Research Highlights: WHO Estimates of Malaria Deaths a Vast Underestimation in India

WHO Estimates of Malaria Deaths a Vast Underestimation in India
By: Caroline Melhado

A new study published in the Lancet journal found that World Health Organization estimates for malarial deaths in India are underestimates. WHO reports only 15,000 cases of deaths due to malaria (10,000 adult and 5,000 children) per year, while researchers found that India probably has closer to 200,000 deaths from malaria a year.

The vast majority of deaths in India, especially rural India, take place at home without any medical intervention. These deaths often go largely unnoted in data collection when studying infectious diseases that cause about 1-3 million deaths in India per year. Researchers used interviews that where then coded by two independent physicians to ascertain whether death with a fever was due to malaria. Of the 122,291 deaths that were available for analysis from the Million Death Study, 3657 deaths were inevitably accepted by both coders (in the case that they did not agree the coders could converse to try and persuade the other), and 2122 deaths were identified by both coders immediately as malaria. The study used the latter number in drawing estimates of nationwide malaria death rates. Of these deaths 90% were in rural areas and 86% were not in health care facilities.

The district rates, calculated from the prevalence of malaria death from the interviews, were then used to find a nationwide figure of death from malaria. Researchers found that about 200,000 people under the age of 70 die from malaria each year in India, nearly 20 times the amount estimated by WHO. These new statistics elucidate certain problems of rural healthcare in accounting for and preventing infectious diseases both in India and worldwide.

Lancet2010; doi:10.1016/S0140-6736(10)60831-8