Estimation of State and district-specific disability adjusted life years (DALYs) due to tuberculosis for Kerala, India, 2017-2020.

Background & objectives Tuberculosis (TB) control programmes routinely use indicators like incidence and mortality. A single indicator, like disability-adjusted life years (DALYs) may yield a more comprehensive burden estimate. This study attempted to estimate the state and district-specific TB burden in Kerala. Methods The sole data source for these computations was the Ni-kshay, notification register for 2017 to 2020, Kerala. Age of the patient and outcome are available in the register. Notified incident TB/1000, the median age of onset of TB, case fatality due to TB, and the median age of mortality were computed using SPSS software. DALYs was calculated using the DALYs package of the R program, using these input parameters. Disability weight was taken as 0.333. The absolute and relative DALY/100,000 population was estimated along with the 95% confidence interval (CI). Results Relative DALYs was highest in 2019 at 1482/100,000 and lowest at 1124/100,000 in the year 2020 during the period 2017 to 2020. The districts, which had the highest incidence were not the same as those with the highest DALYs. Ernakulam and Thrissur districts had the highest burden and Idukki had the least burden. Interpretation & conclusions DALYs estimates for Kerala showed an increasing trend before 2020, which could be due to the increased efforts to detect TB as part of the elimination drive. The study points towards the need for using DALYs as a measure for prioritizing districts for resource allocation.