Malaria deaths in India under-reported? Bad news for pro-DDT partisans


Good news from the war on malaria has been that annual deaths are calculated to be fewer than 1 million annually, as low as 880,000 a year — the lowest human death toll from malaria in human history.

Researchers in India suggest that deaths there are grossly underreported, however — not the 15,000 estimated by the World Health Organization, but closer to 200,000 deaths a year, nearly 15 times as great.

Reading that news, DDT partisans might get a little race of the pulse thinking that this might improve the urgency for the case for using more DDT, as advocated in several hoax health campaigns and media, such as the recent film “3 Billion and Counting.”

The problem, though, is that India is one of the few places where DDT manufacturing continues today, and India is one of the nations where DDT use is relatively unregulated and heavy.  In short, if DDT were the miracle powder it’s claimed to be, any finding that malaria deaths are 15 times greater than reported by WHO is nails in the coffin of DDT advocacy.

Bloomberg News reported:

Researchers based their estimate on interviews with family members of more than 122,000 people who died between 2001 and 2003. The numbers “greatly exceed” the WHO estimates of 15,000 malaria deaths in India each year, the researchers wrote in the study, published today in the journal The Lancet.

“It shows that malaria kills far more people than previously supposed,” said one of the study authors, Prabhat Jha of the Center for Global Health Research in Toronto, in a statement. “This is the first nationwide study that has collected information on causes of death directly from communities.”

Remote regions may have an undocumented malaria burden, because conventional methods of tracking the disease are flawed, according to the authors. In India, the government malaria data, which is used by the Geneva-based WHO, only counts patients who had tested positive for the disease at a hospital or clinic. Others who died of symptoms closely resembling the malady but didn’t get a blood test aren’t included, co-author Vinod Sharma of the Indian Institute of Technology in New Delhi said in an interview today.

The lack of accurate data may hinder efforts by governments and aid organizations to provide diagnosis and treatment to the population at risk, the authors said.

Watch.  Advocates of poisoning Africa and Asia will claim scientists and environmental activists are somehow to blame for any underreporting, and they will call for more DDT use, claiming a ban has made India a refuge for malaria.  Those reports will fail to mention India’s heavy DDT use already, nor will they suggest an ineffectiveness of the nearly-sacred powder.

The article in the Lancet became available on-line on October 21 — it’s a 4.5 megabyte .pdf document:  “Adult and child malaria mortality in India: a nationally representative mortality survey.” A team of researchers is listed as authors of the study:  Neeraj Dhingra, Prabhat Jha, Vinod P Sharma, Alan A Cohen, Raju M Jotkar, Peter S Rodriguez, Diego G Bassani, Wilson Suraweera,Ramanan Laxminarayan, Richard Peto, for the Million Death Study Collaborators.

Accurate counts of infections and deaths provide essential information for effective programming of the fight against the disease.  Researchers point no particular fingers, but make the case in the article that better methods of counting and estimating malaria deaths must be found.

There are about 1·3 million deaths from infectious diseases before age 70 in rural areas in which fever is the main symptom. If there are large numbers of deaths from undiagnosed and untreated malaria in some parts of rural India then any method of estimating overall malaria deaths must rely, directly or indirectly, on evidence of uncertain reliability from non-medical informants and, although our method of estimating malaria mortality has weaknesses, indirect methods may be even less reliable. The major source of uncertainty in our estimates arises from the possible misclassifi cation of malaria deaths as deaths from other diseases, and vice versa. There is no wholly satisfactory method to quantify the inherent uncertainty in this, and indeed the use of statistical methods to quantify uncertainty can convey a false precision. However, even if we restrict our analyses to deaths immediately classifi ed by both physician coders as malaria, WHO estimates (15 000 deaths per year at all ages)1 are only one-eighth of our lower bound of malaria deaths in India (125 000 deaths below the age of 70 years; of which about 18 000 would have been in health-care facilities).

