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This volume is a single up-to-date source on the entire global epidemiology of diseases, injuries and risk factors with a comprehensive statement of methods and a complete presentation of results. It includes refined methods to assess data, ensure epidemiological consistency, and summarize the disease burden. Global Burden of Disease and Risk Factors examines the comparative importance of diseases, injuries, and risk factors; it incorporates a range of new data sources to develop consistent estimates of incidence, prevalence, severity and duration, and mortality for 136 major diseases and inju

BACKGROUND: Despite indications that infection-related mortality in sub-Saharan Africa may be decreasing and the burden of non-communicable diseases increasing, the overwhelming reality is that health information systems across most of sub-Saharan Africa remain too weak to track epidemiological transition in a meaningful and effective way. PROPOSALS: We propose a minimum dataset as the basis of a functional health information system in countries where health information is lacking. This would involve continuous monitoring of cause-specific mortality through routine civil registration, regular documentation of exposure to leading risk factors, and monitoring effective coverage of key preventive and curative interventions in the health sector. Consideration must be given as to how these minimum data requirements can be effectively integrated within national health information systems, what methods and tools are needed, and ensuring that ethical and political issues are addressed. A more strategic approach to health information systems in sub-Saharan African countries, along these lines, is essential if epidemiological changes are to be tracked effectively for the benefit of local health planners and policy makers. CONCLUSION: African countries have a unique opportunity to capitalize on modern information and communications technology in order to achieve this. Methodological standards need to be established and political momentum fostered so that the African continent's health status can be reliably tracked. This will greatly strengthen the evidence base for health policies and facilitate the effective delivery of services. ; Special Issue: Epidemiological Transitions - Beyond Omran's Theory

Information on causes of death is critical for informed decision making in the health sector. This paper reports findings from a study that measured the accuracy of registered causes of death and quality of medical records for a sample of deaths occurring in hospitals in Colombo, Sri Lanka. Five physicians, trained in medical certification of cause of death, reconstructed death certificates for hospital deaths from medical records and assessed the quality of medical records for this purpose. The majority of medical records were found to be of average quality. Concordance between the underlying cause of death in the vital registration data and that from the 'gold standard' (medical records review) diagnosis was 41.4% ( n=249). The sensitivity of all leading causes of death and positive predictive value were below 67%. Major misclassification errors were found in identifying deaths due to vascular diseases and diabetes mellitus. Certified causes of death in Sri Lanka are frequently incorrect, thus limiting their value for health policy and for monitoring progress towards development goals. Sri Lanka, and other countries at a similar level of statistical development, should consider periodically conducting research to evaluate the quality of cause of death reporting at both local and national levels.