Malaria is a major public health problem in India, however, the WHO estimates that there are only 15,000 malaria deaths a year in India. Important, but given that we are talking about a population of over a billion people, this is really just a drop in the bucket. The WHO estimates are based on statistics reported from the Indian Government, which are based on facility based reports of deaths.
But using cause-of-death estimates generated from the use of new verbal autopsy methods in the nationally representative Sample Registration System, researchers estimated that it is possible that deaths from malaria could actually range from 125,000 to 277,000 deaths a year – or roughly 10 times higher than the WHO estimates!
Measuring morbidity and mortality from malaria has always been tricky. The main symptom of malaria – fever – is a common symptom of many illnesses, so attributing cause of death when fever is present can be difficult. As well, malaria is actually reasonably easy to treat if prompt treatment is given, but prompt treatment is rarely given if malaria is not diagnosed, so many malaria deaths may be underreported. In addition, many malaria deaths occur in rural areas where many deaths occur outside of facilities are are not always reported.
No method is going to be perfect, and there are likely substantial measurement issues associated with the use of verbal autopsy methods, but given the huge discrepancy between the measures, it does suggest that something else is at play here. If we believe these new estimates, under reporting of malaria deaths in India alone accounts represents 20-25% of the estimated global mortality from malaria. These findings also raise some serious doubts about the WHO’s estimates from other countries. How could the WHO’s estimates be so wrong?Share on Facebook