Our study suggests that the low WHO estimate of malaria deaths in India (and only 100 000 adult malaria deaths per year worldwide) should be reconsidered. If WHO estimates of malaria deaths in India or among adults worldwide are likely to be serious underestimates, this could substantially change disease control strategies, particularly in the rural parts of states with high malaria burden. Better estimates of malaria incidence and of malaria mortality in India, Africa, and elsewhere will provide a more rational foundation for the current debates about funding for preventive measures, about the need for more rapid access to malaria diagnosis, and about affordable access in the community to effective antimalarial drugs for children and adults.

More:

About these ads

112 Responses to Malaria deaths in India under-reported? Bad news for pro-DDT partisans

  1. firk says:

    your site is excellent with all the information you provide,
    thanks for your time..
    great work

    Like

  2. Ed Darrell says:

    Royce, that piece is copyrighted. I cut out more than an acceptable quote, and posted a link instead. I’m assuming you had not edited Engdahl’s text at all.

    It’s a grand display of major crank thinking -- he’s wrong on history, law, and science. He accuses without foundation, and he inserts claims where the speakers make no such claims.

    Gates is working to fight malaria. He’s not working for population reduction – except, as we have seen throughout history, when people are healthy, sound of mind, body and economy, they voluntarily reduce the number of children they have.

    Surely you have nothing against lifting people out of poverty, and allowing them to choose how many children they have, do you?

    In my quick scan of that article, I did not find a single paragraph without a major false claim. You should try to check out the footnotes he offers.

    Ending malaria should be a self-evidently noble goal. I cannot imagine how Engdahl arrives at his bizarre conclusion, that fighting malaria is an evil plot.

    Like

  3. Ellie says:

    From a brief reading of Engdahl, it looks like he’s another rabid anti-vaccer fundie who wants the world’s children to die or be crippled from preventable diseases.

    Like

  4. Royce says:

    This is an interesting article written by William Engdahl about Bill Gates and his vaccine work

    Bill Gates And Neo-Eugenics: Vaccines To Reduce Population

    F. William Engdahl
    Financial Sense
    Friday, March 5, 2010

    Microsoft founder and one of the world’s wealthiest men, Bill Gates, projects an image of a benign philanthropist using his billions via his (tax exempt) Bill & Melinda Gates Foundation, to tackle diseases, solve food shortages in Africa and alleviate poverty. In a recent conference in California, Gates reveals a less public agenda of his philanthropy — population reduction, otherwise known as eugenics.

    [text cut by blog owner]

    Like

  5. Ed Darrell says:

    Peter proposes to poison Africa completely:

    Ed, aerial spraying and large fogging machines produce a very fine mist, almost like air. A mist is quite different than Soper’s ” dousing. ” For example a can of aerosol hair spray can delivers a mist while a bottle pump delivers more of a dousing ” effect.” You see the the difference ? Dousing is inferior to mist, which was proven on the thatch roofs. Soper did not use overhead aerial spraying nor large “fogging.” Soper doused or wet sprayed the DDT. Dousing or wet spraying makes for thatch roofs falling in and it misses a lot of mosquitoes. You can however wet spray or douse standing water and potholes and such with DDT.

    Yeah, that would make DDT much more deadly — much higher fish kill, much greater bird kill, much quicker immunity to DDT for mosquitoes. More deadly to all other life, less effective against malaria.

    You’re suggesting we repeat the errors of the 1960s when such abuse of DDT as you propose killed the WHO campaign to eradicate malaria, because the mosquitoes quickly evolved resistance (which you deny, though you’ve not dealt with the DNA facts as presented by Jonathan Weiner, noted in a previous post).

    I know of a couple of drunks in Africa who’d probably agree with you, Peter, but other than those two wackoes, I’ll wager your proposal would earn horrified shouts to stay away from Africa from every malaria fighter. Dousing was superior to fogging because it could be controlled, and kept indoors. Fogging was rejected by Soper because it was ineffective overkill. Fogging would be pumping poison to kill everything BUT the mosquitoes.

    Today, a fine spray is used to put the minimum amount to be maximally effective on the places a mosquito is likely to rest after it bites a victim. Note that this is wholly ineffective at preventing malaria infections if the mosquito happens to be one who, two weeks previously, bit a malaria victim and got the parasite in exchange. (We’re assuming those species that carry malaria, which is really a small percentage of all mosquitoes even in areas where malaria is endemic.)

