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Global health: One million deaths
What researchers are learning from an unprecedented survey of mortality in India.
Erica Westly
04 December 2013
...
The Million Death Study (MDS) involves
biannual
in-person surveys of more than
1 million households across India. The study
covers the period from 1997 to the end of 2013,
and will document roughly 1 million deaths. Jha
and his colleagues have coded about 450,000
so far, and have deciphered several compelling
trends that are starting to lead to policy changes,
such as stronger warning labels on tobacco.
...
http://www.nature.com/polopoly_fs/1....df/504022a.pdf
Centre for Global Health Research
MILLION DEATH STUDY (MDS)
Million Death Study
The Million Death Study (MDS) is one of the largest studies of premature mortality in the world. The MDS is an ongoing study that is conducted in India, where, like most low- and middle-income countries, the majority of deaths occur at home and without medical attention. As a result, the majority of global deaths do not have a certified cause.
In collaboration with the Registrar General of India, the MDS will monitor nearly 14 million people in 2.4 million nationally representative households in India between 1998-2014. Any deaths that occur in these households during this period will be assigned a probable cause, as determined by a method called verbal autopsy.
The results for the leading causes of death in India will be provided to governments, research agencies, and media as they become available so that they can take action against preventable deaths.
MDS Study Protocol
MDS Collaborators
MDS Publications
...
http://www.cghr.org/index.php/projec...study-project/
Diarrhea, Pneumonia, and Infectious Disease Mortality in
Children Aged 5 to 14 Years in India
Shaun K. Morris1,2*, Diego G. Bassani1, Shally Awasthi3, Rajesh Kumar4, Anita Shet5, Wilson Suraweera1,
Prabhat Jha1 for the MDS Collaborators
1 Centre for Global Health Research, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario,
Canada, 2 Division of Infectious Diseases, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada, 3 Department of Pediatrics, King George’s Medical
University, Lucknow, Uttar Pradesh, India, 4 School of Public Health, Post Graduate Institute of Medical Education, Chandigarh, India, 5 Department of Pediatrics, St. John’s
National Academy of Health Sciences, Bangalore, India
Abstract
Background: Little is known about the causes of death in children in India after age five years. The objective of this study is
to provide the first ever direct national and sub-national estimates of infectious disease mortality in Indian children aged 5
to 14 years.
Methods: A verbal autopsy based assessment of 3 855 deaths is children aged 5 to 14 years from a nationally representative
survey of deaths occurring in 2001–03 in 1?1 million homes in India.
Results: Infectious diseases accounted for 58% of all deaths among children aged 5 to 14 years. About 18% of deaths were
due to diarrheal diseases, 10% due to pneumonia, 8% due to central nervous system infections, 4% due to measles, and
12% due to other infectious diseases. Nationally, in 2005 about 59 000 and 34 000 children aged 5 to 14 years died from
diarrheal diseases and pneumonia, corresponding to mortality of 24?1 and 13?9 per 100 000 respectively. Mortality was
nearly 50% higher in girls than in boys for both diarrheal diseases and pneumonia.
Conclusions: Approximately 60% of all deaths in this age group are due to infectious diseases and nearly half of these
deaths are due to diarrheal diseases and pneumonia. Mortality in this age group from infectious diseases, and diarrhea in
particular, is much higher than previously estimated.
...
Morris SK, Bassani DG, Awasthi S, Kumar R, Shet A, et al. (2011) Diarrhea, Pneumonia, and Infectious Disease Mortality in Children Aged 5 to 14 Years in
India. PLoS ONE 6(5): e20119. doi:10.1371/journal.pone.0020119
http://cghr.org/wordpress/wp-content...idren-2011.pdf
Causes of neonatal and child mortality in India: a nationally
representative mortality survey
The Million Death Study Collaborators*
Summary
Background More than 2·3 million children died in India in 2005; however, the major causes of death have not been
measured in the country. We investigated the causes of neonatal and child mortality in India and their differences by
sex and region.
Methods The Registrar General of India surveyed all deaths occurring in 2001–03 in 1·1 million nationally
representative homes. Field staff interviewed household members and completed standard questions about events
that preceded the death. Two of 130 physicians then independently assigned a cause to each death. Cause-specific
mortality rates for 2005 were calculated nationally and for the six regions by combining the recorded proportions for
each cause in the neonatal deaths and deaths at ages 1–59 months in the study with population and death totals from
the United Nations.
