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Malaria toll 46 times govt count: Study by Kounteya Sinha

Malaria deaths in India could be more than 40 times higher that what is presently estimated.

New research published in the Lancet shows that malaria kills 1.2 million people worldwide each year - twice as high as the figure in the World Malaria Report, 2011.

In India, the study estimates that "4800 malaria deaths in children younger than 5 years and 42000 malaria deaths in those aged 5 years or older," for the year 2010 as against "19, 000 malaria deaths in children younger than five years and 87,000 malaria deaths in those aged five years or older in 2002."

This means malaria killed an estimated 46,800 Indians in 2010. However, the National Vector Borne Disease Control Programme estimates that 1,023 people died of malaria infection in 2010.

On how it arrived at the figure, the study said "In our analysis for India, we include all available sources of data for malaria mortality. We include data from the Sample Registration Scheme of the National Family Health Survey and the Sample Registration Scheme, both of which record high rates of malaria mortality. We also include findings from the Survey of Causes of Death from 1980 to 1990 and the Medical Certification of Causes of Death from 1990 to 2004."

The study makes another interesting finding. While many believe most malaria deaths occur in young children (under 5 years), this study shows that close to half of all deaths (42%) occur in older children and adults globally. Malaria deaths in individuals aged 15-49 years, 50-69 years, and 70 years or older account for 20%, 9%, and 6% of malaria deaths in 2010, respectively (over a third of all deaths occur in adults).

The proportion of malaria deaths in adults in each country examined was almost always more than 40%.

For the Lancet study, Prof Christopher Murray from the Institute for Health Metrics and Evaluation, University of Washington, collected all available data for malaria mortality from 1980 to 2010.

The authors found that, compared with the World Malaria Report, 2011, their estimates of deaths were 1.3 times higher for children younger than five years in Africa, 8.1 times higher for those aged five years or older in Africa, and 1.8 times higher for individuals of all ages outside of Africa.

Crucially, 4.3 lakh more deaths occurred worldwide in individuals aged five years or older in 2010 than was suggested by WHO estimates (5.24 lakhs against 91,000).

However, they add that more malaria mortality also means that short-term goals - the reduction of malaria deaths to zero by 2015 - might be unrealistic.

The authors say: "We estimated that if decreases from the peak year of 2004 continue, malaria mortality will decrease to less than 100, 000 deaths only after 2020."

According to the recent World Malaria report 2011, over 70% of India's population - 100.41 crore face the risk of malaria infection. Around 31 crore people however face the "highest risk" of getting infected by the vector-borne disease.

India has over 10 crore suspected malaria cases, but only 15.9 lakh could be confirmed in 2010. Of the confirmed cases, 8.3 lakh people were infected by plasmodium falciparum while 7.6 lakh people were infected with Plasmodium Vivax.

How many people exactly die of malaria in India is still a mystery. This is why the ministry had formed a 16-member expert group under the chairmanship of Dr Padam Singh, former additional director general of the Indian Council of Medical Research to estimate the country's exact malaria deaths.

A ministry official said, "At present the malaria mortality figures quoted by the NVBDCP are those cases which are microscopically confirmed."

The official added "The expert committee, which has experts from the ministry, WHO, ICMR and the National Institute of Medical Statistics is developing a mathematical formula to assess the country's actual malaria death burden."

Experts felt the need to clearly define "clinical malaria, probable malaria and confirmed malaria cases so as to avoid any bias in recording/reporting of malaria morbidity and mortality. The directorate is at present striving to come out with some acceptable model for estimation of malaria deaths. If need be, some operational research can be incorporated in the programme."

Professor Prabhat Jha, who earlier estimated India's malaria deaths to be much higher, had said "WHO only counts patients who tested positive for malaria at a hospital setting. We conducted direct interviews with those who died of symptoms closely resembling to malaria like high fever and shivering but didn't get a blood test done. We found that 4% of all deaths in India in the age group 1-70 years were due to malaria," Jha had said.

He had added, "WHO's methodology is flawed because most of those who reach a hospital with malaria do get treated. Those who die are the ones who don't reach a hospital."