Thursday, 12 December 2013

Detecting Hidden Chronic Respiratory Deaths

Statistics of what types of disease are causing the most deaths (and how many deaths result)  in an area of the world are important for governments and other authorities to calculate what provisions to make for the healthcare in each country. Those that cause high death rates are likely to receive priority for higher funding and drug companies are likely to respond by investing in research to produce appropriate drugs if they can see that there is a large enough market for it to get a return on its investment.

In areas of the world where health services are well funded, widely available and have a long history of well organised research into the use of those services healthcare data has been routinely collected for many years.

This is not the case in parts of the world where there are barriers to the use of healthcare provision due to factors like cost & distance. People get ill and die possibly without ever seeing a healthcare worker in for example rural areas of large countries like India, where there are 10 million deaths per year. Cause of death is often not recorded and this valuable information used to be lost. Estimates of causes of death nationwide are made by organisations such as the World Health Organisation based on the recorded causes of deaths of people who died in hospital - but this may be vastly different to the rates of cause of death in the very different rural areas where risks could be quite different.

An initiative was launched in 1997 by Canadian researcher Prabhat Jha to address this shortcoming. In the absence of official figures he realised that a reasonable impression of cause of death could be attained by talking to relatives about the symptoms noted leading up to the death. These 'verbal autopsies' have now been carried out throughout India and have reached 1 million records to date.

The results of this survey when compared with WHO figures suggest that in particular there are far more cases of malaria and snake bite than are currently recorded, but others differ too.

'Correcting' existing figures to take in for account these new mortality figures we can see that in a country like India there is massively more chronic respiratory disease (6 fold high frequency) and TB (90 fold higher frequency) in age range 30 - 69 compared with high income countries (e.g. UK, USA), while there is less cancer.

Such figures strongly suggest that the demand for drug development in those areas is far higher than previously thought and hopefully this will open the way for due consideration of higher investment by drug companies, individual countries and international communities.

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