Gynaecological disease in developing countries: Whose burden?

Abstract

This paper offers a critique of the DALY (Disability Adjusted Life Years) approach in relation to gynaecological morbidity, criticising both the methodology as applied to morbidities with a strong social component, and also the omission of some key gynaecological conditions from any of the previously calculated disease groups. A summary of findings is presented on physician diagnosis, and self report, syndromic approaches and an update on affordable lab testing appropriate in community studies and also for clinical settings resource poor areas. As no study ever has the same definition of gynaecological disease, the authors aim to enumerate an exhaustive list based on the International Classification of Diseases. Although this is a predominantly biomedically determined initial approach, it is argued that building a consistent list can only begin here - then extensively tested 'quality of life' indicators should be used to understand these conditions in relation to the associated physical and mental distress as suffered by women. The authors advocate a biomedical list built on by a quantitative as well as qualitative assessment of women's loss of quality of life