Incorporating scale dependence in disease burden estimates:the case of human African trypanosomiasis in Uganda

The WHO has established the disability-adjusted life year (DALY) as a metric for measuring the burden of human disease and injury globally. However, most DALY estimates have been calculated as national totals. We mapped spatial variation in the burden of human African trypanosomiasis (HAT) in Uganda for the years 2000-2009. This represents the first geographically delimited estimation of HAT disease burden at the sub-country scale.Disability-adjusted life-year (DALY) totals for HAT were estimated based on modelled age and mortality distributions, mapped using Geographic Information Systems (GIS) software, and summarised by parish and district. While the national total burden of HAT is low relative to other conditions, high-impact districts in Uganda had DALY rates comparable to the national burden rates for major infectious diseases. The calculated average national DALY rate for 2000-2009 was 486.3 DALYs/100 000 persons/year, whereas three districts afflicted by rhodesiense HAT in southeastern Uganda had burden rates above 5000 DALYs/100 000 persons/year, comparable to national GBD 2004 average burden rates for malaria and HIV/AIDS.These results provide updated and improved estimates of HAT burden across Uganda, taking into account sensitivity to under-reporting. Our results highlight the critical importance of spatial scale in disease burden analyses. National aggregations of disease burden have resulted in an implied bias against highly focal diseases for which geographically targeted interventions may be feasible and cost-effective. This has significant implications for the use of DALY estimates to prioritize disease interventions and inform cost-benefit analyses

Comparison of average annual DALY rates for HAT and other infectious diseases.

<p>The calculated historic average annual DALY rates by district population over the period 2000–2009 are shown in grey. The calculated national average DALY rate for HAT and 2004 GBD DALY rates for HAT and major infectious diseases in Uganda are shown in black. Estimates of completeness of case reporting for HAT (33% <i>gambiense</i>, 5% <i>rhodesiense</i>) and DALY rates for other diseases are taken from the GBD 2004 report <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002704#pntd.0002704-WHO4" target="_blank">[22]</a>.</p

Total HAT burden in Uganda for 2000–2009 in age-weighted DALYs, with sensitivity analysis of the under-reporting rate.

<p>Total HAT burden in Uganda for 2000–2009 in age-weighted DALYs, with sensitivity analysis of the under-reporting rate.</p

Summary of parameters used in DALY formula.

<p>Summary of parameters used in DALY formula.</p

Total HAT burden in Uganda by parish, 2000–2009.

<p>Shaded parishes indicate the total burden in DALYs estimated over the ten-year study period, as modelled with an under-reporting rate of 40% <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002704#pntd.0002704-Odiit1" target="_blank">[21]</a>.</p

Burden of reported HAT cases in Uganda, 2000–2009.

<p>Burden of reported HAT cases in Uganda, 2000–2009.</p

DALYs per year by district, showing temporal trends in HAT burden calculated with a 40% under-reporting rate, averaged over 2000–2009 and four sub-periods.

<p>DALYs per year by district, showing temporal trends in HAT burden calculated with a 40% under-reporting rate, averaged over 2000–2009 and four sub-periods.</p

The Medical Education Planetary Health Journey: Advancing the Agenda in the Health Professions Requires Eco-Ethical Leadership and Inclusive Collaboration

Climate change and the declining state of the planet’s ecosystems, due mainly to a global resource-driven economy and the consumptive lifestyles of the wealthy, are impacting the health and well-being of all Earth’s inhabitants. Although ‘planetary health’ was coined in 1980, it was only in the early 2000s that a call came for a paradigm shift in medical education to include the impact of ecosystem destabilization and the increasing prevalence of vector-borne diseases. The medical education response was, however, slow, with the sustainable healthcare and climate change educational agenda driven by passionate academics and clinicians. In response, from about 2016, medical students have taken action, developing much-needed learning outcomes, resources, policies, frameworks, and an institutional audit tool. While the initial medical education focus was climate change and sustainable healthcare, more recently, with wider collaboration and engagement (Indigenous voices, students, other health professions, community), there is now planetary health momentum. This chronological account of the evolution of planetary health in medical education draws on the extant literature and our (an academic, students, and recent graduates) personal experiences and interactions. Advancing this urgent educational agenda, however, requires universities to support inclusive transdisciplinary collaboration among academics, students and communities, many of whom are already champions and eco-ethical leaders, to ensure a just and sustainable future for all of Earth’s inhabitants

AMEE Consensus Statement: Planetary health and education for sustainable healthcare

The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to ‘rapid, far-reaching and unprecedented changes’ to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet.The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals.This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. ‘Consensus’ implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE).To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as ‘the system comprising structures, curricula, faculty and activities contributing to a learning process’. This Statement is relevant to the full continuum of training – from undergraduate to postgraduate and continuing professional development