A section of government doctors in Chhattisgarh admits to gross under reporting of malarial deaths in the State

“Is it ever possible to find out the actual number of malarial deaths in Chhattisgarh?” asked an exasperated government doctor, who worked for many years in intensely malaria prone districts of central India.

He himself provided the answer.

The National Rural Health Mission (NRHM) records malarial deaths. But NRHM also adds that the death could be due to “fever of unknown origin”.

“The government will always say that the death is not due to malaria but because of fever of unknown origin. The Health Department refuses to accept [malaria] unless the blood smear test is positive,” said the doctor on conditions of anonymity.

Blood testing facility is a rarity in rural Chhattisgarh. More importantly, malarial parasite is a difficult organism to detect unless repeated tests are conducted, said the doctor.

A number of doctors, working in the State, told The Hindu that health officials often attribute malaria deaths to complications such as renal failure, severe anemia or adult respiratory distress syndrome and remove the “antecedent malaria” as the primary cause of death. “It is somewhat like deaths due to malnutrition. In that, too, the patient dies due to complications like infections, ditto for malaria,” said another doctor.

Ask any officer in the State Health Department, they will all privately agree that malarial deaths are grossly underreported and that they themselves don’t appreciate any of the subordinate staff reporting such deaths.

Moreover, systematic underreporting of malaria has totally ruined the resource base. If a district underreports malaria, it gets less resource like bed nets, drugs or diagnostics and thus weakens its own resource base.

“Finally, nobody would ever know the actual number of deaths [as people are not aware of blood tests in rural areas] and the Health Department will keep coming up with ridiculous death figures,” the government doctor said.

The gap between the number of malarial deaths and the figure officially acknowledged by the State Health Department has taken a “ridiculous proportion”, feel health activists in Chhattisgarh. Data collected under community based health monitoring initiative of NRHM show that malarial deaths in rural areas are actually almost 28 times higher than the figures furnished by the State Health Department.

Moreover, the NRHM data has also warned that the actual number of deaths “ascribed to any cause are likely to be much higher” than the “absolute number” reported by the NRHM’s community monitoring team.

It is believed that Chhattisgarh has one of the highest malarial deaths in the country, but official data never confirms that.

Village Health Sanitation and Nutrition Committees (VHSNC), working under NRHM, are mandated to record rural deaths in the State. Data released by VHSNC shows that 2,467 persons, including a large number of children, died from malaria or fever in 2012.

In the corresponding period, the National Vector Borne Disease Control Programme (NVBDCP) announced death of only 90 persons, a number almost 28 times less than the NRHM figure, from malaria in Chhattisgarh. The data was provided by the State Health Department to NVBDCP.

Moreover, only 17 people died from malaria till July this year, according to State government data. Whereas NRHM data says, in the corresponding period of the previous year, 1,100 persons had died. “The figure should be around 1,000 — little more or less — but it could not be an absurd 17,” said a health activist.

Most of the States have a similar problem as they are not keen to disclose the actual number of malarial deaths. So, the figures are fudged to an extent, feels a researcher attached with Indian Council of Medical Research (ICMR).

In Chhattisgarh, officially only 11 persons died of malaria in 2008. The number rose to 47 in 2010, followed by 42 in 2011. Health workers feel the figures are “totally fudged”.

Officials in the State’s Health Department, however, believe that the NRHM data is “exaggerated and thus unacceptable”.

“NRHM data are collected by mitanins or community health workers and locals. They assume any fever is a malarial fever, without the proper tests, which is unjustified,” said Dr. Kamalpreet Singh, the Director of State Health Services. He added that the figures released by the State government are on basis of “actual cases diagnosed” in public or private health facilities and are “confirmed through tests”.