Monetary value of disability-adjusted life years lost from all causes in Mauritius in 2019 [version 1; peer review: awaiting peer review]

Background: The Republic of Mauritius had a total of 422,567 disability-adjusted life years (DALYs) from all causes in 2019. This study aimed to estimate the monetary value of DALYs lost in 2019 from all causes in Mauritius and those projected to be lost in 2030; and to estimate the monetary value of DALYs savings in 2030 if Mauritius were to attain the national targets related to five targets of the United Nations Sustainable Development Goal 3 on good health and well-being. Methods: The human capital approach was used to monetarily value DALYs lost from 157 causes in 2019. The monetary value of DALYs lost in 2019 from each cause was calculated from the product of net gross domestic product (GDP) per capita in Mauritius and the number of DALYs lost from a specific cause. The percentage reductions implied in the SDG3 targets were used to project the monetary values of DALYs expected in 2030. The potential savings equal the monetary value of DALYs lost in 2019 less the monetary value of DALYs expected in 2030. Results:  The DALYs lost in 2019 had a total monetary value of Int$ 9.46 billion and a mean value of Int$ 22,389 per DALY. Of this amount, 84.2% resulted from non-communicable diseases; 8.7% from communicable, maternal, neonatal, and nutritional diseases; and 7.1% from injuries. Full attainment of national targets related to the five SDG3 targets would avert DALYs losses to the value of Int$ 2.4 billion. Conclusions: Diseases and injuries cause a significant annual DALYs loss with substantive monetary value. Fully achieving the five SDG3 targets could save Mauritius nearly 8% of its total GDP in 2019. To achieve such savings, Mauritius needs to strengthen further the national health system, other systems that tackle the social determinants of health, and the national health research system. Open Peer Review Reviewer Status AWAITING PEER REVIEW Any reports and responses or comments on the article can be found at the end of the article. Page 1 of 24 F1000Research 2021, 10:63 Last updated: 05 AUG 2021


Introduction
The Republic of Mauritius is one of 16 Southern African Development Community (SADC) member states 1 .It had an estimated population of 1.279 million people; gross domestic product (GDP) of International dollars (Int$) 30.171 billion; and GDP per capita of Int$ 23,818.571 in 2019 2 .In 2017, the country had a high human development index (HDI) of 0.79, and the income inequality Gini coefficient was 35.8 3 .
Figure 2 depicts the share of DALYs by 22 disease categories in 2019.About 26.7% of the NCD DALYs resulted from diabetes and kidney diseases; 20.7% from cardiovascular diseases; 11% from neoplasms; 8.4% from musculoskeletal disorders; 6.3% from mental disorders; 5.7% from neurological disorders; 4.2% from chronic respiratory diseases; 3.9% from sense organ disease; 3.8% from digestive diseases; 2.2% from skin and subcutaneous diseases; 1.9% from substance use disorders; and 5.2% from other NCDs 4 .Nearly 47.4% of the NCD-related DALYs were attributed to diabetes and kidney diseases, and cardiovascular diseases.
Development Goals (SDGs) and 169 targets.The SDG3 on ensuring healthy lives and promoting wellbeing for all at all ages has 13 targets.The following five of these SDG3 targets are intended for reducing the abovementioned disease burden 6 : Source: Generated by authors using data from the Global Burden of Disease CollaboraƟve Network [4].95  Target 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births.
Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and wellbeing.
Target 3.6: By 2020, halve the number of global deaths and injuries from road traffic accidents' (p.14).
