Measuring the burden of premature mortality in Pakistan: use of sentinel surveillance systems A.A. Hyder a, * , S.A. Wali a , A. Ghaffar b,1 , T.I. Masud a,1 , K. Hill c a Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Suite E-8132 Baltimore, MD 21205, USA b Global Forum for Health Research, Geneva, Switzerland c Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA Received 15 December 2003; received in revised form 27 August 2004; accepted 31 August 2004 Available online 20 December 2004 KEYWORDS Burden of disease; Mortality; Healthy life years (HeaLYs); Pakistan Summary Introduction. In developing countries, finding valid and reliable data is a great challenge. The Federal Bureau of Statistics in Pakistan maintains a surveillance system that records vital events. Results are reported as the Pakistan Demographic Survey (PDS). Methods. The adjusted mortality data from PDS-1997 was used to estimate the burden of premature mortality using the healthy life year (HeaLY) methodology. Results. The burden of premature mortality for Pakistan was 367 HeaLYs lost per 1000 population. More than half of the HeaLYs are being lost due to infection, maternal and perinatal conditions, and malnutrition. Conclusion. In the absence of a system maintaining reliable information regarding vital events, PDS provides a good alternate source of such information that can be used to aid policy making for health care and future research. Q 2004 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. Introduction Summary measures of population health estimate the impact of diseases on populations by combin- ing morbidity and mortality components. 1 One example is the disability adjusted life year (DALY), which measures the deviation of current healthy life from an ideal or standard healthy life. The healthy life year (HeaLY) is an alternative health gap measure devised to estimate the burden of disease, especially in resource-poor settings, and can be applied to population groups in order to determine the impact of a particular disease, to work out the effects of an interven- tion, or to compare areas, populations or socio- economic groups. 2 The HeaLY methodology has been used in burden of disease assessment, to evaluate the effectiveness of various Public Health (2005) 119, 459–465 0033-3506/$ - see front matter Q 2004 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2004.08.017 * Corresponding author. Tel.: C1 410 955 1253; fax: C1 410 614 1419. E-mail address: ahyder@jhsph.edu (A.A. Hyder). 1 At the time of the study at Health Services Academy, Islamabad, Pakistan.