Malaria: Killer Bug

Image: Mark Tomalty/Corbis

How many does malaria really kill? The figure varies, but one thing’s certain: It’s much more than what’s recorded

A study by medical journal Lancet throws up shocking numbers for malaria mortality in India. At 205,000 deaths annually, this is more than 13 times the World Health Organization’s estimate of 15,000 and over 100 (136 to be precise) times the Indian government’s piddling figure of 1,500 malaria deaths.

The new statistics now make malaria one of the top 10 killer diseases in the country. According to Indian Council of Medical Research (ICMR), cardiovascular disease, which is one of the top killers, takes the lives of 900,000 to 1.5 million people every year. Now malaria is way behind heart disease, but has overtaken deaths from HIV infection.

While the WHO has been swift to rebut, asking for a revalidation of this study, local government agencies have, by and large, accepted it. They are involved in the study, and agree that far more malaria deaths occur than what is recorded today.

From the days of the notorious black plague of England in the 1500s, death has remained a critical public health event to be examined. Reliable mortality data is essential for sound public policy and India falls short here. Citing the swine flu pandemic scare of 2009, the lead author of the Lancet study — the first nationally representative study on malaria — Prabhat Jha says, one big reason why the world went in a tizzy was that the Mexican region which reported early deaths didn’t have baseline mortality data (the basic benchmark data against which any new programme is evaluated). It could be ascertained only later that the percentage of people dying from swine flu infection was much lower.

“I am not breaking my head over the numbers; maybe it lies somewhere in between, but what I do worry about is the fact that these are preventable deaths. We should now hurry to stop them,” says V.M. Katoch, director general of ICMR.

At the International Centre for Genetic Engineering and Biotechnology in New Delhi, scientist Chetan Chitnis, whose malaria research is focussed on the tribal belt of Orissa, says there are vast deaths in the country that go underreported. “In Orissa at least, the problem is as big as in Africa; children get multiple episodes of malaria in a year,” says Chitnis, who won the Infosys Science Foundation Prize in October this year for his work in life sciences, a significant part of which involves development of a vaccine for the type of malaria endemic in India.

Jha says studies so far have looked at death rates in cured populations, which is misleading. “Logically, if you can cure a disease quickly and simply, you can’t really study how it kills people,” says Jha, director of the Centre for Global Health Research, University of Toronto, Canada. So he adopted a method called ‘verbal autopsy’ which is a systematic way of getting information directly from the community. In conclusion, his research came up with two numbers: A lower bound of 125,000 and an upper bound of 205,000 annual deaths in India. Even if we go by the lower bound, it’s significantly higher than all estimates so far.