The current health expenditure per capita (CHEPC) in Mauritius was US$ 600 in 2017 7 .It consisted of the domestic general government health expenditure of US$ 257 per capita; domestic private health expenditure of US$ 338 per capita (of which US$ 293 was from out-of-pocket spending); and external health expenditure of US$ 5 per capita.The Mauritius CHEPC was within the range of US$ 297 (minimum) and US$ 984 (maximum) per year of health systems investment recommended for attaining SDG3 among upper-middle-income economies 8 .The fact that out-of-pocket payments (OOPS) constitute 49% of CHEPC is a matter of concern because, according to the World Health Organization (WHO) 9 , when OOPS exceed 20% of total health expenditure, the incidence of financial catastrophe and impoverishment increases.Between 2012 and 2018, the population with households with health expenditures exceeding 25% of total household expenditure (or income) grew slightly from 1.79% to 1.8% 10,11 .
The Mauritius domestic general government health expenditure is 10% of general government expenditure, which is below the African Heads of State and Government 2001 target of allocating at least 15% of the national budget to health development 12 .Furthermore, in 2017, the Mauritius CHEPC of US$ 600 (2% of GDP) was about seven-fold lower than the average of US$ 4,003 (9% of average GDP per capita) for Organisation for Economic Co-operation and Development countries 13 .As a result, Mauritius has a universal health service coverage index (UHSCI) of 63 (on a scale of 0 to the target of 100), denoting a gap in essential health services coverage of 37 14 .The deficit in the UHSCI was attributed to suboptimal component scores of 69 in reproductive, maternal, newborn, and child health; 53 in infectious diseases; 52 in NCDs; and 80 in service capacity and access 14 .
Embracing the principles of a welfare state, Mauritius ensures the provision of free healthcare at the point of use in all public facilities.Steady economic growth over the last decade has enabled the national economy to sustain social protection systems, including health 10,15 .To attain SDG3, Mauritius needs to sustainably increase its investments in the national health system and other systems that address the social determinants of health 16 .The health sector will have to keep on competing for scarce budgetary allocations with economic sectors.Thus, the health and health-related sectors ought to mount sustained evidence-based advocacy within the government and the private sector to sustain, grow, and efficiently utilize funding for health development to bridge the existing gap in access to essential health services.
People who control the national resources in the public and private sectors are not public health experts 17 , and thus, they might not fully understand the intricacies around the negative impact of disability and premature mortality (from various causes) on economic indicators, such as GDP.Therefore, health sector stakeholders will have to couch their advocacy messages in a language that those who control national resources can understand [17][18][19] .
Evidence from the economic burden of disease studies in both economically developed and developing countries continues to be used to advocate for increased investments in health development [20][21][22][23][24][25][26][27][28][29][30][31][32][33] .The WHO Regional Office for Africa (WHO/AFRO) report titled A Heavy Burden: The Productivity Cost of Illness in Africa, contains useful aggregated economic evidence for use in advocacy at global and regional forums 34 .However, it is of limited usefulness to individual countries for two reasons: (a) it is not disaggregated by country and disease; and (b) the analysis is based on 2015 DALYs data.Mauritius policymakers require updated and contextualized economic evidence for use in making a case for increased investment in health development.

