Malaria deaths in India may be much higher than estimated, study says

NEW DELHI -- A new study claims that malaria kills nearly 13 times more Indians than previously estimated. If confirmed, the findings could call into question the effectiveness of the government’s efforts to stem the parasitic disease.

“Adult and Child Malaria Mortality in India: A Nationally Representative Mortality Survey” published in the British medical journal the Lancet last month claims to have investigated tens of thousands of deaths in more than 6,500 areas of India from 2001 to 2003.

Using this data, the authors conclude that more than 200,000 people from 1 month of age to 70 years old die each year due to malaria -- a figure higher than the estimated toll of 15,000 by the World Health Organization.

The data were collected by about 800 non-medical staff trained by the registrar general of India, who interviewed relatives to assess each death, a method called verbal autopsy. This information was then sent to at least two of 130 collaborating physicians trained to identify the cause of death.

The study, co-funded by the U.S. National Institutes of Health, asks WHO to “reconsider the low estimate of malaria deaths worldwide.” Prabhat Jha, a professor with the Center for Global Health Research and one of the study’s lead authors, was quoted in an Indian newspaper saying the U.N. agency’s methodology was flawed as it counted only patients who tested positive at a hospital setting. “Most of those who reach a hospital with malaria do get treated,” he said. “Those who die are the ones who don’t reach a hospital.”

The study has spurred controversy. Dr. Nata Menabde, WHO’s top official in India, said she accepted the limitations of current estimation methods but questioned the new higher estimates since the verbal autopsy method were not suited to measuring malaria, an illness that has several symptoms in common with other diseases and can be misinterpreted.

The study, if true, could mean that the anti-malaria program run by the government is inadequate. Dr Gagan Singh Sonal, a director with the government’s anti-malaria campaigned, dismissed the new estimates as excessive, suggesting the study was aimed at getting media attention.

“Five people died in a remote district in [the Indian state of] Orissa and the papers were full of it. Are you telling me that 200,000 people die every year and no one gets to know?” he said.

In 2008, WHO reported nearly a million deaths from malaria worldwide resulting from 250 million cases of the disease in 109 countries.