Malaria hotspots in India. Image from Nature magazine, 2010. News report on Lancet study that suggests mortality from malaria in India may be significantly higher than WHO reports indicate.
Good news from the war on malaria has been that annual deaths are calculated to be fewer than 1 million annually, as low as 880,000 a year — the lowest human death toll from malaria in human history.
Researchers in India suggest that deaths there are grossly underreported, however — not the 15,000 estimated by the World Health Organization, but closer to 200,000 deaths a year, nearly 15 times as great.
Reading that news, DDT partisans might get a little race of the pulse thinking that this might improve the urgency for the case for using more DDT, as advocated in several hoax health campaigns and media, such as the recent film “3 Billion and Counting.”
The problem, though, is that India is one of the few places where DDT manufacturing continues today, and India is one of the nations where DDT use is relatively unregulated and heavy. In short, if DDT were the miracle powder it’s claimed to be, any finding that malaria deaths are 15 times greater than reported by WHO is nails in the coffin of DDT advocacy.
Researchers based their estimate on interviews with family members of more than 122,000 people who died between 2001 and 2003. The numbers “greatly exceed” the WHO estimates of 15,000 malaria deaths in India each year, the researchers wrote in the study, published today in the journal The Lancet.
“It shows that malaria kills far more people than previously supposed,” said one of the study authors, Prabhat Jha of the Center for Global Health Research in Toronto, in a statement. “This is the first nationwide study that has collected information on causes of death directly from communities.”
Remote regions may have an undocumented malaria burden, because conventional methods of tracking the disease are flawed, according to the authors. In India, the government malaria data, which is used by the Geneva-based WHO, only counts patients who had tested positive for the disease at a hospital or clinic. Others who died of symptoms closely resembling the malady but didn’t get a blood test aren’t included, co-author Vinod Sharma of the Indian Institute of Technology in New Delhi said in an interview today.
The lack of accurate data may hinder efforts by governments and aid organizations to provide diagnosis and treatment to the population at risk, the authors said.
Watch. Advocates of poisoning Africa and Asia will claim scientists and environmental activists are somehow to blame for any underreporting, and they will call for more DDT use, claiming a ban has made India a refuge for malaria. Those reports will fail to mention India’s heavy DDT use already, nor will they suggest an ineffectiveness of the nearly-sacred powder.
The article in the Lancet became available on-line on October 21 — it’s a 4.5 megabyte .pdf document: “Adult and child malaria mortality in India: a nationally representative mortality survey.” A team of researchers is listed as authors of the study: Neeraj Dhingra, Prabhat Jha, Vinod P Sharma, Alan A Cohen, Raju M Jotkar, Peter S Rodriguez, Diego G Bassani, Wilson Suraweera,Ramanan Laxminarayan, Richard Peto, for the Million Death Study Collaborators.
Accurate counts of infections and deaths provide essential information for effective programming of the fight against the disease. Researchers point no particular fingers, but make the case in the article that better methods of counting and estimating malaria deaths must be found.
There are about 1·3 million deaths from infectious diseases before age 70 in rural areas in which fever is the main symptom. If there are large numbers of deaths from undiagnosed and untreated malaria in some parts of rural India then any method of estimating overall malaria deaths must rely, directly or indirectly, on evidence of uncertain reliability from non-medical informants and, although our method of estimating malaria mortality has weaknesses, indirect methods may be even less reliable. The major source of uncertainty in our estimates arises from the possible misclassifi cation of malaria deaths as deaths from other diseases, and vice versa. There is no wholly satisfactory method to quantify the inherent uncertainty in this, and indeed the use of statistical methods to quantify uncertainty can convey a false precision. However, even if we restrict our analyses to deaths immediately classifi ed by both physician coders as malaria, WHO estimates (15 000 deaths per year at all ages)1 are only one-eighth of our lower bound of malaria deaths in India (125 000 deaths below the age of 70 years; of which about 18 000 would have been in health-care facilities).
Our study suggests that the low WHO estimate of malaria deaths in India (and only 100 000 adult malaria deaths per year worldwide) should be reconsidered. If WHO estimates of malaria deaths in India or among adults worldwide are likely to be serious underestimates, this could substantially change disease control strategies, particularly in the rural parts of states with high malaria burden. Better estimates of malaria incidence and of malaria mortality in India, Africa, and elsewhere will provide a more rational foundation for the current debates about funding for preventive measures, about the need for more rapid access to malaria diagnosis, and about affordable access in the community to effective antimalarial drugs for children and adults.
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Posted by Ed Darrell 
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