British medical journal The Lancet published a report on Thursday, October 21, 2010, that concluded World Health Organization (WHO) estimates of malaria deaths in India are hugely underestimated. It said WHO numbers are misleadingly low. According to the WHO, about 15,000 die of malaria (5,000 early childhood and 10,000 thereafter) each year in India. Whereas the survey funded by the U.S. National Institutes of Health, Canadian Institute of Health Research and Li Ka Shing Knowledge Institute put the figure at as high as 205,000 each higher, nearly 13 times more estimates than that of WHO.
Deaths at Home
The Lancet said most deaths in rural India take place at home rather than at health centers. So, it argues, most cases are undiagnosed due to absence of health personnel. The cases of malarial deaths reported by Indian government are centered primarily in a few states, called high-malaria states: Orissa, Chhattisgarh, Jharkhand and the states in the northeast India.
Malaria deaths in India are prevalent in tribal areas due to unavailability of health care facilities. With no lab test facilities and meager if not nil transport facilities force the tribal people remain at home leaving them untested for malaria fever. They get treatment from uncertified rural medical practitioners who offer general treatment for every fever case.
Andhra Pradesh Case
Andhra Pradesh, one of the four southern states, is considered one of the wealth states in India. Five years back, the opposition leader and the leader of regional political party TDP, Mr. Chandrababu Naidu, toured tribal areas in North and Central Andhra regions and brought to light how the tribal people’s villages were reeling under the wave of malaria fever that had been left unattended until then. A local vernacular daily Andhra Jyothi also published several reports of malaria deaths in interior regions that were left unreported.
In the face of rapid privatization of health services and collection of user charges in Government Hospitals, under the strictures of the World Bank, poor people are deprived of health care even in towns and cities. Mosquitoes are uncontrollably high in all areas, which are fed by poor sanitation and unhygienic premises. This situation is common in all regions of India. Political corruption, lack of political motivation and insensitivity of administration and government people towards people’s problems further add further health hardships to the people.
The Lancet Findings
The Lancet study found that malaria caused 205,000 deaths every year before the age of 70, of which 55,000 occurring in early childhood, 30,000 between the age of 5 and 14 and 120,000 at ages 15 to 69. The study was conducted by trained field personnel. They interviewed families or other respondents about each of 122,000 deaths occurred during 2001-2003 in 6,671 randomly selected areas across the country.
“The data was sent to two to 130 ‘trained physicians,’ who independently coded underlying causes of deaths with discrepancies resolved via either anonymous reconciliation or adjudication,” according to The Lancet. Of all coded deaths 2,681 (3.6%) were attributed to malaria, of which 2,419 (90%) were took place in rural areas and 2,311 deaths not in any health care facility. The plausible lower and upper bounds were found to be 125,000 and 277,000. It implies even the lower bound is nowhere near to WHO figure of 15,000. The study comments, “Small studies in specific regions of India or in special sub-populations cannot directly estimate national numbers of malaria deaths.”
The director of global health care programme of WHO, Dr. Robert Newman, was quoted by BBC News as conceding that WHO current methods have their limitations, but expressed serious doubts about the high estimates from The Lancet study. He opined verbal autopsy was not a credible method of counting malaria deaths as the disease shared several of its symptoms with many other common causes of acute fever.
However, WHO has to agree with the general fact that the deaths due to epidemics are severely under-reported given the track record of the Indian national and provincial governments in addressing health issues of the people.