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Indian J Public Health. 2019 Apr-Jun;63(2):107-113. doi: 10.4103/ijph.IJPH_166_18.

Burden of dengue in Kerala using disability-adjusted life years from 2006 to 2016.

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Associate Professor, Department of Community Medicine, Government Medical College, Kollam, India.
Professor and Head, Department of Community Medicine, Amrita Institute of Medical Sciences, Kochi, India.
Additional Director, Public Health, Directorate of Health Services, Thiruvananthapuram, Kerala, India.
Professor and Head, Department of Biochemistry, Government Medical College, Thiruvananthapuram, Kerala, India.



State-specific disability-adjusted life years (DALYs) are seldom calculated. Understanding the health and disease trends in groups of states is useful for finding the heterogeneity of disease epidemiology in the country.


The objective of the study was to assess dengue burden in Kerala state, using DALY.


DALY was computed using the DALY package of R. Incidence was derived using reported and estimated dengue cases for 2006-2016. Mortality was calculated using reported deaths. We computed DALYs using the mortality estimates for the South-East Asia region (SEAR) also. Sensitivity and scenario analyses were done.


The highest estimated relative DALY for dengue is 7.22 (95% confidence interval [CI]: 6.66-7.72) per lakh population. The DALY obtained using the mortality rates of SEAR ranged from 19.89 (95% CI: 8.44-29.45) per lakh population to 28.56 (95% CI: 17.04-38.05). We observed a cyclical pattern of increase in DALY every 2-3 years. The DALY in lower age groups is lesser. DALY in females was higher than males.


The dengue-related DALY for the state of Kerala is lower than that of the global burden of disease due to lower mortality rates. Mortality reduction becomes the key to reducing burden, especially in areas of low incidence. The study also forms the benchmark for evaluating and implementing cost-effective measures for dengue control in the state.


Absolute disability-adjusted life year; Kerala; dengue; disability-adjusted life year package in R; relative disability-adjusted life year

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