ADULT AND CHILD MALARIA MORTALITY IN INDIA
Download
1 / 24

Conclusions - PowerPoint PPT Presentation


  • 388 Views
  • Updated On :

ADULT AND CHILD MALARIA MORTALITY IN INDIA. Sources of support: ICMR and RGI (India); FIC, NIH (US); LKSKI, IDRC & CIHR (Canada); CTSU & MRC (UK). Prabhat Jha, on behalf of MDS Collaborators. [email protected] CGHR.ORG. Conclusions.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Conclusions' - KeelyKia


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Slide1 l.jpg

ADULT AND CHILD MALARIA MORTALITY IN INDIA

Sources of support:

ICMR and RGI (India); FIC, NIH (US); LKSKI, IDRC & CIHR (Canada); CTSU & MRC (UK)

Prabhat Jha, on behalf of MDS Collaborators

[email protected]

CGHR.ORG


Conclusions l.jpg
Conclusions

  • Malaria deaths should not occur with basic health services: prompt diagnosis and treatment are effective

  • India had over 200,000 avoidable malaria deaths (55,000 child, 30,000 at ages 5-14, 120,000 ages 15-69) in 2005

  • Reconsider WHO total of 5,000 child and 10,000 adult malaria deaths in India and 100,000 adult malaria deaths worldwide

CGHR.ORG


What s new about this research l.jpg
What’s new about this research?

  • Large, nationally representative sample of all deaths based on household interviews with families

  • The study results reflects the whole of India

  • This is NOT a study of properly treated malaria patients (in whom few deaths occur)

CGHR.ORG


Slide4 l.jpg

Nationally representative sample

(Sample Registration System)

  • 6,671 of these small areas randomly chosen from all parts of India (each with about 1000 people per area)

CGHR.ORG


Slide5 l.jpg

How was the study done?

800 Registrar of General India field workers interviewed 122 thousand families of people who had died in 2001-2003

Written reports each coded independently by at least two physicians to attribute a probable cause to each death (i.e. malaria)

Coded malaria deaths likely represent malaria, despite the potential for misclassification

CGHR.ORG


Slide6 l.jpg

How was the study done?

Calculate proportion of malaria deaths in each age group within the study

Combine with national 2005 UN totals of deaths in each age group

Produce national (and state) estimates of numbers of malaria deaths at various ages

CGHR.ORG


Slide7 l.jpg

Malaria-attributed deaths in the present study by age

3·6% at ages 1 month-69 years

CGHR.ORG


Malaria deaths before age 70 in the study l.jpg
Malaria deaths before age 70 in the study

  • 90% (2422/2685) were in rural areas

  • 86% (2315/2685) did not occur at a health facility

CGHR.ORG



Slide10 l.jpg

Malaria mortality rates were high in early childhood and in later middle age

*

Study-attributed Indian malaria mortality rates

WHO indirect estimates of Indian malaria mortality rates

Age-specific all-India malaria-attributed death rates estimated from the present study, and those estimated indirectly for WHO *No. of study deaths per age class (in red)

CGHR.ORG


Slide11 l.jpg

Half of the malaria deaths were in a few high-malaria states in eastern India

~100

* Malaria death rates, India 2005, standardised to population aged 0-69

CGHR.ORG


Slide12 l.jpg
Risk of a newborn Indian dying from malaria before age 70 in eastern India(at current rates, in the absence of other disease)

  • About 2% overall in India

  • Over 12% in Orissa

CGHR.ORG


Slide13 l.jpg

Malaria deaths occurred where the most dangerous type ( in eastern IndiaPlasmodium falciparum) of malaria parasite occurs

CGHR.ORG


Slide14 l.jpg

Malaria deaths did not occur in states where dengue or meningitis or typhoid * were common (1)

* These diseases can be confused with malaria

CGHR.ORG


Slide15 l.jpg

Malaria deaths did not occur in states where dengue or meningitis or typhoid * were common (2)

* These diseases can be confused with malaria

CGHR.ORG


Fever deaths in india 2005 age 70 n 1 8m 18 lakh l.jpg
Fever deaths in India, 2005 meningitis or typhoid * were common (2)< age 70, n=1.8M (18 lakh)

  • 1.3 M (13 lakh) UNDIAGNOSED, mostly untreated FEVER deaths in RURAL India

  • Malaria is a significant minority of these fever deaths, but more so in high-malaria states

CGHR.ORG


Conclusions17 l.jpg
Conclusions meningitis or typhoid * were common (2)

  • Malaria deaths should not occur with basic health services: prompt diagnosis and treatment are effective

  • India had over 200,000 avoidable malaria deaths (55,000 child, 30,000 at ages 5-14, 120,000 ages 15-69) in 2005

  • Reconsider WHO total of 5,000 child and 10,000 adult malaria deaths in India and 100,000 adult malaria deaths worldwide

CGHR.ORG


Slide18 l.jpg

www.cghr.org/malaria meningitis or typhoid * were common (2)

  • The Lancet Paper and Web appendix

  • Press and video releases: English, Hindi, Oriya and Assamese (plus B-roll)

  • Lancet Press release

  • Quotes from noted scientists

  • Frequently-asked questions

  • PowerPoint slides

  • Pictures of malaria

CGHR.ORG


Million death study collaborators l.jpg
Million Death Study Collaborators meningitis or typhoid * were common (2)

