With limited healthcare resources, rational prioritization of
healthcare interventions requires knowledge and analysis of disease
burden. In the absence of actual disease-burden data from
less-developed countries, various types of morbidity and mortality
estimates have been made. Besides having questionable reliability,
these estimates do not capture the full burden of a disease since they
provide only the number of cases and deaths. The modelling methods that
include disability are more comprehensive but are difficult to
understand, and their reliability is affected by baseline
approximations. To provide policy-makers with information needed for
rational decision-making, the Diseases of the Most Impoverished (DOMI)
Programme of the International Vaccine Institute has used a
multidisciplinary approach to describe the burden of disease due to
typhoid fever, shigellosis, and cholera. Recognizing the relative
advantages and disadvantages of various methodologies, the programme
employs passive clinic-based surveillance in defined communities to
provide prospective data. The prospective data are complemented with
retrospectively-collected information from existing sources, frequently
less accurate and complete but readily available for the whole
population over extended periods. To create a more complete picture,
economic and qualitative studies specific to each disease are
incorporated in these prospective studies. The goal is to achieve a
more complete and realistic picture by combining the results of these
various methodologies, acknowledging the strengths and limitations of
each. These projects also build in-country capacity in terms of
treatment, diagnosis, epidemiology, and data management