Don't ignore the adults

The number of people around the world, including children under five, who have died from malaria has been steadily declining since 2004. But the sobering news is that the number of deaths worldwide in 2010 from this disease is more than 1.24 million, almost double the figure previously estimated by the World Health Organisation (WHO) for the same year. The result was published recently in The Lancet journal. Though children under five should account for most deaths, an unexpected finding is that the proportion of older children and adults succumbing to malaria is high — “almost always more than 40 per cent.” For instance, it is 76 per cent in Asia, and 69 per cent in the case of both North America and South America. Compared with grown-up children and adults, mortality in children under five in south and Southeast Asia constitutes only a “small proportion” of the global deaths. In the case of India, in 2010, less than 5,000 younger children and 42,000 above five died. This goes against the grain of acquired resistance seen in adults living in endemic regions. While individuals of all age groups in these areas quite frequently suffer from malarial infections, younger children with naturally weaker immunity are at a greater risk of dying. Those who escape death tend to develop resistance gradually and hence are less likely to be killed later in life when infected. Hence higher mortality in adults reflects lower immunity, probably due to reduced infection during childhood. The vital message is that while continuing to focus on those below five, older children and adults cannot be ignored in any malaria protection programmes.

The research has a limitation. Part of the data used comes from less reliable verbal autopsies — where the probable cause of death is inferred based on interviews with the family of a deceased person. But researchers are often compelled to use verbal autopsies as many developing countries, India included, do not have national registries that have highly reliable and robust data of the cause of death. Hence the true scale and distribution of several diseases is never known. This not only hampers research, but greatly affects policy-building process and funding priorities. India cannot complain, and has only itself to blame, when policies and guidelines drawn by global agencies like the WHO ignore the ground reality. After all, the WHO uses sketchy data available in research papers and undependable figures recorded in registries. It is time India realised that the first step to prevent and control diseases is by having a proper registration system in place to record the cause of all deaths.