    You’re not paying any attention to the material Karl, Ellie and others are sending your way, are you.

    Fogging would make the thatched roofs fall in the same way dousing does — maybe a bit faster — and it would lead to a lot more dead cats, an explosion of rodents, and a real threat of typhus. Stupid-man-made disasters are no less disasters because they are stupid, nor because they are archly ironic (DDT having been hailed first as a solution to typhus . . .).

    Ed, it doesn’t matter if the mosquitoes mutate. Repellency is unaffected by resistance.

    But repelling mosquitoes, with DDT, doesn’t do much to stop malaria. If your goal is poison Africa, you’re on the right track. You’re aiding the spread of malaria, though, and I find that repugnant.

    The REPELLENCY action of DDT never stops working on the mosquitoes no matter how the mosquito mutates.

    That’s a pretty big assertion — one that is wholly unsupported by research. Not all mosquitoes are repelled by DDT, not even all malaria-carrying mosquitoes.

    That’s the beauty of DDT. A repelled mosquito does not bite.

    Actually, new research shows that they continue to bite, since they are not killed by the DDT. In fact, using DDT probably aids the spread of malaria according to recent research.

    See the press release from the University of Queensland (and follow up with the citations, if you care to):

    A new malaria study by UQ scientists challenges World Health Organisation guidelines for using DDT chemical spray to kill mosquitoes.

    DDT is highly toxic, posing significant risks to human health, yet is still commonly used with insecticide-treated bednets to control malaria.

    The Stockholm Convention DDT Expert Group met last week to lay out new recommendations for gradually phasing out DDT.

    Dr Laith Yakob and Dr Rebecca Dunning, from the UQ School of Biological Sciences, have been investigating the use of DDT in Kenya and at other sites across Africa.

    “During the DDT phase-out, DDT must be strictly reserved for households which do not already use insecticide-treated bednets,” Dr Yakob said.

    “When used in the same household as bednets, repellent DDT will reduce mosquitoes contacting the insecticides with which bednets are treated.”

    Current strategy of combining DDT with bednets may actually detract from the community-wide benefits experienced with bednets alone.

    “Treated bednets are highly effective at killing malaria-carrying mosquitoes,” Dr Yakob said.

    “Spraying DDT in the same residence will divert the mosquito away from the treated bednets, onto unprotected homes.”

    The study is presented in the Journal of the Royal Society Interface. Published online before print November 17, 2010, doi:10.1098/rsif.2010.053. Indoor Residual Spray and Insecticide-Treated Bednets for Malaria Control: Theoretical Synergisms and Antagonisms.

    Peter said:

    Ed, we want to stop the biting and for this to happen the mosquito doesn’t need to die. Just repelling the mosquito is enough to stop it from biting.

    Repelled mosquitoes bite next door. Soper was aware of this issue, which is why his rules required 80% coverage of huts in an affected area. Any less than 80% and you get an increase in malaria infections.

    Plus, you gotta kill the damn mosquito to be effective. Once it consumes a blood meal from a malaria-infected human, it becomes a time bomb. In two weeks it will begin spreading that malaria, unless it is killed in the interim. If the mosquito is immune to DDT, and isn’t killed shortly after that blood meal, you’ve created a pesticide-resistant malaria-carrying machine.

    You really do need to study up on malaria sometime, so you know what the issues are.

    Malaria Life Cycle, WHO

    Like

  6. karl says:

    Peter:

    I hate to break it to you but, Don Robert’s hypothesis that DDT’s repellent effect is a good thing for malaria control is disputed. He has indeed shown that some resistant mosquitos are nonetheless repelled by DDT (though his flagship study on this phenomenon was in a species that’s not a malaria vector.) He and his buddies at AFM contend that this repellency translates means that DDT can still effectively protect people from malaria, but other researchers argue that it actually doesn’t, and it may even increase malaria transmission. In fact, as far as I can tell, Robert’s is the only entomologist and/or malaria researcher who claims DDT’s repellency is helpful, and advocates using the insecticide against resistant populations.

