Neurological, Psychiatric, and Developmental Disorders Meeting the Challenge in the Developing World (2001) / Chapter Skim
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2 The Magnitude of the Problem
2 The Magnitude of the Problem
Pages 21-56
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From page 21... ...
This report seeks to counter each of these notions, the first of which is addressed in this chapter. The impact of brain disorders in developing countries is reviewed from several perspectives: the impact on nations and communities in teIms of the overall disease burden due to death and disability, the impact on individuals and families due to lost time, lost productivity, stigmatization and discrimination, the reinforcing roles of poverty and gender inequality, and the lack of capacity to address these problems.
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. 2 Data on such developmental disorders as mental retardation, cerebral palsy, and autism along with adult neurological conditions such as peripheral nerve disease and severe migraine were not accounted for in the estimates of the 1996 Global Burden of Disease study.
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24 NEUROLOGICAL, PSYCHIATRIC, AND DEVELOPMENTAL DISORDER Other NonCommunicable Diseases \ _ 20% ~ Congenital — Abnormalities 5% Respiratory Disease 11% Malignant Neoplasms J 13% Brain Disorders 34% Cardiovascular Disease 17% FIGURE 2-1 Non-communicable disease DALYs attributable to brain disorder, estimates for 1998. Neuropsychiatric Conditions and Other Category 11 26% Total brain disorders 15% / Stroke / 13.5% / Suicide _/ ^2% 44°/ Other Categoly lil 15% FIGURE 2-2 Burden of brain disorders as a percentage of total disease burden in low- and middle-income countries, estimates for 1998.
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based on trends in cause-specific mortality rates, life expectancy, income per capita, human capital, smoking intensity, and HIV and tuberculosis infection rates. One projected calculation is that unipolar depression (the fourth leading cause of DALYs in 1990 for all age groups and the leading cause of DALYs among those aged 15 to 44)
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Meanwhile, current estimates using this indicator have provided the public health community with a valuable way to rank the impact of various diseases on health and to recognize the major role of diseases that cause a high level of disability.
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DALYs ~ 1.000s) Deaths All Disease 1,274,259 45,897 Brain Disorders Unipolar major depression 51,217 4.02 0 0 Stroke 36,407 2.86 4,213 9.20 Self-inflicted injuries 19,095 1.50 818 1.80 Bipolar affective disorder 14~421 1.13 15 0.03 Alcohol dependence 13,553 1.06 42 0.09 Psychoses 11,984 0.94 40 0.08 Obsessive compulsive 10~062 0.79 0 0 disorders Alzheimer s disease and 5,527 other dementias Drug dependency Panic disorders Epilepsy Post traumatic stress disorders Multiple sclerosis Parkinson s disease Other neuropsychiatric disorders 0.43 4,782 4,710 4659 1,896 0.38 0.37 0.37 0.15 1308 0.10 621 9,308 ]
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From page 30... ...
All causes 1,218,244 Lower respiratory 1 10,506 % of Total 9.1 infections 2 Diarrheal diseases 99~168 8.1 3 Conditions arising 89,193 7.3 during the perinatal period 4 Unipolar major 41,031 3.4 depression 5 Tuberculosis 37,930 3.1 6 Measles 36,498 3.0 7 Malaria 31,705 2.6 8 lschemic heart disease 30,749 2.5 9 Congenital anomalies 29~441 2.4 10 Cerebrovascular 29,099 2.4 ]
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lifelong dependency." 18,21,22,27-30] Stigma and Discrimination The stigma and discrimination associated with disorders such as epilepsy, schizophrenia, and mental retardation increase the toll of illness for many people with brain disorders and their families.
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THE ROLES OF POVERTY AND GENDER INEQUALITY Poverty and gender inequality underlie many key risk factors for disease generally; neurological, psychiatric, and developmental disorders are no exception. indeed, these are the two risk factors of greatest salience for brain disorders in the developing world.
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while high infant and child mortality among families living in extreme poverty can have significant psychosocial effects on parents and other family members.~63] Inadequate Access to Health Care Poor people in the developing world rarely receive preventive care or effective treatment for brain disorders.
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Poverty-related factors are associated with increased neonatal and postneonatal mortality rates; developmental disorders; and injuries from accidents, abuse, or neglect.~76] When health and housing are inadequate, infection and malnutrition often limit a child's growth and development.~77]
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From page 37... ...
The data also suggest associations between indicators of impoverishment, such as hunger or indebtedness, and these disorders. In Indonesia, lower rates of depression and other common mental disorders were observed in individuals with higher levels of education, access to amenities such as electricity, and television ownership.
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38 NEUROLOGICAL, PSYCHIATRIC, AND DEVELOPMENTAL DISORDERS Other 16% PTSD _ 3% Psychoses 7% Epilepsy, 10% Drug dependence 7% Other 17% __ is_ Psychoses 7% Epilepsy 9% Self-lnflicted injury 18% Depressive disorders 10% ~ ' - ~ _Alzeimer's/dementia Alcohol dependence 18% Males 11% Depressive disorders 25% - _// _ \ /~lf-lnflicted injuries 14% Drug dependence/ ~ _ / ~ Alcohol dependence 3% Females Alzheimer's/ L dementia 15% FIGURE 2-3: Mental Health Problems of Males and Females Worldwide Percentages of DALYs Lost Note: DALY = disability-adjusted life years; PTSD = posttraumatic stress disorder Source: [1]
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From page 39... ...
This issue is separate from gender inequality, though biology may serve to reinforce societal causes of high depression rates among women. Many of women's reproductive health issues also have significant implications for mental health.
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From page 40... ...
Female genital mutilation, forced sterilization or involuntary abortion, and partners who demand unprotected sex also contribute to dire mental health consequences.[l20-122] HI V/AIDS People with HIV are at increased risk for depression for a variety of reasons: the stigma and discrimination associated with the disorder, the knowledge that they are likely to die prematurely of AIDS, the discovery that other family members may also have the disease, and the direct and indirect effects of HIV on the brain, as well as the effects of secondary neoplastic and infectious diseases.[ 123,124]
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From page 41... ...
With human resources being so limited, policy makers in the developing world face difficult choices on how to allocate these and equally limited financial resources to best meet health care needs. Since many brain disorders impair cognitive function, an attempt must be made to estimate the costs and benefits associated with all aspects of care, as well as lost wages and the time and financial commitments borne by family members (see Chapter 4~.
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Despite the increasingly significant contribution of brain disorders to disease burden, these conditions are largely missing from the international health agenda.[l] Stigma, discrimination, economic and gender inequalities, and lack of capacity for addressing these add to their burden in developing countries.
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Presentation to 1OM Committee on Neurological, Psychiatric, and Developmental Disorders in the Developing World, 2000.
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British Medical Journal 296~1 1)
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Todd. Women, Poverty and Common Mental Disorders in four restructuring societies.
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The prevalence, classification and treatment of mental disorders among attenders of native faith healers in rural Pakistan. Social Psychiatry and Psychiatric Epidemiology Oct;35~10)
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British Medical Journal 31 1,22~230, 1995.
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Postnatal mental illness: A transcultural perspective. Social Psychiatry and Psychiatric Epidemiology, Nov;29~6~25~264, 1994.
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Alcohol problems among patients attending five primary health care clinics in Harare city. Central African Journal of Medicine 36,26-32, 1993.
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Mental health manpower development in Afghanistan: A report on a training course for primary health care physicians. Eastern Medi~errean Health Journal Mar;5~2)
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