Burundi in Numbers
Burundi is infamous for several things: coffee & tea, a decades long civil war and year after year it makes it’s way to the top of the list as the poorest country in the world- not exactly an illustrious title.
With this in mind I was unsure what to expect before arriving and I was super curious what life on the ground actually looked like. After a few months here, I can say that Burundians are some of the kindest, warmest and welcoming people you will meet. Amidst the poverty is great resilience and I’m in awe of their fortitude.
From a public health perspective I was also curious about local health trends and it was this curiosity that inspired this next blog post!
And now a random side story for context- in 2018 I got a master’s in global health science from UCSF- my entire family was like BUT WHY?? I was already working as a Nurse Practitioner and the degree didn’t financially or professionally make sense, but on a whim I did it anyways. So this post is to prove to V and my entire family that my Global Health Master’s was not in vain (I told you V- I learned something!!). So yeah-one year and a few thousand dollars later this blog post is my redemption. 😂
What does the state of health in Burundi look like? What are the major diseases and causes of mortality and morbidity? (Morbidity is just a fancy word for having a disease that does not kill you, but may cause disability or a decrease in quality of life).
There are some pretty cool metrics we can use to assess this! Let’s nerd out on this data. And if at any point this post bores you to death, just scroll to the bottom, watch the music video and let your body sway to the beat- it’s the anthem of Bujumbura right now and my JAM!!
First a few data points on Burundi:
It’s a relatively small country with a total population of 12.5 million.
The local currency is the Burundian Franc AKA BIF. Current exchange rate is 1 USD = 2,000 BIF.
The capital is actually Gitega- 40 miles east of Bujumbura with a population of about 130,000. Some say there are actually two capitals and Bujumbura is the economic capital.
Bujumbura is the largest city in Burundi and has a population of around 380,000 (still pretty small town).
Fertility rate is 5.6 (average number of children each woman births).
The number one risk factor that drives death and disability is malnutrition.
Diarrheal disease causes the most deaths.
Life expectancy for women is 63.6 and for men 59.7 (to compare, this is 81 and 76 for Americans).
The top two exports in Burundi are Gold and coffee (ok the gold one surprised me).
The Institute for Health Metrics and Evaluation (IHME) provides evidence based data on global health metrics. They track global burden of disease and have a tool where you can plug in a country and get a snapshot of what is happening health and disease wise. This data is from 2019 but still relevant.
Here is a look at all cause mortality for all ages and sexes in Burundi:
Diarrheal disease is the number one cause of mortality for all ages and sexes at 11.8%, followed by: Neonatal deaths (10.6%), Tuberculosis (10.4%) and Malaria (8.7%).
Note: communicable disease are in pink, non communicable diseases in blue, and injuries in green.
How about if we look at Mortality in women age 15-49:
Maternal mortality is number one at a shocking 18.2% (for comparison in the U.S this number is 1.2%). The high rate of communicable disease (in pink) jumps out at me- but as a primary care provider the rates of cervical cancer are also astonishing- especially considering that this is a preventable and treatable disease with routine pap smears and the HPV vaccine.
As a comparison lets look at the burden of disease in a high income country- this is mortality for all sexes ages 15-49 in the United States:
Drug use is number one at 21% followed by self harm at 10% (if this is not indicative of a mental health crisis- yikes!).
Note the high burden of non communicable diseases in blue (as compared to the majority pink or communicable diseases that we saw in Burundi). Going from low to high income countries you will see this shift in burden of disease.
What about older burundians?
As Burundians age, you will see an increase in non communicable diseases (in blue). The communicable diseases are still present but ischemic heart disease (IHD) and stroke start to emerge.
And the under five…
Neonatal disorders lead at almost 30%, followed by diarrheal disease and malaria both at 19%.
Under 5 mortality and maternal mortality are strong indicators of the overall wellbeing and health of a country. If you can’t keep these two vulnerable populations alive then it does not bode well for the country or health system.
A global view on under 5 mortality- over represented in subsaharan africa.
But mortality is not the only metric! There are plenty of things that won’t kill you but can cause significant morbidity and affect quality of life. This is where the YLD’s and DALY’s come in!
YLD: Years lived with disability. Kind of a weird metric used in research because it takes the prevalence of a condition and gives it a disability weight that is scored zero to one. Where zero is fully healthy and one is death. For example: blindness has a disability weight of 0.187 and chronic mild low back pain has a weight of 0.020. Some of the numbers are interesting. If you have both arms amputated with no treatment or prosthetic the disability weight is 0.383 and migraines regardless of severity are 0.441 —> so migraines are weighted higher than having no arms… interesting.
DALY: Disability adjusted life years. DALYs are calculated by adding together the years of life lost (YLLs) and years lived with disability (YLDs). One DALY is equal to one year of healthy life lost.
The graph below is years lived with disability for all sexes age 15-49 in Burundi.
YLD’s- not surprising is conflict and terrorism at almost 20%, followed by depression at 7.9%. The mental health toll that years of conflict* inflicts is evident.
*Burundians are no stranger to conflict and genocide. After the assassination of the first democratically elected president in 1993 there was widespread ethnic violence- and again in 2005 nearly 200,000 Burundians were killed in an ethnic civil war.
Want to give it a try? Check out the IHME burden of disease tool here!
You can also get a country profile which gives a nice concise overview of a particular country.
The World Bank has more data on social and economic factors by country.
Take a dive in the data!! Did any other health trends stick out to you? Drop a comment below!
#GlobalHealth
And now for that music video….