    Like

  7. PeterG says:

    Ed Darrell says: ” That’s a foolhardy way to fight malaria, we now know. It kills much more life than needs to be killed, it kills the beneficial life that fight malaria with us (by preying on the mosquitoes) which gives malaria a big win. It contaminates streams and kills food fish, in Africa. It’s expensive, and relatively ineffective. ”

    “Soper stopped that sort of peseticide use in the 1950s. It’s a mark of how regressive is the current pro-DDT crew that anyone would suggest we go back to the Malaria Dark Ages.”

    “Fighting malaria requires that we stop mosquitoes from transmitting the disease for a short period while we cure the local humans of the disease. Fogging doesn’t do that.”

    Ed, aerial spraying and large fogging machines produce a very fine mist, almost like air. A mist is quite different than Soper’s ” dousing. ” For example a can of aerosol hair spray can delivers a mist while a bottle pump delivers more of a dousing ” effect.” You see the the difference ? Dousing is inferior to mist, which was proven on the thatch roofs. Soper did not use overhead aerial spraying nor large “fogging.” Soper doused or wet sprayed the DDT. Dousing or wet spraying makes for thatch roofs falling in and it misses a lot of mosquitoes. You can however wet spray or douse standing water and potholes and such with DDT.

    Ed Darrell says: “No mistake. Now we know from DNA studies that the mosquitoes were pushed to evolve resistance and immunity to DDT. It’s an established fact, not surmise in any form. You could read about it in Jonathan Weiner’s Pulitzer Prize-winning book, The Beak of the Finch, a story of evolution in our time. The claims that resistance did not occur are false claims, lies by now with 30 years of DNA analysis to prove the point. Surely you wouldn’t repeat old, firmly disproven lies, would you?”

    Ed, it doesn’t matter if the mosquitoes mutate. Repellency is unaffected by resistance. The REPELLENCY action of DDT never stops working on the mosquitoes no matter how the mosquito mutates. That’s the beauty of DDT. A repelled mosquito does not bite. Ed, we want to stop the biting and for this to happen the mosquito doesn’t need to die. Just repelling the mosquito is enough to stop it from biting.

    Ed Darrell says: “Could you be suffering DDT poisoning, Peter? Is there any rational explanation for what you claim?”

    Ed, would that I could suffer “DDT poisoning”. The only poison we suffer from is the Rachel Carson Litany which was as near as she could come to some psychotic retribution for her own
    cancer—- claiming the sensationalist dream of no birds and one out of four contracting cancer from DDT. All of which, like Ehrlich’s “Population Bomb” has proven to be sheer unscrupulous feeding upon an uninformed, hence fear based public. Zero of their “predictions” a sort of deranged lunacy meant for an unsuspecting public, have materialized. Absolutely zero. DDT is both an exterminator and a repellent. Dr. Roberts discusses this at great length in his new book, “DDT, the Excellent White Powder”. Dr. Roberts, as most do, one day shake the fog induced litany of Carson, and come to brilliant clarity. DDT is making a resurgence precisely because it works, it was scandalized, and is now being redeemed. All of your claims have not one shred of “peer reviewed” and that Ed, means reviewed before they are plastered all over to be “later debunked” which most of the public never see. Ed, if DDT is so poisonous as you claim, show me the peer reviewed science that supports your contention. And while I am on this subject, when are you going to address the info I provided concerning immediate death to farm workers——not from DDT, Ed——-but from those chemicals you praise as “better” as “alternatives”???

    Like

  8. Ed Darrell says:

    Peter said:

    I also brought this point again in another post were I said: ” Well there’s several points I’d like to address in reference to this. First of all yes, Ed, in order to move quickly over an area one must use large fogging machines and the use of overhead aerial spraying.

    That’s a foolhardy way to fight malaria, we now know. It kills much more life than needs to be killed, it kills the beneficial life that fight malaria with us (by preying on the mosquitoes) which gives malaria a big win. It contaminates streams and kills food fish, in Africa. It’s expensive, and relatively ineffective.

    Soper stopped that sort of pesticide use in the 1950s. It’s a mark of how regressive is the current pro-DDT crew that anyone would suggest we go back to the Malaria Dark Ages.

    Fighting malaria requires that we stop mosquitoes from transmitting the disease for a short period while we cure the local humans of the disease. Fogging doesn’t do that.