Indian Academic Partners (in alphabetical order):

Clinical Epidemiology Resource and Training Centre Trivandarum: KB Leena, KT Shenoy (until 2005)

Department of Community Medicine Gujarat Medical College Ahmedabad: DV Bala, P Seth KN Trivedi

Department of Community Medicine Kolkatta Medical College Kolkatta: SK Roy

Department of Community Medicine Regional Institute of Medical Sciences Imphal: L Usharani

Department of Community Medicine S.C.B. Medical College Cuttack Orissa: Dr. B Mohapatra

Department of Community Medicine SMS Medical College Jaipur: AK Bharadwaj, R Gupta

Epidemiological Research Center Chennai: V Gajalakshmi, CV Kanimozhi

Gandhi Medical College Bhopal: RP Dikshit, S Sorangi

Healis-Seskarhia Institute of Public Health Mumbai: PC Gupta, MS Pednekar, S Sreevidya

Indian Institute of Health & Family Welfare, Hyderabad: P Bhatia

Institute of Health Systems Research Hyderabad: P Mahapatra (until 2004)

St. John’s Research Institute St. John’s Academy of Health Sciences Bangalore: A Kurpad, P Mony, M Vaz, R Jotkar, S Rao-Seshadri, S Shrihari, S Srinivasan

King George Medical College Lucknow: S Awasthi

Najafgarh Rural Health Training Centre Ministry of Health Government of India New Delhi: N Dhingra, J Sudhir, I Rawat (until 2007)

National Institute of Mental Health and Neurosciences Bangalore: G Gururaj (until 2004)

North Eastern Indira Gandhi Institute of Regional Medical Sciences Shillong Meghalaya: FU Ahmed (until 2005), DK Parida

Regional Medical Research Center ICMR Institute Bhubaneshwar: AS Karketta, SK Dar

School of Preventative Oncology Patna: DN Sinha

School of Public Health Post Graduate Institute of Medical Education and Research Chandigarh: N Kaur, R Kumar, JS Thakur

Tata Memorial Hospital Mumbai: RA Badwe, RP Dikshit, K Mohandas

Lead Partners:

Office of the Registrar-General India RK Puram New Delhi India: C Chandramouli (Registrar General of India [RGI]), RC Sethi, B Mishra, S Jain (until 2008), DK Dey (until 2009), AK Saxena, MS Thapa, N Kumar, JK Banthia and DK Sikri (former RGIs)

Million Death Study Coordinating Centre for Global Health Research (CGHR) Li Ka Shing Knowledge Institute Keenan Research Centre St. Michael’s Hospital Dalla Lana School of Public Health University of Toronto Canada: DG Bassani, P Jha (Principal Investigator), R Jotkar, R Kamadod, B Pezzack, S Rao-Seshadri, P Rodriguez, J Sudhir, C Ramasundarahettige, W Suraweera

Affiliated Partners:

Indian Council of Medical Research New Delhi India: VM Katoch (Director General or DG from 2008), NK Ganguly (DG to 2008), L Kant, B Bhattacharya

School of Population Health The University of Queensland Australia: AD Lopez, C Rao

World Health Organisation Geneva and SEARO Office New Delhi: T Boerma, T Evans, A Fric, S Habayeb (former WHO Representative-India), S Khanum, C Mathers, DN Sinha, N Singh, P Singh (Deputy Regional Director)

Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU) University of Oxford England: N Bhala, J Boreham, Z Chen, R Collins, R Peto, G Whitlock


Slide20 l.jpg

Background slides meningitis or typhoid * were common (2)

CGHR.ORG


Slide21 l.jpg

Key messages meningitis or typhoid * were common (2)

  • First nationally representative study of the causes of all deaths in India

  • Of 75 342 study deaths at ages 1 month to 70 years, 2681 (3.6%) were attributed to malarial fever

  • Malaria caused about 200 thousand (2 lakh) deaths before age 70 in 2005in India as a whole

  • This is far more than the WHO estimate of only 15 thousand at all ages

  • Of malaria deaths:

  • 55 thousand <age 5 years

  • 30 thousand at 5-14 years old

  • 120 thousand (1.2 lakh) in adults 15-69 years old

  • Malaria mortality rates were high in early childhood and in later middle age

CGHR.ORG


Slide22 l.jpg

Key messages meningitis or typhoid * were common (2)

  • 90% of malaria deaths were in rural areas and 86% were not in any health facility

  • Half the malaria-attributed deaths were in a few high-malaria states in eastern India (Orissa, Chhattisgarh, Jharkhand, Assam and its smaller neighbours)

  • At current malaria death rates, an average Indian baby would have a 2% chance of dying from malaria before age 70, but this risk is much greater in the high-malaria states

  • Malaria deaths occurred in the states where the Indian malaria control program finds a high prevalence of the most dangerous type (Plasmodium falciparum) of malaria parasite

CGHR.ORG


Slide23 l.jpg

Geographical variation in absolute numbers of malaria deaths in the different populations studied by the MDS and NVBDCP

CGHR.ORG


Slide24 l.jpg

Age patterns of malaria deaths in Africa and India in the different populations studied by the MDS and NVBDCP

ACTUAL AGE PATTERNS: INDIA and AFRICA

GBD WHO ASSUMPTIONS

CGHR.ORG


ad