Findings There were 10 892 deaths in neonates and 12 260 in children aged 1–59 months in the study. When these
details were projected nationally, three causes accounted for 78% (0·79 million of 1·01 million) of all neonatal deaths:
prematurity and low birthweight (0·33 million, 99% CI 0·31 million to 0·35 million), neonatal infections
(0·27 million, 0·25 million to 0·29 million), and birth asphyxia and birth trauma (0·19 million, 0·18 million to
0·21 million). Two causes accounted for 50% (0·67 million of 1·34 million) of all deaths at 1–59 months: pneumonia
(0·37 million, 0·35 million to 0·39 million) and diarrhoeal diseases (0·30 million, 0·28 million to 0·32 million). In
children aged 1–59 months, girls in central India had a fi ve-times higher mortality rate (per 1000 livebirths) from
pneumonia (20·9, 19·4–22·6) than did boys in south India (4·1, 3·0–5·6) and four-times higher mortality rate from
diarrhoeal disease (17·7, 16·2–19·3) than did boys in west India (4·1, 3·0–5·5).
Interpretation Five avoidable causes accounted for nearly 1·5 million child deaths in India in 2005, with substantial
differences between regions and sexes. Expanded neonatal and intrapartum care, case management of diarrhoea and
pneumonia, and addition of new vaccines to immunisation programmes could substantially reduce child deaths in India.
Funding US National Institutes of Health, International Development Research Centre, Canadian Institutes of Health
Research, Li Ka Shing Knowledge Institute, and US Fund for UNICEF.
...
http://cghr.org/wordpress/wp-content...India-2010.pdf
Health Datasets from the Government of India;
http://data.gov.in/catalogs/?filter=...rt=title%20asc
Adult and child malaria mortality in India: a nationally
representative mortality survey
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*
Summary
Background National malaria death rates are difficult to assess because reliably diagnosed malaria is likely to be cured,
and deaths in the community from undiagnosed malaria could be misattributed in retrospective enquiries to other
febrile causes of death, or vice-versa. We aimed to estimate plausible ranges of malaria mortality in India, the most
populous country where the disease remains common.
Methods Full-time non-medical field workers interviewed families or other respondents about each of 122 000 deaths
during 2001–03 in 6671 randomly selected areas of India, obtaining a half-page narrative plus answers to specific
questions about the severity and course of any fevers. Each field report was sent to two of 130 trained physicians, who
independently coded underlying causes, with discrepancies resolved either via anonymous reconciliation or
adjudication.
Findings Of all coded deaths at ages 1 month to 70 years, 2681 (3·6%) of 75 342 were attributed to malaria. Of these,
2419 (90%) were in rural areas and 2311 (86%) were not in any health-care facility. Death rates attributed to malaria
correlated geographically with local malaria transmission rates derived independently from the Indian malaria control
programme. The adjudicated results show 205 000 malaria deaths per year in India before age 70 years (55 000 in early
childhood, 30 000 at ages 5–14 years, 120 000 at ages 15–69 years); 1·8% cumulative probability of death from malaria
before age 70 years. Plausible lower and upper bounds (on the basis of only the initial coding) were 125 000–277 000.
Malaria accounted for a substantial minority of about 1·3 million unattended rural fever deaths attributed to infectious
diseases in people younger than 70 years.
Interpretation Despite uncertainty as to which unattended febrile deaths are from malaria, even the lower bound greatly
exceeds the WHO estimate of only 15 000 malaria deaths per year in India (5000 early childhood, 10 000 thereafter). This
low estimate should be reconsidered, as should the low WHO estimate of adult malaria deaths worldwide.
Funding US National Institutes of Health, Canadian Institute of Health Research, Li Ka Shing Knowledge Institute.
...
http://cghr.org/wordpress/wp-content...India-2010.pdf
Official number of cases & deaths due to Acute Diarrhoeal Diseases, Acute Respiratory Infection, Deaths, Japanese Encephalitis, Malaria & Viral Hepatitis 2000 - 2011
http://data.gov.in/dataset/number-ca...s-due-diseases
FluTrackers Threads:
India malaria deaths hugely underestimated, says report
20,000 rabies deaths per annum in India - Maybe not
What researchers are learning from an unprecedented survey of mortality in India.
