BACKGROUND: National malaria death rates are difficult to assess because reliably diagnosed malaria is likely to be cured, and deaths in the community from undiagnosed malaria could be misattributed in retrospective enquiries to other febrile causes of death, or vice-versa. We aimed to estimate plausible ranges of malaria mortality in India, the most populous country where the disease remains common. METHODS: Full-time non-medical field workers interviewed families or other respondents about each of 122,000 deaths during 2001-03 in 6671 randomly selected areas of India, obtaining a half-page narrative plus answers to specific questions about the severity and course of any fevers. Each field report was sent to two of 130 trained physicians, who independently coded underlying causes, with discrepancies resolved either via anonymous reconciliation or adjudication. FINDINGS: Of all coded deaths at ages 1 month to 70 years, 2681 (3·6%) of 75,342 were attributed to malaria. Of these, 2419 (90%) were in rural areas and 2311 (86%) were not in any health-care facility. Death rates attributed to malaria correlated geographically with local malaria transmission ratesderived independently from the Indian malaria control programme. The adjudicated results show 205,000 malaria deaths per year in India before age 70 years (55,000 in early childhood, 30,000 at ages 5-14 years, 120,000 at ages 15-69 years); 1·8% cumulative probability of death from malaria before age 70 years. Plausible lower and upper bounds (on the basis of only the initial coding) were 125,000-277,000. Malaria accounted for a substantial minority of about 1·3 million unattended rural fever deaths attributed to infectious diseases in people younger than 70 years. INTERPRETATION: Despite uncertainty as to which unattended febrile deaths are from malaria, even the lower bound greatly exceeds the WHO estimate of only 15,000 malaria deaths per year in India (5000 early childhood, 10 000 thereafter). This low estimate should be reconsidered, as should the low WHO estimate of adult malaria deaths worldwide. FUNDING: US National Institutes of Health, Canadian Institute of Health Research, Li Ka Shing Knowledge Institute.
BACKGROUND: National malaria death rates are difficult to assess because reliably diagnosed malaria is likely to be cured, and deaths in the community from undiagnosed malaria could be misattributed in retrospective enquiries to other febrile causes of death, or vice-versa. We aimed to estimate plausible ranges of malaria mortality in India, the most populous country where the disease remains common. METHODS: Full-time non-medical field workers interviewed families or other respondents about each of 122,000 deaths during 2001-03 in 6671 randomly selected areas of India, obtaining a half-page narrative plus answers to specific questions about the severity and course of any fevers. Each field report was sent to two of 130 trained physicians, who independently coded underlying causes, with discrepancies resolved either via anonymous reconciliation or adjudication. FINDINGS: Of all coded deaths at ages 1 month to 70 years, 2681 (3·6%) of 75,342 were attributed to malaria. Of these, 2419 (90%) were in rural areas and 2311 (86%) were not in any health-care facility. Death rates attributed to malaria correlated geographically with local malaria transmission ratesderived independently from the Indian malaria control programme. The adjudicated results show 205,000 malaria deaths per year in India before age 70 years (55,000 in early childhood, 30,000 at ages 5-14 years, 120,000 at ages 15-69 years); 1·8% cumulative probability of death from malaria before age 70 years. Plausible lower and upper bounds (on the basis of only the initial coding) were 125,000-277,000. Malaria accounted for a substantial minority of about 1·3 million unattended rural fever deaths attributed to infectious diseases in people younger than 70 years. INTERPRETATION: Despite uncertainty as to which unattended febrile deaths are from malaria, even the lower bound greatly exceeds the WHO estimate of only 15,000 malaria deaths per year in India (5000 early childhood, 10 000 thereafter). This low estimate should be reconsidered, as should the low WHO estimate of adult malaria deaths worldwide. FUNDING: US National Institutes of Health, Canadian Institute of Health Research, Li Ka Shing Knowledge Institute.
Authors: Martin Adjuik; Tom Smith; Sam Clark; Jim Todd; Anu Garrib; Yohannes Kinfu; Kathy Kahn; Mitiki Mola; Ali Ashraf; Honorati Masanja; Kubaje Adazu; Ubaje Adazu; Jahit Sacarlal; Nurul Alam; Adama Marra; Adjima Gbangou; Eleuther Mwageni; Fred Binka Journal: Bull World Health Organ Date: 2006-03-22 Impact factor: 9.408
Authors: Alexander K Rowe; Samantha Y Rowe; Robert W Snow; Eline L Korenromp; Joanna Rm Armstrong Schellenberg; Claudia Stein; Bernard L Nahlen; Jennifer Bryce; Robert E Black; Richard W Steketee Journal: Int J Epidemiol Date: 2006-02-28 Impact factor: 7.196
Authors: Prabhat Jha; Binu Jacob; Vendhan Gajalakshmi; Prakash C Gupta; Neeraj Dhingra; Rajesh Kumar; Dhirendra N Sinha; Rajesh P Dikshit; Dillip K Parida; Rajeev Kamadod; Jillian Boreham; Richard Peto Journal: N Engl J Med Date: 2008-02-13 Impact factor: 91.245
Authors: Aparup Das; Anupkumar R Anvikar; Lauren J Cator; Ramesh C Dhiman; Alex Eapen; Neelima Mishra; Bhupinder N Nagpal; Nutan Nanda; Kamaraju Raghavendra; Andrew F Read; Surya K Sharma; Om P Singh; Vineeta Singh; Photini Sinnis; Harish C Srivastava; Steven A Sullivan; Patrick L Sutton; Matthew B Thomas; Jane M Carlton; Neena Valecha Journal: Acta Trop Date: 2011-11-28 Impact factor: 3.112
Authors: Diego G Bassani; Rajesh Kumar; Shally Awasthi; Shaun K Morris; Vinod K Paul; Anita Shet; Usha Ram; Michelle F Gaffey; Robert E Black; Prabhat Jha Journal: Lancet Date: 2010-11-12 Impact factor: 79.321