Age stratified disability adjusted life year burden from infectious diseases in four African countries for equity oriented health planning

Abstract Introduction : Infectious diseases disproportionately burden sub-Saharan Africa, contributing 61.5% of global disability-adjusted life years in 2021. Age-stratified analyses are critical for equitable health planning but remain many a time underexplored. This study quantifies age-specific DALY burdens from infectious and parasitic diseases in Sierra Leone, Burkina Faso, Chad, and the Central African Republic, assessing inequalities to inform targeted interventions. Methods Using 2021 World Health Organization Global Health Estimates accessed via the WHO Health Equity Assessment Toolkit (HEAT, version 6.0), we conducted a cross-sectional analysis of disability-adjusted life years (DALYs) per 100,000 population across 19 age groups. Inequality metrics, including ratio, population attributable risk, and population attributable fraction, were calculated to evaluate age-based disparities in four countries with diverse epidemiological and health system contexts. Results CAR reported the highest overall national DALY rate (32,924.9 per 100,000 population), followed by Chad (23,180.9), Sierra Leone (20,679.0), and Burkina Faso (15,075.3). Infants (< 1 year) bore the heaviest burden, with CAR peaking at 313,956.5 DALYs (95% CI: 134,769.9–493,143.0). Inequality ratios (comparing infants to the least-affected age groups) ranged from 35.5 in CAR to 70.0 in Sierra Leone, reflecting extreme relative disparities, highlighting substantial relative disparities. Burkina Faso showed a negative PAR of -554.5 (95% CI: -1,171.8 to 62.9); however, the confidence interval included zero, indicating no statistically significant age-related inequality when measured by population-weighted impact measures. In Sierra Leone, Chad, and CAR, PAR estimates were centered at zero with confidence intervals encompassing zero, indicating no significant deviation from an equitable age distribution after accounting for population size. Conclusion This study applies WHO Health Equity Assessment Toolkit metrics to age-stratified DALY data across multiple sub-Saharan African countries, offering a framework to guide age-targeted interventions and monitor progress toward universal health coverage. The disproportionately high burden among infants, with DALY rates 35 to 70 times higher than the least-affected age groups and rising DALYs in older adulthood, highlights the need for age-targeted interventions. Integrating HEAT metrics into national surveillance can guide equitable resource allocation, advancing Sustainable Development Goals and universal health coverage.