Nepal Burden of disease 2019: A country reported based on the 2019 global burden of disease study.

Research Report.

EXECUTIVE SUMMARY: The Global Burden of Disease (GBD) study is a systematic effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geographies for specific points in time. The objective is to provide a comprehensive picture of total health loss due to diseases, injuries, and death to facilitate health sector planning and policy making. GBD considers 369 diseases and 87 risk factors in estimating burden of disease (BoD) and attribution of different risk factors. In 2019 GBD estimates, a total of 281,577sources were used including 402 data sources for Nepal. Institute for Health Metrics and Evaluation (IHME), in October 2020, produced GBD 2019 estimates, which highlight Nepal's health performance in terms of mortality, morbidity, and overall disease burden alongside 203 other countries and territories. These estimates for Nepal have been extracted to produce this Nepal Burden of Disease (NBoD) Study 2019 Report. NBoD Study 2019, measures overall mortality, causes of mortality, causes of morbidity, and risk factors. Overall mortality is expressed in the form of number of deaths due to diseases and injuries and their rates per 100,000 population. Causes of mortality are captured through years of life lost (YLLs), which give years of life lost due to premature death from a disease or injury. Years lived with disability (YLDs) measure causes of morbidity; they are used to indicate the number of years lived with disability due to a nonfatal disease or injury weighted for severity. YLLs and YLDs together give the overall burden of disease or injury. It is expressed in the form of disability adjusted life years (DALYs). The GBD study reports that the life expectancy of the Nepalese population is 71.1 years, which has increased by 12.7 years since 1990. However, not all these additional years gained will be healthy ones. Healthy life expectancy stands at 61.5 years, which is an increase of 11.1 years from 1990. A total of 193,331 deaths were estimated to have occurred in 2019, of which 71.1% of deaths were due to non-communicable diseases (NCDs), 21.1% were due to communicable, maternal, neonatal, and nutritional (CMNN) diseases and the remaining 7.8% were due to injuries. Cardiovascular diseases (CVDs) were the leading cause of deaths, with 24% of total deaths being attributable to CVDs. The proportion of deaths attributable to CVDs was 26.8% in males and 20.7% in females. In 2019, chronic obstructive pulmonary disease (COPD) was responsible for 16.3% of total deaths which is an increase from 6.1% of total deaths in 1990. Ischemic heart disease (IHD) was responsible for 12.3% of total deaths which is an increase from 4.0% of total deaths in 1990. The age standardised mortality rate for COPD and IHD were Executive Summary 182.5 and 124.0 per 100,000 population respectively in 2019. Among CMNN diseases, lower respiratory infections were the leading cause of death in 2019 accounting for 4.5% of total deaths, which is a decline from 12.9% of total deaths in 1990. Similarly, drug susceptible tuberculosis (TB) was responsible for 3.5% of total deaths in 2019, which is a decline from 6.7% in 1990. Age standardised mortality rates for lower respiratory infections and drug susceptible TB stood at 41.7 and 30.5 per 100,000 population, respectively. Among injuries, falls were the leading cause of death in 2019 with almost 2.0% of total deaths being due to falls, which is an increase from 1.0% of total deaths in 1990. The younger population bear a greater burden of mortality due to CMNN diseases while the older population bear a greater burden of mortality due to NCDs. Deaths due to injuries were more common in young adults. The proportion of deaths and DALYs attributable environmental/occupational risk factors and behavioural risk factors have declined from 1990 to 2019. However, both the proportion of deaths and DALYs attributable to metabolic risk factors have steadily increased. Among different risk factors in 2019, 17.7% of deaths were due to smoking, 12.3% of deaths were due to high systolic blood pressure, 11.2% of deaths were due to household air pollution from solid fuels, 9.3% of deaths were due to ambient particulate matter pollution and 8.0% were due to high fasting plasma glucose. These results could have important policy and programme implications. The notable increase in burden of NCDs indicates the need for additional focus while sustaining the progress made on CMNN diseases is still a challenge with their notable presence in 2019. NCDs could pose a complex challenge to the health system that may require proactive measures on multiple fronts like addressing risk factors in healthy population, health promotion interventions and preparing health systems to cater to the needs of NCD patients who require chronic care. This could also have important implications on financial and human resources needed for the health system. As local governments are currently responsible for delivering basic health services, it could also be an opportunity for context specific and culturally sensitive interventions to address the burden of diseases. Strengthening record keeping and generating additional evidence at local level could be useful in further refining the estimates of BoD and could provide important data for sub-national estimates of BoD in future.