Trends in health and disability in Botswana. An analysis of the global burden of disease study

Purpose: Globally, years of life lost are declining, while years lived with disability are increasing. In high socio-demographic index countries, this trend has been attributed to an overall ageing population and rehabilitation services have begun to adjust to this change. In low- and middle-income countries, this trend is less well understood. Hence, the WHO's 'Rehabilitation 2030 Call for Action' and 'Rehabilitation in Health Systems Guide' call for better assessment of the situation. In order to understand trends and causes in middle income countries such as Botswana, we examine the change over time in causes and number of years lived with disability and years of life lost. Methods: We conducted a secondary analysis of the Global Burden of Disease 2017 data, exploring the change over time in Disability Adjusted Life Years per 100 000 people over the period 1990-2016. The descriptive analysis focuses on the contribution of years lived with disability towards the burden of disease within Botswana compared with the world, sub-Saharan Africa, and high-income countries. Results: Our results show that Botswana's top causes of years of life lost are HIV and other sexually transmitted infections, cardiovascular diseases, maternal and neonatal disorders, respiratory infections and tuberculosis, and neoplasms. Years lived with disability have increased over time, which is driven by mental disorders, HIV and other sexually transmitted infections, musculoskeletal disorders, neurological disorders, and skin and subcutaneous diseases. Conclusions: Botswana needs better data to prepare its emerging health systems to accommodate the increased need for disability support and rehabilitation services caused by communicable and non-communicable diseases.

Automated summary

Globally, years of life lost are declining while years lived with disability are increasing. High socio-demographic index countries have started adjusting rehabilitation services to the overall ageing population, while the situation in low- and middle-income countries is less well understood. Better assessment of the situation is needed to prepare health systems to accommodate the increased need for disability support and rehabilitation services.