One Million Deaths - survey in India

The Centre for Global Health Research is conducting an incredible research program, called Million Death Study (MDS). This program had been started 16 years ago and has been set up to document death in India using ‘verbal autopsy’ strategies. The MDS involves in-person surveys of more than 1 million households in India to study premature mortality from 1997 to 2013 which occurred outside the hospital.  Using the verbal autopsy method, the researchers can determine the probable causes of death in cases where there was no medical record or formal medical attention. Families are questioned by field-workers about the events that preceded the deaths. The narratives are then sent to physicians to assign a probable cause of death to each case. The data is valuable for public health experts to monitor disease and assess interventions. That is why the CGHR will be providing the results of the Million Death Study to governments, research agencies and the media.

Nature has published an article on this study which highlights the gathering of the data, the progress of the study and of course the preliminary results on the top causes of deaths. The four most significant causes of death for Indians aged 30-69 are vascular disease, chronic respiratory disease, tuberculosis and cancer. However, the real value of the MSD lies in the observed trends and differences between deaths in hospital and in rural areas. For instance, of the deaths attributed to malaria 90% occurred in rural areas outside of hospital or health-care facilities. These estimates

are much higher than the estimates of the WHO. The use of verbal autopsy to gather the data has been criticized, also by the WHO, as it is not always possible to differentiate malaria from other diseases that cause fever symptoms. However, other teams have also reported higher mortality rates due to malaria.

 (c) CGHR: Million Death Study

The MDS was started by Prabhat Jha, an epidemiologist at the University of Toronto, who wanted to found more information on his grandfather’s death, who had died at home in India. Jha went on to found the CGHR, an independent, not-for-profit organization.