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200,000 deaths in India from malaria avoidable: study

The number of premature deaths from malaria in India has been vastly under-estimated, according to a new study co-written by researchers from St. Michael's Hospital.

New Delhi, India, October 21, 2010

Because malaria is so easily and cheaply curable, surveys of properly diagnosed malaria patients see misleadingly few deaths. Most malaria deaths occur among people in rural areas with a sudden severe fever that is never seen by any healthcare worker.

The new study is of a nationally representative sample of all deaths from any cause in India, asking family members to describe the fatal illness. Its results show that malaria accounts for about 200,000 premature deaths before age 70 in India (including 80,000 children below age 15 and 120,000 adults). Previous estimates of malaria deaths were less than 10 per cent of this new figure.

“What is striking about these numbers is that, unlike AIDS or cancer, malaria is curable if treated promptly,” said Dr VM Katoch, Secretary, Department of Health Research and Director-General, Indian Council of Medical Research. “We have safe, effective and inexpensive drugs that can quickly cure malaria patients. What we need is rapid access to healthcare facilities.”

The findings are from the first nationally representative sample of the causes of all deaths in India. The research, led by teams from the office of the Registrar-General of India and from the Centre for Global Health Research (CGHR) at St. Michael’s Hospital and University of Toronto, Canada, is published online today (21 October 2010) in The Lancet, a leading UK medical journal.

“This is the first nationwide study that has collected information on causes of death directly from communities all over India. It shows that malaria kills far more people than previously supposed. Most of these deaths are in the few Indian states where the most dangerous type of malaria parasite is common,” said co-lead author Prof. Prabhat Jha, Director of the CGHR.

The Indian state of Orissa had more malaria deaths than any other state, 50 thousand each year. The other large “high-malaria” states, also in eastern India, were Chhattisgarh, Jharkhand and Assam.

In an accompanying editorial, Dr. Simon Hay of Oxford University, UK, co-founder of the Malaria Atlas Project, explains how the estimate of only 15,000 malaria deaths a year previously accepted by the World Health Organization (WHO) could have missed most of the malaria deaths where illness came on quickly and was never seen by any healthcare worker.

He adds that, since most malaria deaths in India occur far from any healthcare facilities, “deaths from malaria are predominantly invisible to the health reporting system.”

The study authors conclude: “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 a high malaria burden.” They further suggest that better estimates of malaria incidence and mortality in India, Africa and elsewhere could provide a more rational foundation for affordable access to community treatments for both children and adults.

(Home page photo credit: Japanese Red Cross)