The new figures, arrived at through a method called ‘verbal autopsy’, put the annual malarial deaths in India at 2,05,000, out of which 120,000 are aged between 15 and 69, and more than 80,000 are children.
As much as 90 per cent of the deaths occur in rural areas and 86 per cent within the confines of homes and outside of medical care. If detected in time, most of these deaths — occurring mainly in Orissa, Chhattisgarh, Jharkhand, Assam and other eastern pockets — can be averted.
The researchers actually provide a range with a lower (125,000) and upper estimate (277,000) of the death count. Going by the figures, even the lower estimate is 13 times more than the WHO numbers. “The WHO estimates of malaria deaths in India are likely to be serious underestimates. It should be reconsidered as it could substantially change the disease control strategies,” they reported in the prestigious medical journal “The Lancet” on Thursday.
But within hours, the WHO retorted saying it has “serious doubts” on the estimate and methods used to derive it and the findings could not be accepted without further validation.
While the national malaria programme detects only about 1,000 deaths out of those who go to the hospital, the WHO estimates that malaria causes only about 15,000 deaths every year in India — 5,000 children and 10,000 adults. Both estimates have their limitations.
The public health researchers, led by Prabhat Jha from the University of Toronto, used a different method. Since most deaths in rural India happen at homes and outside medical attention, they used “verbal autopsy” in which trained government interviewers visited randomly selected homes in 6,671 localities accounting for 122,000 deaths between 2001-2003.
The data collected by this “million death study” undertaken by the Registrar General of India (RGI) was analysed — first by the RGI doctors and secondly by Jha and his team — to show malaria kills 13 times more people than was estimated by the WHO, the researchers said. “If you don’t know where the fire is, you don’t try to put it out. Our data shows one malaria death in every three minutes. The method (verbal autopsy) is by no means perfect, but it is pretty good as a public health tool,” Jha said.
“There is increasing evidence that the scale of the problem has been greatly underestimated. The study gives the WHO and the Indian authorities a pause for thought,” said three independent scientists from the University of Oxford, in a comment in the same issue.
Asked about the WHO criticism of the method, Jha told the Deccan Herald: “The reality is that for poor, often rural populations, verbal autopsy, for all its shortcomings, remains the only practical option for measuring levels and trends in specific causes.”