Malaria-attributed death rates in India

Abstract

Neeraj Dhingra and colleagues1Dhingra N Jha P Sharma VP et al.for the Million Death Study CollaboratorsAdult and child malaria mortality in India: a nationally representative mortality survey.Lancet. 2010; 376: 1768-1774Summary Full Text Full Text PDF PubMed Scopus (202) Google Scholar report higher estimates of annual malaria deaths in India than previously suggested. South Asia abounds in life-threatening undifferentiated febrile illnesses like malaria. Typhoid, typhus (rickettsial illness), leptospirosis, and dengue are some of the common diseases that mimic malaria. The transmission rate of typhoid fever, for example, is 1600 per 100 000 population in some parts, and conservative annual estimates of typhoid deaths worldwide are about 200 000.2Parry CM Basnyat B Typhoid and paratyphoid fevers.in: Warrell DA Cox TM Firth JD Oxford textbook of medicine. 5th edn. Oxford University Press, Oxford2010Crossref Google Scholar Blood cultures, when available, are only positive in about 50% of cases, and typhoid, like malaria, remains a largely undiagnosed disease in the community.Additionally, in a large fever study3Murdoch DR Woods CW Zimmerman MD et al.The etiology of febrile illness in adults presenting to Patan Hospital in Kathmandu, Nepal.Am J Trop Med Hyg. 2004; 70: 670-675PubMed Google Scholar in south Asia, typhus and leptospirosis were very important causes of undifferentiated fever, yet none of the treating physicians was sufficiently informed about these diseases to put them down as differential diagnoses. Unlike for malaria, however, studies on these undifferentiated febrile illnesses, including typhoid fever, are poorly funded. Indeed, the burden of disease for these common illnesses remains unknown owing to a severe lack of proper fever diagnostics.Against this background, more concrete proof of malaria with better methods might be required to establish Dhingra and colleagues' claims about increased malaria mortality in India.I declare that I have no conflicts of interest. Neeraj Dhingra and colleagues1Dhingra N Jha P Sharma VP et al.for the Million Death Study CollaboratorsAdult and child malaria mortality in India: a nationally representative mortality survey.Lancet. 2010; 376: 1768-1774Summary Full Text Full Text PDF PubMed Scopus (202) Google Scholar report higher estimates of annual malaria deaths in India than previously suggested. South Asia abounds in life-threatening undifferentiated febrile illnesses like malaria. Typhoid, typhus (rickettsial illness), leptospirosis, and dengue are some of the common diseases that mimic malaria. The transmission rate of typhoid fever, for example, is 1600 per 100 000 population in some parts, and conservative annual estimates of typhoid deaths worldwide are about 200 000.2Parry CM Basnyat B Typhoid and paratyphoid fevers.in: Warrell DA Cox TM Firth JD Oxford textbook of medicine. 5th edn. Oxford University Press, Oxford2010Crossref Google Scholar Blood cultures, when available, are only positive in about 50% of cases, and typhoid, like malaria, remains a largely undiagnosed disease in the community. Additionally, in a large fever study3Murdoch DR Woods CW Zimmerman MD et al.The etiology of febrile illness in adults presenting to Patan Hospital in Kathmandu, Nepal.Am J Trop Med Hyg. 2004; 70: 670-675PubMed Google Scholar in south Asia, typhus and leptospirosis were very important causes of undifferentiated fever, yet none of the treating physicians was sufficiently informed about these diseases to put them down as differential diagnoses. Unlike for malaria, however, studies on these undifferentiated febrile illnesses, including typhoid fever, are poorly funded. Indeed, the burden of disease for these common illnesses remains unknown owing to a severe lack of proper fever diagnostics. Against this background, more concrete proof of malaria with better methods might be required to establish Dhingra and colleagues' claims about increased malaria mortality in India. I declare that I have no conflicts of interest. Malaria-attributed death rates in India – Authors' replyMalaria can be cured easily if treated promptly. The Indian National Vector-Borne Disease Control Programme diagnoses about 1 million cases of Plasmodium falciparum annually. It successfully treats nearly all cases it diagnoses, reporting among them only about 0·1% mortality.1 But, since infection with P falciparum can progress rapidly from mild symptoms to life-threatening disease, in some of the parts of India with limited health-care facilities, many cases are never diagnosed and malaria remains a major cause of death. Full-Text PDF