Official statistics underestimate malaria deaths in India

ResearchBlogging.orgA recent Lancet study (Dhingra, Jha et al. 2010),  show there are 13 times more malaria deaths in India than the World Health Organisation (WHO) estimates. The authors conclude that malaria kills more than 200,000 deaths each year in India. And, the findings suggest that malaria kills not just children, but also adults.

In this study, fieldworkers asked families to describe how their relative died. Two doctors then reviewed each description, and decided if the death cause was malaria. This method is called verbal autopsy.

The WHO disputes these figures, mainly because of the doubt of using verbal autopsies in diagnosing malaria. However, the same organisation (WHO) often recommends such studies to measure mortality rates in communities when vital registration is not available.

This research is important as it raises doubts over the total number of malaria deaths worldwide, including Africa. The findings are consistent with the spatial and temporal epidemiology of malaria in India (Hay, Okiro et al. 2010), and suggest the WHO has underestimated the clinical incidence of malaria in India by a similar order of magnitude.

However, In a recent commentary in Nature, Butler (Butler 2010) discusses that Verbal autopsy is increasingly being questioned by statisticians. On a population level, the aim of verbal autopsy is not to make clinical diagnoses of individual cases, but to estimate the distribution of causes of deaths (cause-specific mortality fractions (CSMFs)). Such a measure is better for setting health-system and research priorities, and to overseeing the effectiveness of disease-control measures.

Dhingra, N., Jha, P., Sharma, V., Cohen, A., Jotkar, R., Rodriguez, P., Bassani, D., Suraweera, W., Laxminarayan, R., & Peto, R. (2010). Adult and child malaria mortality in India: a nationally representative mortality survey The Lancet DOI: 10.1016/S0140-6736(10)60831-8

Butler, D. (2010). Verbal autopsy methods questioned Nature, 467 (7319), 1015-1015 DOI: 10.1038/4671015a

Hay, S., Okiro, E., Gething, P., Patil, A., Tatem, A., Guerra, C., & Snow, R. (2010). Estimating the Global Clinical Burden of Plasmodium falciparum Malaria in 2007 PLoS Medicine, 7 (6) DOI: 10.1371/journal.pmed.1000290

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