The DALYs
The seminal application of DALYs to measure the global burden of disease was in 1993 in the World Bank report titled World Development Report 1993: Investing in Health, which 'examined the interplay between human health, health policy, and economic development' (p.iii) 35 .However, it was only in 1994 that Professor CJL Murray developed and published in the Bulletin of the World Health Organization the conceptual basis for the DALYs 36 .He defined DALY as the sum of potential years of life lost (PYLL) due to premature death and years lived with disability (YLD).
WHO 37 further explains that DALYs for a specific cause are calculated using the following formula: DALY (c,s,a,t) = PYLL (c,s,a,t) + YLD (c,s,a,t) for a specific disease or injury c, age a, sex s, and year t.
Even though debate has been ranging since 1996 about various real and perceived shortcomings of the DALYs [38][39][40][41] , it has withstood the test of time and continues to be a useful metric in global health discourse 42 .
In this study, we calculate the monetary value of DALYs lost in Mauritius in 2019 from all 157 causes.The DALYs data are from the Institute for Health Metrics and Evaluation (IHME) global burden of disease (GBD) Study 2019 database 4 .Methodological details and sources of data used in the GBD study 2019 are from an article published by the GBD 2019 Diseases and Injuries Collaborators 43 .

Estimating the monetary value of DALYs lost in Mauritius in 2019
This study replicates the human capital approach initially suggested by Weisbrod 44 , and subsequently, adapted to financially value DALYs in Kenya among the elderly 45 and all age groups 46 , the Arab Maghreb Union (AMU) 47 , the Central African Economic and Monetary Community (CEMAC) 48 , the East African Community (EAC) 49 , Zambia 50 , and the African region 34 , to estimate the economic value of DALYs lost in 2019 in Mauritius.The development of healthrelated human capital begins at birth and ends at death; and thus, diseases have inter-and intra-generational negative impact on the process of human capital creation 43 .
According to Weisbrod 44 , 'The present value of a man at any given age may be defined operationally as his discounted expected future earnings stream net of his consumption …' (p.427).GDP per capita is sometimes used as an indicator of an individual's economic contribution per year.Any loss of DALYs erodes GDP through its components of consumption of household goods and services, investment (from savings), government spending (from taxes and service fees), and net exports (i.e. exports minus imports).The WHO 51 clarifies that 'GDP includes expenditure on health goods and services, so this component should be omitted and the focus of analysis be redirected towards establishing the present value of discounted aggregate flows of current and future consumption of non-health-related goods and services linked to disease' (p.4).As further explained by the WHO 51 and Chisholm et al. 52 , individuals do not derive utility (pleasure or happiness) from consumption of health goods and services, but from consumption of non-health consumption commodities (goods and services), leisure time, and health status.Thus, it has become common practice to use net GDP (i.e.GDP per capita minus health expenditure per person) in the valuation of DALYs 34,[45][46][47][48][49][50] .
The total monetary value of DALYs lost in Mauritius from 157 causes (TMOVD) is the sum of the monetary value of DALYs lost from each i th disease or injury (MOVD i ) [45][46][47][48][49][50] , denoted arithmetically as where is the summation of monetary values of DALYs lost from the 1 st to the 157 th cause; MOVD 1 is the monetary value of DALYs lost from the 1 st disease; MOVD 2 is the monetary value of DALYs lost from the 2 nd disease; MOVD 3 is the monetary value of DALYs lost from the 3 rd disease; and MOVD γ is the monetary value of DALYs lost from the γ th disease.
The monetary value of DALYs lost from each of the 157 diseases is equal to the number of DALYs lost from each disease (DALY i = 1, . ., γ ) multiplied by Mauritius GDP per capita (GDPPC) minus CHEPC [45][46][47][48][49][50] , denoted algebraically as where DALY 1 is the number of DALYs lost from the 1 st disease, DALY 2 is the number of DALYs lost from the 2 nd disease, DALY 3 is the number of DALYs lost from the 3 rd disease, and DALY γ is the number of DALYs lost from the γ th disease.The DALYs acquired from the IHME GBD Study 2019 database are already discounted at 3% 43 .
The reductions in the monetary value of DALYs lost from maternal disorders (SDG3 target 3.1), neonatal disorders (SDG3 target 3.2), HIV/AIDS (SDG 3 target 3.3a), TB (SDG3 target 3.3b), NTDs (SDG3 target 3.3c), viral hepatitis (SDG3 target 3.3d), NCD (SDG3 target 3.4), and transport injury (SDG3 target 3.6) are estimated using the form of equations below.For example, the equation used in estimating the SDG3 target 3.1 envisages a reduction in the monetary value of DALYs from maternal disorders (MD) as follows: where Calculate the potential monetary savings from DALYs lost averted By subtracting the monetary value of DALYs lost in 2019 from the monetary value of DALYs lost in 2030 from the i th disease (or injury), we obtain the potential savings in the monetary value of DALYs, assuming that the i th SDG3 disease (or injury) target is fully accomplished [45][46][47][48][49][50] .For example, the projected savings in the monetary value of DALYs lost from NTDs is estimated as follows:

Data sources
The DALYs data for the 157 causes are from the IHME GBD study 2019 database 4 ; the CHEPC data are from the WHO Global Health Expenditure Database 7 ; and the 2019 per capita GDP data are from the IMF World Economic Outlook database 2 .A summary of the data analysed can be found in the Extended data 60 .

