New Delhi, Oct. 20: New research has suggested that malaria kills about 205,000 people in India each year, amplifying suspicions that the national malaria programme and the World Health Organisation are vastly underestimating India’s malaria deaths.

The national malaria programme detects only about 1,000 malaria deaths each year and a technique used by the World Health Organisation which is expected to make corrections for under-reporting of cases estimates 15,000 deaths each year.

But Indian, British and Canadian researchers who analysed deaths across Indian households through verbal autopsies have attributed 85,000 deaths among children below 15 years and 120,000 deaths among people between 15 and 69 years to malaria.

The study, which appears in the journal Lancet on Thursday, found 86 per cent of the deaths attributed to malaria did not take place in health-care facilities.

Most of these deaths were in rural areas and involved high fever not seen or diagnosed by health workers, it said.

“Malaria kills far more people in India than previously assumed,” said Prabhat Jha, the lead author of the study, and director of the Centre for Global Health Research at the University of Toronto, Canada. “This is really unfortunate because malaria is easily treated and cured by drugs — the key to reducing deaths from malaria is quick diagnosis and treatment," Jha told The Telegraph.

“Let us hope these findings shake up the system — the first thing the health ministry has to do is to accept these results,” said Vinod Sharma, former director of the National Institute of Malaria Research, New Delhi, and a co-author of the study.

Jha and his colleagues analysed verbal autopsies — field workers’ documentation of patients’ symptoms in the days prior to their deaths — for 75,342 deaths between 2001-2003 from 6,671 sites across the country.

Using typical malaria symptoms such as episodes of high fever and shivering, the researchers have attributed malaria as the cause in 2,681 deaths in the age group of 12 months to 70 years.

An extrapolation yields a national malaria death count of 205,000. The new study has shown that nearly half of the malaria-attributed deaths occurred in a few high-malaria states such as Orissa, Chattisgarh, Jharkhand, and Assam.

Malaria researchers in India have for long suspected that the malaria control programme doesn’t always present the true picture. “We saw this even back in the 1980s,” said Mantosh Malhotra, a senior scientist at the NIMR. A study by the NIMR in the 1980s had detected 1,546 cases of Plasmodium falciparum — the most dangerous of malaria parasites — in a region of Uttar Pradesh where the malaria control programme had reported only 15 cases.

“District medical officers used to tell us that they were discouraged from reporting large numbers,” Malhotra told The Telegraph. “But things have changed now. The national rural health mission is making a difference. There are drugs available, and higher awareness that makes people seek out treatment early.”

Scientists not associated with the study have cautioned that verbal autopsies remain an “imperfect method” of assessing malaria deaths, but have said that the unexpected findings justify more investigations.

“The evidence emphasises the inadequacies in the way WHO reports malaria cases,” Simon Hay, Peter Gething and Robert Snow, three independent epidemologists at the University of Oxford wrote in a commentary in the same issue of the journal Lancet.