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Malaria: The view from India

In India, malaria has become a hidden problem.

Children play as a health worker fumigates a residential area where cases of malaria were reported, in Mumbai March 20, 2009. (Arko Datta/Reuters)

DELHI — Twenty-six people died of malaria in a single hospital in the northeastern Indian state of Assam this winter. But as far as the government is concerned, they might as well never have existed. The district administration reported no deaths, and nobody except members of a local NGO took any notice.

India has always underreported its malaria cases, government officials admit off the record. But the scope of the hidden problem has become astounding. While the official figures state that in 2008 India had 1.5 million malaria cases, resulting in 924 deaths, the real number of deaths is higher by several orders of magnitude.

"These numbers are a joke,” said Sunil Kaul, a doctor who works for a volunteer organization called the Ant that treats villagers. “In Assam alone we had at least 1,500 deaths last year.”

The real number of malaria-related deaths in India was closer to 40,000 in 2008, according to various non-governmental sources and some government officials who didn't want to be named.

"Unless you know the level of the disease burden how can you plan to prevent or treat it?" Kaul asked.

Indeed, the underreporting of malaria cases is one of the main reasons that India has been unable to prevent malaria or treat malaria cases. It has led to an astounding absence of knowledge — even among supposedly qualified private and government health workers. Few know, for instance, that malaria occurs in different topographies for different reasons and must be prevented differently in each area.

These problems are further complicated by foreign agencies such as the World Health Organization (WHO), which — under the influence of global lending agencies like the World Bank and big pharmaceutical companies — have pushed India to adopt prevention methods that don't suit the local conditions and to initiate huge, ill-considered projects rather than targeted ones.

For example, under the National Vector Borne Disease Control Program, the umbrella program for prevention and control of malaria, the Indian government has introduced new “rapid diagnostic tests,” put a legion of India's version of barefoot doctors in the field and rushed to convert to expensive Artemisinin-based Combination Therapy (ACT). None of these tools is sufficient, according to the grassroots health workers who are fighting this disease in the jungles.