Data analysis
The analysis is conducted using Excel Software developed by Microsoft (New York) 61 .It is undertaken in seven steps.
Step 1: Construct economic model on Excel software The economic model containing the equations is developed on an Excel spreadsheet.
Step 2: Collate DALYs data The 2019 data on DALYs lost from 157 causes are extracted from the IHME GBD 4 and saved in an Excel spreadsheet.
The data are then sorted by the three broad categories of health conditions (i.e.NCDs, CMNND, and INJ).Then, the 157 causes are organized under the relevant broad category.
Step 3: Collate health expenditure data The Mauritius 2017 CHEPC of Int$ 1,278.01147461was from the WHO Global Health Expenditure Database 7 .The latest expenditure data available are for 2017, and thus, it is necessary to project the CHEPC for 2019 (the baseline year of the analysis) in three sub-steps: Step 3: Collate per capita GDP data The Mauritius GDP per capita (GDPPC) of Int$ 23,818.571 in 2019 is from the IMF World Economic Outlook Database 2 .
Step 4: Calculate non-health per capita GDP Non-health GDP per capita is estimated as the difference between GDP per capita and CHEPC.The non-health per capita GDP (NHGDPPC) = GDPPC -CHEPC = Int$ 23,818.571-Int$ 1,429.63534738949= Int$ 22,388.9356526105.
Step 5: Estimate 2019 monetary value of DALYs lost from each cause The monetary value of DALYs lost from a specific cause i equals the number of DALYs lost multiplied by non-health per capita GDP 61 .For example, the monetary value of DALYs from neonatal disorders (MOVD ND ) is estimated as follows: Step 6: Project 2030 potential monetary value of DALYs lost from SDG3-related causes All the abbreviations are as defined earlier.
Step 7: Estimate the savings in the monetary value of DALYs We obtain the potential savings in the monetary value of DALYs lost prevented, assuming that the i th SDG3 (or national) disease target is fully realized, by subtracting the monetary value of DALYs lost in 2019 from the monetary value of DALYs projected to be lost in 2030 from the i th disease.We demonstrate, using target SDG 3.2 on neonatal disorders, how savings for all the SDG3-related causes are estimated:  64 .
The monetary value of DALYs in 2019 from five SDG3 related targets Table 2 shows that the five SDG3-related health conditions analysed in this study resulted in 387,235 DALYs in 2019 with a value of Int$ 8.67 billion, which is 91.6% of the national total monetary value from all causes.About 97.24% of the monetary value of SDG3-related DALYs was attributed to NCDs, neonatal disorders, and transport injuries.
Estimates of reductions in the monetary value of DALYs in Mauritius between 2020 and 2030 assuming the five SDG3-related targets are attained Table 3 shows the monetary value of DALYs in 2019, the monetary value of DALYs lost in 2030, and the potential savings from DALY losses prevented assuming that the five disease-related SDG3 targets analysed in this study are attained.

Late Neonatal
Post Neonatal   49 .In Kenya, about 56.6%, 35.9%, and 7.4% of the total monetary value of DALYs was ascribed to CMNND, NCDs, and INJ, respectively 46 .In Zambia, 62.5%, 31.2%, and 6.3% was attributed to CMNNDs, NCDs, and INJ, respectively 50 .Therefore, it is evident that the lion's share of the monetary value of DALYs lost in Mauritius was from NCDs, unlike in the AMU, CEMAC, EAC, Kenya, and Zambia, where CMNNDs dominated.
The diseases and injuries related to SDG 3 targets 3.1-3.4and 3.6 caused DALY loss valued at Int$ 8.67 billion, that is, 91.6% of the total monetary value of DALYs lost in Mauritius.We found that full attainment of the five targets would yield an estimated Int$ 2.4 billion saving in monetary value of SDG-related DALYs lost by 2030.This saving is about 27.7% of SDG-related DALYs.

