Fever pitch

India’s malaria problem seems far more acute than hitherto feared. New research published in ‘The Lancet’ indicates that around 205,000 deaths per year are caused by malaria. This number is 13 times that estimated by the World Health Organisation (WHO). The WHO has rejected the new figures as “implausibly high”. WHO’s lower figures could be on account of the fact that it takes into consideration only confirmed cases and those seeking medical intervention at healthcare facilities. Besides, its figures are restricted to only a few states in India like Orissa and Chhattisgarh, where malaria is widely prevalent. However, only a small number of people in India go to healthcare centres for treatment for fever. Thus, many who self-medicate or go to traditional doctors in villages, whose death is not medically certified, slip through the cracks and go uncounted.

Coming up with accurate figures for the number of malaria deaths is of course difficult. High fever, one of the warning signs of malaria, is a symptom of an array of other illnesses as well. In malaria-infested areas, people are known to over-diagnose malaria without blood tests. However, rather than dismissing the new figures off hand, WHO should look into its counting procedures and accordingly re-frame its strategies.

If the new figures are correct, there is reason for concern. It means that the threat from treatment-resistant strains of malaria is far greater than believed. Furthermore, it is clear that healthcare facilities in rural India, which accounts for the overwhelming majority of malarial deaths, are far from adequate. Early diagnosis is important in the fight against malaria and the presence of and access to trained healthcare workers is essential.

An important way of preventing malaria that India has ignored for decades is that of denying mosquitoes breeding grounds. If sanitation and drainage are improved, the problem of stagnant water will be effectively tackled. While focusing on fogging and distribution of medicines is vital, public health authorities are overlooking the role better drainage can play in reducing malaria deaths but also other water-borne diseases. The new figures are a reminder that the government must remain committed to public health problems that devastate the poorest of our population, rather than focus on devising strategies to boost medical tourism.

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