    Now what Soper tried to do was to isolate the anopheles mosquito. That in it self is nearly impossible on a large scale.

    Which is why fogging and outdoor use is stupid.

    Also Soper mistakenly interpreted and took the ” lack of death ” of the mosquito for ” resistance. ”

    No mistake. Now we know from DNA studies that the mosquitoes were pushed to evolve resistance and immunity to DDT. It’s an established fact, not surmise in any form. You could read about it in Jonathan Weiner’s Pulitzer Prize-winning book, The Beak of the Finch, a story of evolution in our time. The claims that resistance did not occur are false claims, lies by now with 30 years of DNA analysis to prove the point. Surely you wouldn’t repeat old, firmly disproven lies, would you?

    That is not true. As Dr Donald Roberts stated, during the 2005 U.S. Senate Committee on Environment and public works hearings, ” The active years of the global malaria eradication program were from 1959 to 1969.

    DDT use and most of the eradication campaign stopped by 1965. It took four more years before a convention of WHO affiliates voted on a formal end to the program, but DDT had killed the campaign by 1965.

    You could read Socrates Litsios’s history (The Tomorrow of Malaria), or Sonia Shah’s recent book. Check the facts, and stick to them.

    Before, during, and after the many years of this program, malaria workers and researchers carried out their responsibilities to conduct studies and report their research. Through those studies, they commonly found that DDT was functioning in ways other than by killing mosquitoes. In essence, they found that DDT was functioning through mechanisms of repellency and irritancy. Eventually, as people forgot early observations of DDT’s repellent actions, some erroneously interpreted new findings of repellent actions as the mosquitoes’ adaptation to avoid DDT toxicity, even coining a term, “behavioral resistance,” to explain what they saw. This new term accommodated their view that toxicity was DDT’s primary mode of action and categorized behavioral responses of mosquitoes as mere adaptations to toxic affects. However this interpretation depended upon a highly selective use of scientific data. The truth is that toxicity is not DDT’s primary mode of action when sprayed on house walls. Throughout the history of DDT use in malaria control programs there has always been clear and persuasive data that DDT functioned primarily as a spatial repellent. Today we know that there is no insecticide recommended for malaria control that rivals, much less equals, DDT’s spatial repellent actions, or that is as long-acting, as cheap, as easy to apply, as safe for human exposure, or as efficacious in the control of malaria as DDT.”

    I don’t know why Donald Roberts joined the pro-malaria group Africa Fighting Malaria, but his views cannot be counted as accurate. In any case, as we’ve discussed before, DDT is worthless if it does not kill mosquitoes. DEET is a much more effective repellent, and as a simple prophylactic, bednets are more than 100 times as effective a “repellent” as DDT.

    North’s claims that DDT works as a repellent are desperate attempts to preserve some value of the stuff, to justify poisoning Africa. As I noted, it’s logically inconsistent — DDT should kill, if it is to be used. But logical consistency has never been a hallmark of the unholy campaign against Rachel Carson and science. Logically, anyone can figure out that U.S. EPA’s banning spraying of DDT on cotton in Texas had nothing to do with the slowdown of DDT use in Africa seven years earlier — there is too much separation in distance and time, and EPA cannot time travel.

    But here you are, urging the aerial spraying of poison known to ruin entire ecosystems and be wholly ineffective against malaria in that form — and you do it without any obvious sense of irony, nor any indication that you parody.

    Could you be suffering DDT poisoning, Peter? Is there any rational explanation for what you claim?

    Like

  9. Ed Darrell says:

    Climategate U-turn: Astonishment as scientist at centre of global warming email row admits data not well organised

    Correct. Demonstrating global warming. Showing that global warming is human-caused.

    But not well organized.

    Right.

    Rutledge Taylor is wrong. His data on how DDT work are completely in error (DDT is not effective against viruses). His history is false. His legal research is shoddy.

    But it’s well-organized.

    Well-organized and wrong, or badly organized and correct. Which to choose, ethically?