SDG Targets 3.1 and 3.2: Maternal and neonatal disorders
Attainment of the national targets related to SDG3 targets 3.1 and 3.2 by 2030 would avert DALYs with a monetary value of Int$ 109.9 million.The projected savings could be achieved assuming full implementation of the national sexual and reproductive health policy 65 , the health sector strategic plan 2020-2024 53 , the sexual and reproductive health strategy and plan of action 66 , and the white paper on health sector development and reform 67 .The existing national legal framework in underpins the implementation of those policy and strategic documents 68 .
The formulation and implementation of the national policy and strategies are buttressed by the SADC strategy for sexual and reproductive health rights 69 ; the SADC regional gender-based violence strategy and framework for action 70 ; the AU ministers of health commitments on universal health coverage 71 and ending preventable maternal and child deaths in Africa 72 ; the AU Assembly decision on progress on maternal, newborn, and child health 73 ; and the AU Assembly declaration on addressing social determinants of health using health in all policies approach 74 .
Mauritius' efforts to reduce child and maternal morbidity, disability, and deaths are informed and supported by various pertinent WHO Governing Bodies resolutions, for example, the Regional Committee for Africa strategic plan for immunization 75 and its resolution 76 ; the World Health Assembly (WHA) resolution on reduction of perinatal and neonatal mortality 77 ; the global vaccine action plan 78 and related WHA resolution 79 ; and the global strategy for women's, children's, and adolescents' health 2016-2030 80,81 plus the associated WHA resolution 82 .
The UNGA resolutions on the rights of the child 83,84 and preventable maternal mortality and morbidity and human rights 85 provide high-level political backing for full implementation of Mauritius' policies and strategies.Therefore, the full attainment of target 3.3 could enable Mauritius to save DALYs with a total monetary value of Int$ 125.6 million.These savings are achievable if the following plans are made universally accessible to all people in need: communicable disease prevention and control services planned in chapter 7 of the Mauritius health sector strategy 53 ; the national HIV and AIDS policy 86 ; the national HIV action plan 87 ; and the national multi-sectoral HIV and AIDS strategic framework 88 .The implementation of pertinent policies, strategies, and plans is augmented with the national legal framework 68 .
Mauritius' battle against HIV/AIDS, TB, and hepatitis is also guided by the SADC strategy for HIV prevention, treatment, and care and sexual and reproductive health 89 ; the framework for the prevention and control of sexually transmitted infections 90 ; the strategic plan for the control of TB 91 ; and the advocacy strategy on HIV/AIDs, TB, and sexually transmitted infections 92 .
Moreover, communicable disease control policies, strategies, and plans in Mauritius and the SADC are informed and reinforced by the WHO Governing Bodies documents and resolutions, including the end TB strategy 57 ; the global health sector strategy on HIV 56 ; the HIV/AIDS strategy for the African Region 93 and resolution AFR/RC62/R2 94 ; the global health sector strategy on viral hepatitis 59 ; the framework for action on prevention, care and treatment of viral hepatitis in the African region 95 and resolution AFR/RC64/R5 96 ; the global health sector strategy on sexually transmitted infections 97 ; NTDs 98 ; the regional strategy on NTDs in the WHO African Region 99 and its resolution AFR/RC63/R6 100 ; the global vector control response strategy 58 and its resolution WHA70.16 101; the regional strategy for integrated disease surveillance and response 102 and its draft resolution AFR/RC69/WP2/Rev1 103 ; and the health promotion strategy for the African region 104 and resolution AFR/RC62/R4 105 .

SDG Target 3.4: Non-communicable diseases
We estimate that Mauritius could avert DALYs worth Int$ 1.95 billion if it successfully decreases the NCD burden by 24.4% between 2020 and 2030.Such savings can be realized if Mauritius were to make accessible, to everyone in need (i.e. with the capacity to benefit), the prevention and control health interventions and services planned in the health sector strategic plan 53 ; the national sport and physical activity policy 116 ; the national cancer control programme action plan 117 ; and the national action plan on tobacco control 118 .The implementation of NCD strategies and plans is supported by the set of national legislation 68,119 ; and the UNGA Political Declaration on the prevention and control of NCDs as well as the AU commitment on NCDs 120,121 .
The Mauritius NCD strategies and plans were partially informed by various WHA and RC resolutions on global strategy for the prevention and control 122 and its resolution WHA53.17 123; the global action plan for the prevention and control of NCD 124 and its endorsing resolution WHA66.10 125 ; the global action plan on the public health response to dementia 126 and related resolution WHA70(17) 127 ; the comprehensive mental health action plan 128 and its resolution WHA66.8 129 ; the WHO Framework Convention on Tobacco Control 130 and related resolution WHA53.16 131; strategies to reduce the harmful use of alcohol resolution WHA61.4 132 ; cancer prevention and control resolution WHA70.2 133 ; the global action plan 2014-2019 on universal eye health 134 and its resolution WHA66.4 135 ; the global action plan on physical activity resolution WHA71.6 136 ; the NCD regional strategy for the African region 137 and its resolution AFR/RC50/R4 138 ; the Brazzaville declaration on NCD prevention and control in the African region 139 and its resolution 140 ; the strategic plan to reduce the double burden of malnutrition 141 and its resolution AFR/RC69/WP1/Rev1 142 ; the regional oral health strategy 143 and the resolution AFR/RC66/R1 144 ; and the health promotion strategy for the African region 104 and its resolution AFR/RC62/R4 105 .
The UNGA Declaration on NCDs 145 , ageing 146,147 , food 148 , and nutrition 149 commits the Mauritius government to provide high-level political leadership and requisite resources to prevent and control NCDs.

