates of the global burden of disease measured both in deaths by cause and in disability-adjusted life-years (DALYs) (Murray, Lopez, and Jamison 1994; World Bank 1993, appendix B). Murray and Lopez (1997) provide updated and extended results and a complete description of methods. Global burden of disease estimates have subsequently been used to help guide resource allocation in the health sector and to inform debates about national and international disease control priorities (see chapter 1 in this volume); however, the global burden of disease literature currently provides little insight into the importance of deaths near the time of birth. The purpose of this chapter is to explore the sensitivity of results within the Global Burden of Disease (GBD) framework to alternative approaches to encompassing the large number of deaths that occur near the time of birth, namely almost 4 million neonatal deaths and 3.3 million stillbirths. The sensitivity analyses in this chapter thus complement those of chapter 5, which explore the effect of variations in discount rates, age weights, and disability weights. Chapter 3 in this volume describes the GBD framework and provides estimates of deaths and DALYs by cause for 2001 using the World Bank regional grouping of countries. (Map 1, inside the front cover of this volume, shows the World Bank regional groupings used throughout this book.) This Chapter 6 Incorporating Deaths Near the Time of Birth Into Estimates of the Global Burden of Disease