Malaria kills around 205,000 people in India each year, more than 13 times the estimate made by the World Health Organisation, researchers said. Malaria is a big problem in Africa too.
WHO, the public health arm of the United Nations, estimates that approximately 15,000 people a year die from malaria in India, and 100,000 adults worldwide.
The researchers called for both figures to be urgently revised so they do not hurt funding for prevention, rapid diagnosis and treatment.
"If you do not know the disease in any area, your requirement of drugs and all that (will not) be correct. Your control programme will suffer, it's really important to know these figures correctly," Vinod Sharma of India's National Institute of Malaria Research said.
860,000 malaria deaths a year
The new numbers would boost WHO's estimate of around 860,000 malaria deaths a year, most of whom are children under five, to more than a million, but WHO disputed the analysis.
Sharma said WHO based its estimates on figures provided by governments and it would be important for governments to put in place reliable disease surveillance systems. India detects only 1,000 malaria deaths each year, he added.
The study, led by Prabhat Jha of the Centre for Global Health Research at the University of Toronto in Canada, was published in The Lancet medical journal.
122,000 died in two years
The team sent field workers to 6,671 areas in India from 2001 to 2003 to interview families of 122,000 people who died.
The data suggested that about 205,000 people died from malaria in India each year - 55,000 young children, 30,000 children aged 5-14 and 120,000 people 15 and older.
"If WHO estimates of malaria deaths in India or among adults worldwide are likely to be serious underestimates, this could substantially change disease control strategies, particularly in the rural parts of states with high malaria burden," the researchers wrote.
WHO has rejected their argument.
"Although the present estimation procedures have their limitations, WHO has serious doubts about the high estimate of 200,000 malaria deaths in India obtained by Dingra et al. These doubts arise, in part, from the shortcomings of the 'verbal autopsy' approach used in this study," WHO's Robert Newman said.
"Verbal autopsy is not a trustworthy method for counting malaria deaths because the symptoms of malaria are shared with many other common causes of acute fever," he added.
"Recent work by WHO and partners in one Indian setting showed that as few as 4% of deaths attributed to malaria by verbal autopsy were actually caused by malaria."
863,000 died worldwide
WHO estimates that 863,000 people died from malaria worldwide in 2008, down from 881,000 in 2006.
Other experts not involved in the study noted that 86% of deaths from malaria in India did not occur in any formal healthcare facility linked to the national disease reporting system.
"The true effect of the malaria burden in India remains uncertain but evidence is increasing that the scale of the burden has been greatly underestimated," wrote Bob Snow of the KEMRI-University of Oxford-Wellcome Trust Collaborative Programme in Kenya and his colleagues.
They suggested that heavily populated, remote regions exposed to malaria with unreliable access to health care, such as Myanmar, Bangladesh, Pakistan, and Indonesia may also have a undocumented malaria burden. (Reuters Health/ October 2010)
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