Malarial Deaths in India- What is the Real Truth?
The Million Death Study is one of the most important
and ambitious prospective studies ongoing in India. It was conceived with
the far sighted aim to identify the causes and risk factors of deaths in
India. The Registrar General of India’s Sample Registration Scheme (SRS)
in close collaboration with Centre for Global Health Research at the
University of Toronto, leading Indian and foreign academic institutions,
and the ICMR are involved in this project.
The study is monitoring about 14 million people between
2001-2013. Causes of death are identified using a well validated verbal
autopsy. Interim data was recently analyzed and deaths due to malaria were
published in The Lancet in October 2010.
While the WHO claims that 5000 annual deaths in
childhood are due to malaria in India, this study estimates that this
number should be around 55,000. Beyond childhood, WHO annual deaths due to
malaria are 10,000 while The Lancet study estimates it to be 30,000 at
ages 5-14 years and 1,20,000 at ages 15-69 years. Of the 1,22,000 deaths
analyzed between 2001-2003 in 6671 randomly selected areas in India, 3.6%
of all deaths between 1 month and 70 years were attributed to malaria.
However, the WHO has retaliated sharply, expressing serious concerns over
the methodology of the study. It has denigrated the use of the verbal
autopsy. The WHO estimates malarial deaths based on the rate of 3
deaths/1000 estimated falciparum cases (estimated by multiplying total
estimated malaria cases by reported falciparum percentage).
Public health in industrialized countries was
transformed when vital statistics including death and birth rates became
available in the 19th and 20 century. Continuous
reliable mortality data is one of the key elements to monitor the health
of our people. This is the catalyst which will spur research into
preventable deaths, assess success of control programs and determine where
money must be spent. The black truth is that the dead will always teach
the living. (Dhingra N, et al. Adult and child malaria mortality in
India: a nationally representative mortality survey. The Lancet, 21
October 2010, The Hindu; 23 October 2010).
Polio – Is the End in Sight?
In 2010, by October, only 39 cases of polio are reported in India as
compared to 498 last year. An intensive campaign and probably the use of
the bivalent OPV (bOPV) in UP and Bihar have yielded results. A randomized
controlled trial from 3 centers in India, recently published in the
Lancet, establishes the superiority of the mOPV2, mOPV3 and bOPV over the
trivalent OPV (tOPV); and the non-inferiority of the bOPV over the mOPV.
Pakistan has had the maximum cases (101 till November beginning) of the 4
endemic countries. An acute outbreak of polio is on in the Republic of
Congo with more than 120 cases of AFP, 58 deaths and 2 confirmed cases of
wild polio 1. Africa’s leaders demonstrated unprecedented cooperation and
commitment to carry out a series of synchronized immunization activities
in April and October 2010. Since the launch of the Global polio
Eradication Initiative in 1988, incidence of polio has been reduced by 99%
with the only endemic countries being Nigeria, India, Pakistan and
Afghanistan (Sutter RW, et al. Immunogenicity of bivalent types 1 and 3
oral poliovirus vaccine: a randomised, double-blind, controlled trial. The
Lancet 26 October 2010, http://www.polioeradication.org/Dataandmonitoring/Poliothisweek).