SDG Target 3.6: Road injuries
Mauritius could avert DALYs with a monetary value of Int$ 214.4 million if it were to successfully reduce road injuries by 99.9% between 2020 and 2030.With a view to realizing those potential savings, related to the attainment of SDG target 3.6, the government would need to fully implement its national road safety strategy 2016-2025, whose overarching objective is to achieve a 50% reduction in the number of non-fatal injuries and deaths by 2025 150 .The strategy has 10 strategic fields of action, namely, improving safety standards of road infrastructure; reorganising control of roadworthy vehicles; strengthening of road traffic law and enforcement; re-engineering of the driving licensing scheme; improving medical testing of fitness to drive; provision of post-crash trauma care; starting a road safety academy; creating a transport and road safety research and development programme; launching an effective education and communication strategy; and funding implementation of the road safety strategy 150 .The institutions mandated by the Road Traffic Act to spearhead the implementation of the strategy are the National Transport Authority and National Road Safety Council 151 .
The development of Mauritius' national road safety strategy was informed by the AU road safety charter 152 , the AU road safety action plan 2011-2020 153 , the WHO global plan for the decade of action for road safety 154 , the WHO global 2018 status report on road safety 155 , the 69 th WHA resolution on the outcome of the second global high-level conference on road safety 156 , and the status report on the implementation of the decade of action for road safety in the African region 157 .

Limitations
This study has limitations related to the GDP calculations, the human capital approach, and the DALYs index.
Limitations in GDP calculations: The per capita GDP was used in this study as a numeraire for converting DALYs lost into their monetary equivalent.The current systems of national accounts measure GDP without considering unpaid household production (e.g.full-time homemakers' services in a household, including cooking, cleaning, childcare, and nursing ailing household members) and leisure; or the contribution of the elderly in reconciling differences among family members (social cohesion) and transmitting community values and indigenous knowledge to children and youth 163 .The index also does not capture the adverse effects of economic production processes on the environment, animal health, and human health 164 .Moreover, GDP does not account for inequalities in the distribution of income and wealth across households and individuals 165 , and its growth does not indicate whether the societal quality of life has improved 166 .
Limitations in the human capital approach: Strictly applied, the use of the human capital approach would have confined the analysis only to marketed production and working population.Therefore, DALYs lost within the age groups below the minimum legal age for working 167 and above retirement age of 60 years and above 168 would have been monetarily valued at zero.Furthermore, the DALYs lost among people who cannot work due to disability would be valued at zero.However, since the constitution of Mauritius 68,119 , the constitution of the WHO 169 , and the UN Universal Declaration of Human Rights 170 prohibit discrimination against any person, we value every DALYs lost (irrespective of age group) at the same non-health GDP per capita.Our approach is consistent with the lifetime income-based approach developed and applied by Jorgenson and Fraumeni [171][172][173][174] in the context of education-related human capital.
Limitations in the DALYs calculations: We summarize some of the limitations, already discussed by the GBD Study, that are inherent in the calculation of the two components (YLD and YLL) of the DALYs.According to the GBD 2017 Mortality Collaborators 175 , the mortality data used 'include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites' (p.1684).Some of the limitations include the use of sibling history data, which may introduce survivor bias and recall bias; estimates of the completeness of vital registration are based on the use of uncertain death distribution methods; and they cannot capture all fatal discontinuities 176 .Unlike the rest of the WHO African region, where the completeness of the primary cause of death data is 6% owing to fragile vital registration systems, in Mauritius, the proportion is 100% 11 , meaning that mortality estimates are likely to be more accurate than in the rest of the region.
According to the GBD 2017 Disease and Injury Incidence and Prevalence Collaborators 176 , 'YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity' (p.1789).Some of the limitations highlighted by authors include the fact that even though comorbidity distributions are known to vary by cause, age, sex, location, and time, the comorbidity adjustment in GBD 2017 assumes independent distributions of comorbid conditions.In addition, calculations of GBD for some causes depend strongly on clinical data, which are prone to selection bias for segments of the population that have disproportionate access to health services 176 .
In the DALY calculations, the GBD 2017 DALYs and HALE Collaborators 42 assume independence of uncertainty between YLLs and YLDs, even though this assumption may lead to underestimation of the total uncertainty for DALYs.The authors also highlight that DALY estimates are influenced by the availability of data for YLL and YLD estimations.The benefits of publishing with F1000Research:

MOVD ND
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MOVD
NTDs SAVING ¼ Int 113, 021,138 À Int 50, 859,512Þ ¼ Int 62,161, 626: ð where MOVD NTDs SAVING is the probable saving in the monetary value of DALYs lost to NTDs by 2030; MOVD NTDs2019 is the monetary value of DALYs lost to NTDs in 2019; and MOVD NTDs2030 is the monetary value of DALYs anticipated to be lost from NTDs in 2030.