    Like

  10. PeterG says:

    Ed, I think you confused Kathy with me in one of your answer to Kathy. I am the one that posted the need for overhead spraying and fogging machines. You said to Kathy: ” What I pointed out in my last two responses to you is that your premise is in error. Not only are your claims false, and unsupportable by you or anyone else — the very premises you argue from are wrong.”

    “Here, for example, you start arguing about using foggers and spraying broad areas out of doors with DDT (aerial spraying, I presume) — that absolutely is the wrong thing to do, and Fred Soper stopped such methods in the early 1950s. ”

    “That’s way beyond what even most DDT-happy people urge. You’re not fighting malaria with foggers. You’re killing off entire ecosystems for the hell of it. (Foggers and aerial spraying are fantastically non-selective, wasteful of DDT, and particularly deadly to fish, amphibians, and all predators of malaria-carrying mosquitoes).”

    “You’ve gone beyond the pale in your advocacy, Kathy — around the bend, some might say.”

    Ed This is what I posted that you mistook as Kathy saying it.I brought this issue up in several post where I said:

    “Ed, In touching on some of the issues you brought up in your comment. I’d like to mention that it’s my understanding that since the extensive and successful use of DDT in the U.S.ended with the complete eradication of malaria from the United States that DDT has not been used overhead, nor in fogging machines. Enough to kill back or repel mosquitoes so that malaria cases can be isolated completely and rehabilitated so no longer a threat to other populations.”

    I also brought this point again in another post were I said: ” Well there’s several points I’d like to address in reference to this. First of all yes, Ed, in order to move quickly over an area one must use large fogging machines and the use of overhead aerial spraying. Now what Soper tried to do was to isolate the anopheles mosquito. That in it self is nearly impossible on a large scale. Also Soper mistakenly interpreted and took the ” lack of death ” of the mosquito for ” resistance. ” That is not true. As Dr Donald Roberts stated, during the 2005 U.S. Senate Committee on Environment and public works hearings, ” The active years of the global malaria eradication program were from 1959 to 1969. Before, during, and after the many years of this program, malaria workers and researchers carried out their responsibilities to conduct studies and report their research. Through those studies, they commonly found that DDT was functioning in ways other than by killing mosquitoes. In essence, they found that DDT was functioning through mechanisms of repellency and irritancy. Eventually, as people forgot early observations of DDT’s repellent actions, some erroneously interpreted new findings of repellent actions as the mosquitoes’ adaptation to avoid DDT toxicity, even coining a term, “behavioral resistance,” to explain what they saw. This new term accommodated their view that toxicity was DDT’s primary mode of action and categorized behavioral responses of mosquitoes as mere adaptations to toxic affects. However this interpretation depended upon a highly selective use of scientific data. The truth is that toxicity is not DDT’s primary mode of action when sprayed on house walls. Throughout the history of DDT use in malaria control programs there has always been clear and persuasive data that DDT functioned primarily as a spatial repellent. Today we know that there is no insecticide recommended for malaria control that rivals, much less equals, DDT’s spatial repellent actions, or that is as long-acting, as cheap, as easy to apply, as safe for human exposure, or as efficacious in the control of malaria as DDT.”

    Like

  11. kathy says:

    One last item before I leave for airport Ed ..
    enjoy the read!

    Climategate U-turn: Astonishment as scientist at centre of global warming email row admits data not well organised | Mail Onlin

    Like

  12. karl says:

    Kathy,

    Obviously you’re too entrenched in your (sorely misinformed) position to seriously consider anything that Ed, or Ellie, or I say. But perhaps you’ll listen to Amir Attaran. He’s a strong advocate of using DDT to fight malaria and he’s guilty of propagating the ban myth, so needless to say I don’t agree with much what he has to say. But even he thinks 3 Billion and Counting (which seems to be your primary source for information on DDT) is way over the top.

    See his review in The Lancet:

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62017-X/fulltext

    Titled “A distorting take on DDT,” the review says, inter alia, “[Rutledge] claims DDT is suitable for many other diseases, some of which are not even insect-borne, and equates its rejection with genocide—overblown statements that are scientifically and legally untrue.”

    Like

Play nice in the Bathtub -- splash no soap in anyone's eyes.

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 2,333 other followers

%d bloggers like this: