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Table 3
Population health information available in the public domain on the leading causes of disease burden in India.*
Disease or health condition (% of total DALYs lost in 2002 in India [15])	Category	Information available	Lowest geographical level available	Comments

1. Perinatal conditions (9.7%)	Mortality	Perinatal mortality rate [23,58-60]†	State	Based on data from sample registration system and large scale household survey ‡ No cause of perinatal death data.

	Morbidity & health status	Prevalence of low birth weight [38,58,59,61]	District	Based on data from large scale household survey‡

	Risk factors	Anaemia among women [58,59,62]	District	Most estimates based on data from large scale household survey‡

		Underweight among women [34,58,59]	State

		Contraception non-use [38,43,58-61,63]	District

		Birth spacing [58-60]	State

		Number of children ever born 5 or more [58-61,63]	District

		Antenatal care received [33,34,38,41,43,58-61,63]	District

		Skilled birth attendance [33,34,38,41,58-61,63]	District

		Low birth weight [38,58,59,61]	District

		Prevalence of postpartum complications [58-61,63]	District

	Service provision	Contraception coverage [38,43,58-61,63]	District	Most estimates based on data from large scale household survey‡

		Antenatal care coverage [33,34,38,41,43,58-61,63]	District

		Women receiving iron supplementation [38,41,43,58-61,63]	District

		Skilled birth attendance coverage [33,34,38,41,58-61,63]	District

		Postnatal care coverage [33,38,41,58,59]	State

2. Lower respiratory tract infections (8.5%)	Mortality	None*

	Morbidity & health status	Prevalence of cough in children [34,38,58-61,63]	State	Based on data from large scale household surveys‡

	Risk factors	Type of cooking fuel used [19,34,38,40,58-60,63]	District	Most estimates based on large scale household surveys‡

		Tobacco smoking [34,42,53,58]	State

		Childhood underweight [58-60,62]	State

		Breastfeeding practices [38,58-61,63]	District

	Service provision	Treatment of childhood cough [34,38,58-61,63]	State	Based on data from large scale household surveys‡

3. Ischaemic heart disease (5.1%)	Mortality	Percent of adult deaths attributed to chest pain [34]	National	Estimate based on a small sample of verbal autopsy on sibling deaths§

	Morbidity & health status	Self-reported diagnosis with ischaemic heart disease [34]	State\|\|	Estimate based on household survey conducted in 6 states\|\|

		Self-reported hospitalisations for heart disease [33]	National

	Risk factors	Prevalence of overweight & obesity [34,58]	State	Most risk factors have an estimate based on a large scale household survey‡ 'Lack of physical activity' measured by household survey conducted in 6 states\|\|

		Tobacco & alcohol use [34,42,53,58]	State

		Fruit and vegetable intake [32,34,58,59]	State

		Lack of physical activity [34]	State\|\|

		Self-reported diagnosis of diabetes [34,58]	State

	Service provision	Self-reported treatment of disease [34]	State\|\|	Estimate based on household survey conducted in 6 states\|\|

4. Diarrhoeal diseases (5.1%)	Mortality	Percent of adult deaths attributed to diarrhoea [34]	National	Estimate based on a small sample of verbal autopsy on sibling deaths§

	Morbidity & health status	Prevalence of diarrhoea in children [34,38,58-61,63]	State	Most estimates based on data from large scale household surveys‡

		Self-reported hospitalisation for diarrhoea [33]	National

	Risk factors	Access to clean water and sanitation [19,33-35,37-41,58-60,63,64]	District	Most estimates based on data from large scale household surveys‡

		Prevalence of childhood underweight [58-60,62]	State

		Vitamin A deficiency in children [38]	State

		Percentage of children receiving food rich in vitamin A in last 24 hrs [58]	State

		Breastfeeding practices [38,58,63]	District

	Service provision	Treatment of childhood diarrhoea [38,58-61,63]	State	Most estimates based on large scale household surveys‡

		Child vitamin A supplementation [38,43,58,59,61,63]	District

5. Unipolar depression (4.9%)	Morbidity & health status	Self-reported diagnosis of depression [34]	State\|\|	Estimate based on household survey conducted in 6 states\|\|

	Risk factors	Alcohol use [34,53,58]	State	Both risk factors estimated by at least one large scale household survey‡

		Prevalence of women who experienced childhood sexual abuse [58]	National

	Service provision	Self-reported treatment coverage [34]	State\|\|	Estimate based on household survey conducted in 6 states\|\|

6. HIV/AIDS (3.4%)¶	Mortality	None*

	Morbidity & health status	HIV prevalence [8,58]	State	Estimate based on sentinel surveillance and large scale household survey‡

	Risk factors	Unsafe sex [51,58]	State	Both risk factors estimated by large scale household survey‡ Unsafe sex also estimated by behavioural surveillance

		Use of clean injections [58]	State

	Service provision	Coverage of treatment with antiretrovirals [48,65]	State	Estimates mostly based on large scale household surveys and behavioural surveillance‡

		HIV testing uptake [34,51,58]	State

		Condom use [34,51,58]	State

7. Maternal conditions (2.9%)	Mortality	Maternal mortality ratio [59,60,66]	State	Maternal mortality ratio and cause of death estimates based on sample registration system data A large scale household survey has also estimated maternal mortality ratio‡

		Cause of maternal death [66]	National

		Percent of total female deaths attributed to maternal conditions [34]	National

	Morbidity & health status	Prevalence of postpartum complications [58]	State	Both estimates based on large scale household survey‡

		Prevalence of delivery complications [63]	State

	Risk factors	Anaemia among women [58,59,62]	District	Most estimates based on data from large scale household survey‡

		Underweight among women [34,58,59]	State

		Contraception non-use [38,43,58-61,63]	District

		Birth spacing [58-60]	State

		Number of children ever born 5 or more [58-61,63]	District

		Vitamin A deficiency in pregnant women [58,61,63]	National

		Antenatal care received [33,34,38,41,43,58-61,63]	District

		Skilled birth attendance [33,34,38,41,58-61,63]	District

		Low birth weight [38,58,59,61]	District

		Prevalence of postpartum complications [58-61,63]	District

	Service provision	Contraception coverage [38,43,58-61,63]	District	Most estimates based on data from large scale household survey‡

		Antenatal care coverage [33,34,38,41,43,58-61,63]	District

		Women receiving iron supplementation [38,41,43,58-61,63]	District

		Skilled birth attendance coverage [33,34,38,41,58-61,63]	District

		Postnatal care coverage [33,38,41,58,59]	State

8. Tuberculosis (2.8%)	Mortality	Percent of adult deaths attributed to tuberculosis [34]	National	Estimate based on a small sample of verbal autopsy on sibling deaths§

	Morbidity & health status	Self-reported tuberculosis diagnosis [34,58-60,63]	State	Most estimates based on large scale household surveys‡

		Self-reported hospitalisations for tuberculosis [33]	National

	Risk factors	Tobacco & alcohol use [34,42,53,58]	State	Most estimates based on large scale household surveys‡

		Type of cooking fuel used [19,34,38,40,58,59,63]	District

		Malnutrition [32,34,38,58,60,62]	District

	Service provision	Annualised case detection rate for new smear positive cases [45]	District	Most estimates based on tuberculosis surveillance system Self-reported tuberculosis treatment estimates mostly based on large scale household surveys‡

		Proportion of new sputum positive out of total new pulmonary cases [45]	District

		Smear conversion rate [45]	District

		Treatment success rate [45]	District

		Self-reported tuberculosis treatment [34,58,59,63]	State

9. Cerebrovascular disease (2.5%)	Mortality	Percent of adult deaths attributed to paralysis [34]	National	Estimate based on a small sample of verbal autopsy on sibling deaths§

	Morbidity & health status	None*

	Risk factors	Prevalence of overweight & obesity [34,58]	State	Most risk factors have an estimate based on a large scale household survey‡ 'Lack of physical activity' measured only by household survey conducted in 6 states\|

		Tobacco & alcohol use [34,42,53,58]	State

		Fruit and vegetable intake [32,34,58,59]	State

		Lack of physical activity [34]	State\|\|

		Self-reported diagnosis of diabetes [34,58]	State

	Service provision	None

10. Cataract (2.2%)	Morbidity & health status	Prevalence of blindness [36,60,63]	State	Estimates based on both large scale household survey and household survey conducted in 6 states ‡ \|\|

		Previous diagnosis of cataracts [34]	State\|\|

		Self-reported hospitalisations for cataracts [33]	National

	Risk factors	Tobacco smoking [34,42,53,58]	State	Estimates based on of large household surveys, household survey conducted in 6 states and sample registration system ‡ \|\|

		Self-reported diagnosis of diabetes [34,58]	State

	Service provision	Number of cataract operations performed [44]	State	Estimates based on household survey conducted in six states and service generated data\|\|

		Those with previous diagnosis who have accessed surgery [34]	State\|\|

11. Road traffic injuries (2.1%)	Mortality	Deaths from road traffic injuries [25]	State	Estimate based on surveillance

	Morbidity & health status	Prevalence of road traffic injury in last one year [34]	National	Estimate based on household survey conducted in 6 states \|\|

	Risk factors	Alcohol use [34,53,58]	State	Estimates based on both large scale household survey and household survey conducted in 6 states‡ \|\|

	Service provision	Those with previous road traffic injury who had accessed emergency care [34]	State\|\|	Estimate based on household survey conducted in 6 states \|\|

*Other than that generated by modelling and projections †Only the latest National Family Health Survey provides the perinatal mortality rate specifically, the earlier surveys and the sample registration system give the infant mortality rate. ‡The large scale household surveys include: National Family Health Survey (2005/6 survey sampled 109,041 households), Reproductive and Child Health District Level Household Survey (2002/4 survey sampled 620,107 households), National Sample Survey on morbidity, health care and the condition of the aged (sampled 73,868 households), National Sample Survey on nutritional intake in India (sampled 124,644 households) and United Nations Children's Fund Multiple Indicator Survey (sampled 119,305 households). §The World Health Survey examined a total of 1954 deaths of which cause of death was attributed to 55% of female and 61% of male deaths. \|\|The World Health Survey was conducted in six states and state level estimates available only for the states of Assam, Karnataka, Maharashtra, Rajasthan, Uttar Pradesh, West Bengal; national pooled estimates also available; sampled 10,729 households. ¶ The estimated burden of HIV/AIDS in India was reduced recently to about half of the previous estimate based on new population-based data [67]; the estimated DALYs lost in 2002 shown in this table is therefore an overestimate.
Raban et al. BMC Public Health 2009 9:208 doi:10.1186/1471-2458-9-208

Table 3