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Ostrich approach to reporting disease

One of the most important challenges before India, and one closely tied to reducing human distress, is to bring down…

Ostrich approach to reporting disease

Representational Image (PHOTO: GETTY IMAGES)

One of the most important challenges before India, and one closely tied to reducing human distress, is to bring down the incidence of several serious diseases.

The first challenge is to have accurate estimates of prevalence of these diseases so that efforts in keeping with the scale of the problem can be initiated. But in India this first step itself has been marred by the tendency to underestimate important diseases and health problems, and continuance of reporting and estimating procedures that are likely to err on the side of underestimation.

In the case of tuberculosis, for example, the recently released Global TB Report 2016 prepared by the WHO has stated that India reported only 56 per cent of its disease burden in 2014 and 59 per cent in 2015. The revised estimates have put the incidence of TB in India at 217 per 100,000 people in 2015 instead of the previous estimate of 127.

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If a disease is substantially understated, it is certain that funds allocated to fight and treat it will also be significantly below the actual need. This is even clearer in the case of leprosy where premature claims of elimination of the disease as a public health problem created pressures to underreport incidence. Significant underestimation led to an overall curtailment of efforts to reduce the disease. However the folly of this approach has been realised now and special drives are being taken up to bring out the many hidden cases of this badly stigmatized disease. In September-October 2016, a 20-day drive launched by the Union Health Ministry helped to detect at least 20,000 hidden cases of leprosy even though less than a third of the country was covered. Overall about 125,000 new cases were detected in India in 2014-15.

Substantial underreporting of malaria has similarly led to anti-malaria efforts that are well below requirements, particularly in the vast tribal belt of central India. According to government data about 2 million people suffer from malaria in a year while about 700 die due to this disease annually. WHO estimates that about 15 million people suffer from malaria annually in India while about 20,000 of them die. The estimates of people getting affected by malaria and dying from it obtained in the much discussed Million Death Study were many times higher than even the WHO study.

Jan Swasthya Sahyog, a health organization known for its work in the tribal belt of Chattisgarh, reported in 2010 that at the time of a malaria epidemic it counted about 200 deaths in a single block of Bilaspur district while the government reported 42 deaths in the entire state. Government figures were restricted to only laboratory reports from its health facilities, and these also followed norms which were likely to result in significant underreporting of malaria deaths.

Snake-bites are an important cause of death in rural India and the poor are likely to be the victims. These deaths being very sudden are also very distressing and traumatic for rural households. The estimate of 45,900 snake bite-related deaths in a year made by the Million Death Study is regarded as fairly reliable by experts, but this is over 30 times higher than the government estimate based on only hospital reporting. As the government estimate of snake bite deaths is a huge underestimation, this leads to a substantial lowering of the funds and efforts needed to save the lives of mostly poor victims of snake bites.

Similarly in the case of rabies, government figures indicate deaths ranging between 244 and 556 in a year for recent years for which figures are available. However the Million Death Study found that some 12,700 people died from symptomatically identifiable furious rabies in a year. If anything this is likely to have risen due to an alarming increase in the number of stray dogs in many areas. But the huge underestimation of mortality by the government results in a situation where adequate resources are not available for saving dog bite victims from the possibility of a very painful and traumatic death.

There is scattered but convincing evidence that most occupational diseases are underestimated to a shocking extent, and in fact in many cases occupational origins of serious diseases are simply denied. This is certainly true of silicosis, probably the most widely prevalent occupational disease. Yet most of its victims are not even aware that they are afflicted by occupational diseases and have claims to compensation.

Clearly there is significant room for improvement in estimation of diseases so that more reliable and accurate estimates of diseases can become the basis for arranging efforts and funds to fight these.

The writer is a freelance journalist who has been involved with several important social initiatives and movements.

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