Figure 3 .Figure 4 .Figure 6 .
Figure 3. Monetary value of DALYs from all causes by age group in Mauritius (Int$ 2019)

Table 1 .
53alth SDG3 targets and expected percentage reductions for MauritiusBy 2030, reduce the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births6.Mauritius in 2019 had an MMR of 62 per 100,000 live births, that is, SDG 3.1 was exceeded53.The country set an MMR target of 35 per 100,000 live births by 202453.

Table 1 .
ContinuedWe use an example of neonatal disorders to illustrate how the 2030 monetary value of DALYs lost from each of the SDG3 causes is projected: 624, 973 À 144, 037,848 ¼ Int 103,227, 124: In 2019, Mauritius lost a total of 422,566.58DALYsfromallcauses 4 valued at Int$ 9,460,815,967, and with a mean value of Int$ 22,389 per DALY.About 84.2% resulted from NCD, 8.7% from CMNND, and 7.1% to INJ.Figure4presents the monetary value of DALYs from CMNND.Out of the total monetary value of DALYs from CMNND of Int$ 823.47 million, 31.2% ensued from maternal and neonatal disorders; 21.6% from respiratory infections and TB; 13.7% from NTDs; 12.8% from HIV/AIDS and sexually transmitted infections; 10% from nutritional deficiencies; 6.9% from enteric infections; and 3.8% from other infectious diseases.About Int$ 642 million (78%) accrued to DALYs from neonatal disorders, lower respiratory infections, HIV/AIDS, schistosomiasis, and dietary iron deficiency.The detailed monetary value of DALYs per CMNND health condition is contained in the Extended data62.
Figure 3 portrays the monetary value of DALYs accruing to all causes by age.People aged 14 years and lower sustained DALYs with a value of Int$ 575,675,182 (6.1%); 15-59-year-olds bore DALYs valued at Int$ 4,687,590,169 (49.5%); and those aged 60 years and above incurred DALYs valued at Int$ 4,197,550,617 (44.4%).InjuriesFigure6depicts the monetary value of DALYs from various forms of injuries in Mauritius.The 29,876 DALYs from injuries had a total monetary value of Int$ 668.9 million.Out of the latter estimate, Int$ 225.9 million (33.8%) accrued to transport injuries; Int$ 266.7 million (39.9%) to unintentional injuries; and Int$ 176.3 million (26.3%) to self-harm and interpersonal violence.About Int$ 531.3 million (79.4%) of the total monetary value of DALYs associated with injuries emanated from road injuries (32.1%), self-harm (19.1%), falls (15.3%), interpersonal violence (7.2%), and drowning (5.7%).The monetary value of DALYs by each type of injury can be found in the Extended data 48scussionKey findings and comparison with similar studiesIn 2019, Mauritius lost a total of 402,565 DALYs from all causes with a total monetary value of Int$ 9.46 billion.About 84.2% of the latter was attributed to NCDs, 8.7% to CMNNDs, and 7.1% to INJ.By comparison, 67.3%, 21.9%, and 10.8% of the total monetary value of DALYs lost in the AMU emanated from NCDs, CMNNDs, and INJ, respectively47.Approximately 61.3%, 28.4%, and 10.3% of the total monetary value of DALYs lost in the CEMAC was due to CMNNDs, NCDs, and INJ, respectively48.In the EAC, approximately 58.2%, 30.3%, and 11.5% of the total monetary value of DALYs lost in 2015 was attributed to CMNNDs, NCDs, and INJ, respectively

Table 2 .
Monetary value of DALYs in 2019 from five SDG3-related targets in Mauritius (2019 Int$) SDG Target 3.3: HIV/AIDS, TB, acute hepatitis, and neglected tropical diseases The achievement of national targets for SDG target 3.3 by 2030 would avert DALYs with a monetary value of Int$ 53.45 million from HIV/AIDS, Int$ 9 million from TB, Int$ 0.97 million from acute hepatitis, and Int$ 62.2 million from NTDs.