Burden of Disease Trends in India in 21st Century

India has successes in reductions of certain communicable diseases, much more remains to be achieved for non-communicable diseases.

Communicable Diseases: The eradication of Smallpox and Guinea worm came about. Plague and vaccine preventable illnesses brought under much control. In 1988 WHO passed resolution for the eradication of poliomyelitis by the year 2000. Leprosy in 1981 was nearly 25% of the world total. Multi-drug therapy reduced prevalence from 57.6 per 10,000 in 1981 to 5.0 per 10,000 in 1995. Tuberculosis: In 1955-1958 nearly 1.5% of the population suffered from radiologically active pulmonary tuberculosis of whom 25% were sputum positive. The HIV-TB co-infection, increased its incidence. Malaria: In 1953 malaria incidence was 75 million cases and 0.8 million deaths annually. It fell down to 0.05 million cases in 1961. Its resurgence in 1977 had nearly 47 million new cases (particularly of Plasmodium falciparam). This was further reduced to 2.5 million cases in 1984. Acute diarrhoeal diseases: It had been a major problem in the past, continued to remain so by the end of 20th century. Each year children below 5 years suffer from 2-3 episodes of diarrhoea and 0.7 million died from it.

Non-Communicable Diseases: Prevalence of coronary heart diseases and hypertension in 1990 was higher in urban populations. Cancer: In India in 1992 the increase of cancers in big cities was 80/ 100,000 people as compared to 289/100,000 in developed countries. Diabetes mellitus: The prevalence rate of diabetes in urban population of four major regions of India has increased from 0.9 - 3.8% in 1978 to 9.5 - 13.5% in 2001. It was observed higher in urban populations. Accidents and injuries in 1999 were on increase and appeared to emerge as the leading causes of morbidity and mortality in the age group of 15 to 34 years. Mental Disorders: In 1911, Overbeck and Wright estimated the prevalence to be 26-28/1000 for the Indian population. Subsequent studies observed it to be 2 to 8% with higher rates in the urban areas. Suicides: There were 89,000 suicides in 1995 in India, increasing to 96,000 in 1997 and 104,000 in 1998.

Aim and objective: To study the BOD trends in India in the beginning of 21st Century. Material and methods: It was a retrospective study. Data regarding the burden of major diseases in India in the beginning of 21st century and around it were collected, examined, analyzed and the valid conclusions were drawn.

Findings : Communicable diseases: Morbidity trend: Eight major communicable diseases reporting around one lakh or more cases annually from the year 2001 to the year 2012 have shown a rising trend. Mortality trend: Thirteen communicable diseases reporting annually, around 100 or more deaths from 2001 to 2011 have shown a trend of rise. During the intervening period fluctuations have been observed for the various diseases.

Non-communicable diseases: Morbidity due to non-communicable diseases accounts for the second largest share of the disease burden in India after communicable diseases. The major non-communicable diseases like hypertension, coronary heart disease, diabetes mellitus, cancer, mental disorders and suicides have shown a sharp rising trend from the year 2001 to 2011. Blindness is expected to remain more or less the same during the next two decades.

Conclusion: There is the trend of a "protracted" double burden of infectious and chronic diseases in 21st century. Health care delivery system should be reorganized, to reduce BOD both for the communicable and non-communicable diseases. Future research is needed for a deep ischolar_main level understanding of the epidemiological, socio-economic, genetic, and environmental factors for bringing the control. Effective measures to reduce the BOD may be taken from the primary health care setting level to higher levels.