Malaria deaths in India

Malaria mortality in India caused much controversy last fall. The study estimated almost 10 times the number malaria deaths in India during 2001-2003 compared to the estimates of the Government of India and WHO. The key strength of the work by Dhingra et al. was the use of a nationally representative sample of deaths during that period. However, the method for assigning the cause of death, verbal autopsy, is known to be problematic particularly for non-specific illness such as malaria and has come under much criticism. Some good early critiques appeared in Nature and Tropika and now The Lancet has published our reply as well as four others. The authors have also responded and the Government of India is setting up a panel to examine the findings and reconcile the available data.

To enable a proper assessment of research involving burden estimates, The Lancet and other journals should require authors to: 1) perform a validation exercise of the study instrument 2) conduct sensitivity analysis using validation results and other parameters of uncertainty and 3) make the underlying sample, or at least fully disaggregated tables, available for external verification. Otherwise we risk appearing to promote sensationalism over science. It is surprising such standards are not already in place.

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