Erica Westly
04 December 2013
...
The Million Death Study (MDS) involves
biannual
in-person surveys of more than
1 million households across India. The study
covers the period from 1997 to the end of 2013,
and will document roughly 1 million deaths. Jha
and his colleagues have coded about 450,000
so far, and have deciphered several compelling
trends that are starting to lead to policy changes,
such as stronger warning labels on tobacco.
...
http://www.nature.com/polopoly_fs/1....df/504022a.pdf
Centre for Global Health Research
MILLION DEATH STUDY (MDS)
Million Death Study
The Million Death Study (MDS) is one of the largest studies of premature mortality in the world. The MDS is an ongoing study that is conducted in India, where, like most low- and middle-income countries, the majority of deaths occur at home and without medical attention. As a result, the majority of global deaths do not have a certified cause.
In collaboration with the Registrar General of India, the MDS will monitor nearly 14 million people in 2.4 million nationally representative households in India between 1998-2014. Any deaths that occur in these households during this period will be assigned a probable cause, as determined by a method called verbal autopsy.
The results for the leading causes of death in India will be provided to governments, research agencies, and media as they become available so that they can take action against preventable deaths.
MDS Study Protocol
MDS Collaborators
MDS Publications
...
http://www.cghr.org/index.php/projec...study-project/
Diarrhea, Pneumonia, and Infectious Disease Mortality in
Children Aged 5 to 14 Years in India
Shaun K. Morris1,2*, Diego G. Bassani1, Shally Awasthi3, Rajesh Kumar4, Anita Shet5, Wilson Suraweera1,
Prabhat Jha1 for the MDS Collaborators
1 Centre for Global Health Research, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario,
Canada, 2 Division of Infectious Diseases, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada, 3 Department of Pediatrics, King George’s Medical
University, Lucknow, Uttar Pradesh, India, 4 School of Public Health, Post Graduate Institute of Medical Education, Chandigarh, India, 5 Department of Pediatrics, St. John’s
National Academy of Health Sciences, Bangalore, India
Abstract
Background: Little is known about the causes of death in children in India after age five years. The objective of this study is
to provide the first ever direct national and sub-national estimates of infectious disease mortality in Indian children aged 5
to 14 years.
Methods: A verbal autopsy based assessment of 3 855 deaths is children aged 5 to 14 years from a nationally representative
survey of deaths occurring in 2001–03 in 1?1 million homes in India.
Results: Infectious diseases accounted for 58% of all deaths among children aged 5 to 14 years. About 18% of deaths were
due to diarrheal diseases, 10% due to pneumonia, 8% due to central nervous system infections, 4% due to measles, and
12% due to other infectious diseases. Nationally, in 2005 about 59 000 and 34 000 children aged 5 to 14 years died from
diarrheal diseases and pneumonia, corresponding to mortality of 24?1 and 13?9 per 100 000 respectively. Mortality was
nearly 50% higher in girls than in boys for both diarrheal diseases and pneumonia.
Conclusions: Approximately 60% of all deaths in this age group are due to infectious diseases and nearly half of these
deaths are due to diarrheal diseases and pneumonia. Mortality in this age group from infectious diseases, and diarrhea in
particular, is much higher than previously estimated.
...
Morris SK, Bassani DG, Awasthi S, Kumar R, Shet A, et al. (2011) Diarrhea, Pneumonia, and Infectious Disease Mortality in Children Aged 5 to 14 Years in
India. PLoS ONE 6(5): e20119. doi:10.1371/journal.pone.0020119
http://cghr.org/wordpress/wp-content...idren-2011.pdf
Causes of neonatal and child mortality in India: a nationally
representative mortality survey
The Million Death Study Collaborators*
Summary
Background More than 2·3 million children died in India in 2005; however, the major causes of death have not been
measured in the country. We investigated the causes of neonatal and child mortality in India and their differences by
sex and region.
Methods The Registrar General of India surveyed all deaths occurring in 2001–03 in 1·1 million nationally
representative homes. Field staff interviewed household members and completed standard questions about events
that preceded the death. Two of 130 physicians then independently assigned a cause to each death. Cause-specific
mortality rates for 2005 were calculated nationally and for the six regions by combining the recorded proportions for
each cause in the neonatal deaths and deaths at ages 1–59 months in the study with population and death totals from
the United Nations.
