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Malaria Much Bigger Killer In India Than We Thought

New studies show that malaria is a much bigger killer in India than we thought: Investigators said that each year about 205,000 people in India die from the disease, which is more than 13 times the current estimated by the World Health Organization (WHO), the public hand the health of the United Nations.

WHO is a controversial figure, saying that the methods used by researchers are not sufficiently reliable, but researchers said even with the uncertainty of trying to obtain reliable data in a country where most deaths occur at home without medical intervention, the WHO gross underestimate, and now should be reviewed.

You can read about research on co-lead author Dr. Prabhat Jha, and an international team of researchers from India, Canada and the UK, working on the Million Death Study in the 21 October issue of The Lancet.

Jha, director of the Center for Global Health Research (CGHR) in St. Michael's Hospital and the University of Toronto. He said in a statement that it is the first study to collect data on causes of death directly with communities across India.

"It shows that malaria kills more people than previously thought. Most of these deaths can be in several Indian states, where the most dangerous type of malaria parasite is common," he added.

Deaths from malaria are difficult to assess on a nationwide basis, because if reliably diagnosed, it is likely to be cured, leaving open to undiagnosed deaths attributed to other causes of fever.

Million Death Study (MDS) in India is a collaboration Registrar General of India sample registration System (SRS), a nationwide routine population surveys, in close partnership with CGHR, Indian Council of Medical Research, and other leading research centers in India and other countries.

MDS is a next life and death of 1.1 million households throughout India until 2014 and is collecting data on risk factors and causes of death for members of these households.

Data for the study came from non-medical field workers who interviewed family members and others to gather information about the causes of death for each of the 122,000 deaths that occurred in 2001 and 2003 in 6,671 randomly selected areas of India, each of which about 200 households.

The interviewer asked general and specific questions about the severity and course of any fever, and each paper was independently reviewed and coded by two trained physicians to identify the main causes. Any discrepancies were resolved or "anonymous conciliation or adjudication," the authors write.

After analyzing the recognized results, researchers estimated that malaria is approximately 205,000 deaths per year in India in the age of 70 years, with 55,000 of them are under the age of five, 30.000 in age from 5 to 14 years, and 120.000 at the age of 15 to 69 years.

This gave the cumulative probability of 1.8% die from malaria in the age of 70 years, the researchers wrote.

They argued that even plausible lower bound of their assessment, based on the initial coding only give the figure of 125,000 a year. They estimate an upper bound to lie about 277,000 deaths a year.

205,000 Indian deaths from malaria each year, 13 times the current 15,000 deaths estimated by WHO. This is even higher than the WHO estimate of mortality from malaria worldwide: 100.000 people per year, reports Reuters.

Dr Simon Hay of Oxford University in the UK is one of the founders of the Malaria Atlas Project. He wrote in an editorial accompanying the WHO estimates that are likely to exclude many cases where malaria symptoms develop quickly and have never seen a health worker.

He noted that these cases are effectively invisible to the health system of accountability. "

The researchers noted that 90 percent of deaths in the Indian their scores were in rural areas and 86 percent occurred at home without any medical assistance.

They found that the state of Orissa have been more deaths from malaria than any other Indian state, 50.000 a year. Other countries with high mortality due to malaria were also in eastern India: Chattisgarh, Jharkhand and Assam.

Jha and colleagues concluded that:

"Despite the uncertainty in respect of which an automatic fever deaths from malaria, even the lower limit is much higher than WHO estimates that only 15,000 deaths from malaria each year in India (5.000 infancy, 10.000, after it)."

They suggested that the WHO estimates should now be reconsidered, both for the Indian deaths and malaria worldwide.

If the evidence they believe to be under-estimates, it could "could significantly change the strategy to control the disease, especially in rural states with the highest burden of malaria", they added, also noting that more accurate estimates of mortality from malaria in India, Africa and other regions could set a more rational basis for inexpensive access to a community treatment for children and adults.

Dr. VM Katoch, who is the secretary of the Indian Department of Health Research and the Director General, Indian Council of Medical Research, said that the surprise in the new study, figures that "unlike AIDS or cancer, malaria is curable if the treatment is a matter of urgency. "

"We have a safe, effective and inexpensive drugs that can quickly cure malaria patients. We need quick access to medical facilities," he added.

Kenneth J Arrow, an economics professor at Stanford University and winner of the Nobel Prize in Economics in 1972, said:

"Artemisinin combination therapy highly effective and can be accessed at low prices to ensure affordable medicines for malaria.

"Treatment should be easily accessible to children and adults through public and / or private channels of distribution," he added.

Funds for the research came from the U.S. National Institutes of Health, Canadian Institute for Health Research, and Li Ka Shing Knowledge Institute of St. Michael's in Toronto.

"Adult and child deaths from malaria in India: representative survey of mortality." Neeraj Dhingra, Prabhat Jha, Vinod P Sharma, Alan Cohen, M Jotkar Raju, S Peter Rodriguez, Diego Bassani G, Wilson Suraweera, Ramanan Laxminarayan, Richard Peto, for millions of study co-author's death. Lancet, 21 October 2010 DOI: 10.1016/S0140-6736 (10) 60831-8


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