AbstractsMedical & Health Science

Chapter 1 provided the background for this thesis. The main goal of public health policy is to promote, enhance and protect population health. This requires information on the health status of the population, often referred to as the “burden of disease”. Population health is a multifactorial phenomenon with many facets. As a result, the disease burden of a population can be described by a variety of indicators. As current health policy requires a global overview of public health, combining morbidity and mortality and taking into account health-related quality of life, so-called summary measures of population health (SMPH) are gaining wider importance. Driven by the influential Global Burden of Disease projects initiated in the early 1990s, the Disability-Adjusted Life Year (DALY) has become the dominant SMPH. The DALY is a health gap measure, reflecting the number of healthy life years lost due to disease and death. In the DALY philosophy, every person is born with a certain number of life years potentially lived in optimal health. People may lose these healthy life years through living with illness and/or through dying before a reference life expectancy. The importance of burden of disease estimates for health policy in Nepal becomes evident from recent policy documents and recommendations. The Second Long-Term Health Plan 1997–2017 was the first document to recognize the importance of prioritizing health sector needs, motivated by the scarce human, financial and physical resources available. Notwithstanding the importance of disease burden estimates, Nepalese DALYs are scarce and not rooted in local data. Especially for zoonotic and other neglected diseases, this may lead to a vicious cycle of indifference, under-recognition and under-funding. Chapter 2 introduced the rationale and objectives of this thesis. The main objective of this thesis was to unravel the burden of zoonoses in Nepal and to quantify this burden using the DALY metric. To achieve this goal, we contributed to a further standardization of the DALY metric. Although the philosophical and methodological aspects of the DALY calculation have been described (and debated) in great detail, the steps preceding the actual calculation remained less well documented. In Chapter 3, we therefore proposed a stepwise approach for conducting a DALY-based disease burden study, consisting of the following five consecutive steps: Study population definition; Disease mo del definition; Data collection; Data adjustment; and DALY calculation. Nearly every DALY estimation is subject to data uncertainty and modelling choices. The resulting DALY estimate is therefore hardly ever a single, fixed value, defined with perfect accuracy and precision. In Chapter 4, we studied sources of uncertainty inherent to DALY calculations through a systematic review of DALY-based disease burden studies. Of the 228 studies published between 1994 and 2013, only 105 (46%) had performed some sort of uncertainty quantification. Identifying, quantifying and analysing uncertainties should become a…