Findings There were 10 892 deaths in neonates and 12 260 in children aged 1–59 months in the study. When these
details were projected nationally, three causes accounted for 78% (0·79 million of 1·01 million) of all neonatal deaths:
prematurity and low birthweight (0·33 million, 99% CI 0·31 million to 0·35 million), neonatal infections
(0·27 million, 0·25 million to 0·29 million), and birth asphyxia and birth trauma (0·19 million, 0·18 million to
0·21 million). Two causes accounted for 50% (0·67 million of 1·34 million) of all deaths at 1–59 months: pneumonia
(0·37 million, 0·35 million to 0·39 million) and diarrhoeal diseases (0·30 million, 0·28 million to 0·32 million). In
children aged 1–59 months, girls in central India had a fi ve-times higher mortality rate (per 1000 livebirths) from
pneumonia (20·9, 19·4–22·6) than did boys in south India (4·1, 3·0–5·6) and four-times higher mortality rate from
diarrhoeal disease (17·7, 16·2–19·3) than did boys in west India (4·1, 3·0–5·5).
Interpretation Five avoidable causes accounted for nearly 1·5 million child deaths in India in 2005, with substantial
differences between regions and sexes. Expanded neonatal and intrapartum care, case management of diarrhoea and
pneumonia, and addition of new vaccines to immunisation programmes could substantially reduce child deaths in India.
Funding US National Institutes of Health, International Development Research Centre, Canadian Institutes of Health
Research, Li Ka Shing Knowledge Institute, and US Fund for UNICEF.
...
http://cghr.org/wordpress/wp-content...India-2010.pdf
Health Datasets from the Government of India;
http://data.gov.in/catalogs/?filter=...rt=title%20asc
Adult and child malaria mortality in India: a nationally
representative mortality survey
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*
Summary
Background National malaria death rates are difficult to assess because reliably diagnosed malaria is likely to be cured,
and deaths in the community from undiagnosed malaria could be misattributed in retrospective enquiries to other
febrile causes of death, or vice-versa. We aimed to estimate plausible ranges of malaria mortality in India, the most
populous country where the disease remains common.
Methods Full-time non-medical field workers interviewed families or other respondents about each of 122 000 deaths
during 2001–03 in 6671 randomly selected areas of India, obtaining a half-page narrative plus answers to specific
questions about the severity and course of any fevers. Each field report was sent to two of 130 trained physicians, who
independently coded underlying causes, with discrepancies resolved either via anonymous reconciliation or
adjudication.
Findings Of all coded deaths at ages 1 month to 70 years, 2681 (3·6%) of 75 342 were attributed to malaria. Of these,
2419 (90%) were in rural areas and 2311 (86%) were not in any health-care facility. Death rates attributed to malaria
correlated geographically with local malaria transmission rates derived independently from the Indian malaria control
programme. The adjudicated results show 205 000 malaria deaths per year in India before age 70 years (55 000 in early
childhood, 30 000 at ages 5–14 years, 120 000 at ages 15–69 years); 1·8% cumulative probability of death from malaria
before age 70 years. Plausible lower and upper bounds (on the basis of only the initial coding) were 125 000–277 000.
Malaria accounted for a substantial minority of about 1·3 million unattended rural fever deaths attributed to infectious
diseases in people younger than 70 years.
Interpretation Despite uncertainty as to which unattended febrile deaths are from malaria, even the lower bound greatly
exceeds the WHO estimate of only 15 000 malaria deaths per year in India (5000 early childhood, 10 000 thereafter). This
low estimate should be reconsidered, as should the low WHO estimate of adult malaria deaths worldwide.
Funding US National Institutes of Health, Canadian Institute of Health Research, Li Ka Shing Knowledge Institute.
...
http://cghr.org/wordpress/wp-content...India-2010.pdf
Official number of cases & deaths due to Acute Diarrhoeal Diseases, Acute Respiratory Infection, Deaths, Japanese Encephalitis, Malaria & Viral Hepatitis 2000 - 2011
http://data.gov.in/dataset/number-ca...s-due-diseases
FluTrackers Threads:
India malaria deaths hugely underestimated, says report
20,000 rabies deaths per annum in India - Maybe not
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