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Deaths in India from malaria could be massively under-reported

Across the world, malaria infects one in ten of the world’s population and kills over a million people annually. The disease is found in over 90 countries, with ninety per cent of cases reported in sub-Saharan Africa. Here it is the leading cause of death. Now, a recent report based on data in India suggests that fatalities may be underestimated, since many deaths from malaria are going undiagnosed.

In India, the World Health Organisation (WHO) has put the number of deaths each year from malaria at around 15,000. However, new research challenges this figure and suggests that fatalities could be 13 times higher. In a paper published in the UK’s Lancet (based on a study funded by the US National Institutes of Health, the Canadian Institute of Health Research and the Li Ka Shing Knowledge Institute), researchers put the number of deaths each year in India at more than 200,000.

The WHO figures are based on statistics provided by governments, which provide deaths recorded from the disease. However, many poor people in countries such as India, Bangladesh and Pakistan die without medical supervision. The study in India sent trained field workers out to the families of 122,000 people who had died prematurely and asked them to describe how their relative had died. Doctors reviewed the notes of the descriptions and came to a decision on whether the cause of death had been malaria.

The WHO has questioned the accuracy of using verbal autopsy methods for counting cases of malarial deaths, especially since the symptoms of malaria, such as high fever, are share by other acute diseases. But all sides of the debate agree that further work needs to be done to calculate deaths from malaria so that effective treatment programmes can be implemented and scaled up where necessary. Even with the current statistics of malarial cases, experts say there is a 60% shortage in funding. According to the Roll Back Malaria Campaign, 4.9 billion dollars is needed this year to effectively fight malaria, but only 21 countries currently have enough money to pay for effective control measures.

Spread by mosquitoes, if the symptoms of malaria are diagnosed early enough, the disease can be successfully treated. However, malaria is becoming resistant to some traditional treatments and more effort is now being put into prevention. Scientists are trialling various methods to reduce the numbers of mosquitoes and aid organisations such as the Gates Foundation are working to increase the number of bed nets in countries where there is a high prevalence. But if the study in India is correct, many more deaths could be attributed to malaria and more investment will be needed in the future to control this killer disease.

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