Annex Table 7 presents the DALY estimates for the group aged 0–14 years. For the first time, the Global Burden of Disease project (20) has made the data available on a country-by-country basis. These data should be interpreted with caution, however,1 particularly in relation to their comparability between countries. At this stage, the available DALY estimates should be used mainly to complement the understanding of the size and proportions of the overall disease
1 The DALY summary tables for the countries in the WHO European Region are for 2002, with some revisions in December 2004, to adjust for the UNAIDS updates of HIV estimates in eastern European countries in that year. While based on the best information currently available to WHO, the DALY estimates in general have more uncertainty at the country level than the Region level, and in some cases could be improved with additional work and input of data on countries.
Fig. 9. Deaths from injuries and poisoning in two groups of young people in most countries in the WHO European Region, 2002 or latest available year
0 20 40 60 80 100 Russian Federation
Lithuania Estonia Kazakhstan Latvia Belarus Ukraine Iceland Luxembourg Greece Turkmenistan Slovenia Austria Poland Republic of Moldova Ireland Czech Republic Finland Croatia France Portugal Albania Norway Kyrgyzstan Denmark Slovakia Romania Germany Spain Uzbekistan Switzerland Italy Bulgaria Hungary Armenia Netherlands Sweden United Kingdom Israel TFYR Macedoniaa
Azerbaijan Tajikistan Malta Georgia
99.7 27.89
69.82 13.88
69.78 10.99
65.21 25.87
62.43 14.47
61.31 17.12
54.56 19.34
52.55 4.49
47.95 14.71
42.38 6.85
40.97 20.1
36.62 4.33
36.05 4.99
35.79 10.58
35.53 22.73
35.27 7.57
6.4 34.5
34.34 5.52
34.31 4.52
33.57 7.6
33.38 10.02
31.83 15.99
31.45 3.02
31.35 17.23
30.86 4.94
29.34 10.62
28.79 18.17
28.01 5.13
27.62 5.29
26.97 14.35
26.61 5.19
26.32 5.03
24.44 12.02
24 8.75
22.81 5.27
22.5 4.02
20.82 4.02
20.36 3.87
19.41 7.57
18.52 9.26
16.14 7.53
15.01 8.56
13.9 0
11.3 5.84
Deaths per 100 000
a The former Yugoslav Republic of Macedonia.
Source: WHO mortality database (27).
Group aged 15–19 years Group aged 10–14 years
burden in children, and possibly to qualify some conclusions about priority needs and levels of achievement on the basis of indicators of mortality and the occurrence of specific diseases.
From this perspective, the following broad picture has emerged from the analysis of the data.
Overall, neonatal morbidity accounts for the largest share of the disease burden on children in the European Region. In this report, it includes low birth weight, birth asphyxia and birth trauma, which are largely preventable. The rates of DALYs per 1000 children aged 0–14 years range between 1.5 in Sweden and 41.6 in Kyrgyzstan. While countries have achieved very large reductions in neonatal morbidity, considerable further improvements can be made at relatively low cost. The large variations within the Region and the country groups emphasize the role of efficient health and social systems.
Respiratory infections are the second-largest overall cause in terms of DALYs, but they appear among the top 10 causes in only 20 of the 52 countries in the Region. Among these 20, their burden in DALYs ranges from 1.5 per 1000 children in Bosnia and Herzegovina, Slovakia and Ukraine to 59.1 per 1000 in Turkmenistan.
Congenital anomalies are among the leading 10 causes of the disease burden in every country in the Region, and the third most important in the Region as a whole. The estimated burdens at country level vary between 1.7 and 14.1 DALYs per 1000 children. Some of the limitations of the data on congenital anomalies have been mentioned. In general, however, evidence points to multiple reasons for the relatively high and persisting burden. These include increasing average maternal age, uneven progress with primary prevention (for example, encouraging pregnant women to take folic acid supplements and increasing prenatal screening programmes, which should respond effectively to cultural differences), and unmet needs for counselling and a choice of preventive interventions. In addition, the socioeconomic differentials seem to have increased because the lower socioeconomic groups of the population have less knowledge of the available preventive measures or lack the means to take full advantage of them. Even the countries in Eur-A do not take full advantage of the benefits of folic-acid supplementation.
Neuropsychiatric disorders are among the 10 leading causes of the disease burden on children in all countries and the Region as whole. In this report, these disorders include unipolar depressive disorders, schizophrenia and migraine. The other major causes of the disease burden on the Region’s children are iodine deficiency, unintentional injuries and asthma. The first and third of these are discussed below.
The DALY profiles vary considerably across country groups. In summary, the data presented in Annex Table 7 indicate the following.
1. The total burden of disease on the group aged 0–14 years varies across countries by a factor of about 6. At the country level, the burden is highest in Tajikistan (224 DALYs per 1000 children) and lowest in Sweden (36 DALYs per 1000 children).
2. Neuropsychiatric disorders are the leading cause of the disease burden in Eur-A, but rank lower in Eur-B and -C. Further, the differences between countries in terms of DALYs due to these conditions are relatively small, in contrast to the variations in the shares of the burden due to infectious diseases and other acute conditions. As acute conditions become well controlled in central Asian and some other countries, the relative importance of neuropsychiatric problems will increase there and in the Region as a whole.
3. The situation with congenital anomalies is similar. These are among the leading 10 causes in all countries, but the burden is smaller in the western and central countries in the Region than in the rest.
4. Neonatal morbidity is a major problem in all countries, although its share of the disease burden varies widely.
5. Asthma is among the leading 10 causes in all countries in Eur-A, but in only about half of the countries in Eur-B and -C.
6. Unintentional injuries are among the leading 10 causes of the burden of disease on children in nearly all countries in the Region.