Here is why Excess Mortality posed a Challenge for India

“Estimating the extent of excess mortality in India will not be as easy as it is in many developed countries, but knowing what Indian mortality statistics it will be a good place start”, said Usha Ram, professor and head of the Department of Public Health and Mortality Studies at International Institute of Population Science.

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Excess Mortality posed a challenge for India_The Policy Times
Source: National Health Profile 2019/Global Burden of Disease 2017 via IndiaSpend

Excess mortality is defined as the number of deaths above that is expected during normal times. India’s officially recorded deaths have always been high, even before the Covid-19 pandemic, only 70% of deaths in India are registered, and only a fifth of these are medically certified and more often the underlying cause of death is recorded incorrectly. Even the countries that had near-complete registration of deaths in normal times reported that their officially recorded COVID-19 death tolls might have been underestimated and most of the developed countries globally are now focusing not on directly reported COVID- 19 deaths but on excess mortality.

India’s National Health Mission reports monthly data over 150, 000 health facilities in every district of the country. Data for March indicated a fall in deaths reported to district and sub-district hospitals and under most categories data for subsequent months have not been released, though they are usually updated every day. All-cause national mortality data are not yet available in India, but data from some cities and states show fewer deaths overall or lower “all-cause mortality”.

In a press conference on May 29 CM of Kerala said that total mortality had fallen in the state until mid- May. Last year in Kerala between January 1 and May 15, 93, 717 deaths have been recorded whereas this year during the same period, 73, 155 deaths have been recorded. The number has been lowered by 20, 562. COVID- 19 was first reported in Kerala ate the end of January this year. As of the end of April, Mumbai had found similarly as per the Brihanmumbai Municipal Corporation data shared with Indian Spend, all-cause mortality had declined as compared to previous months and years.



Even before COVID- 19 is was well observed that India’s annual estimates of deaths from disease crossed a significant number of deaths, by comparing officially recorded data with the estimates using multiple other methods including verbal autopsies. Official data relying largely on government hospitals estimated 194 deaths from malaria in 2017, while the Global Burden of Disease, which uses multiple sources including verbal autopsies, estimated to 50, 000 deaths for the same year. Estimates for tuberculosis incidence are 10 times the official numbers, our analysis shows.

What India has to do?

“Estimating the extent of excess mortality in India will not be as easy as it is in many developed countries, but knowing what Indian mortality statistics it will be a good place start”, said Usha Ram, professor and head of the Department of Public Health and Mortality Studies at International Institute of Population Science.  At the first place, India must quantify the problems with its baseline data. “The baseline data for many states is very poor so it is not possible to build on it,” said Ram. He added to his statement that, “The less developed states have virtually no reliable data on medically certified causes of death and for smaller states, the sample sizes were so small in the past that their numbers are unusable.”

The only way to know the excess deaths caused due to COVID- 19 is by conducting a sample post- COVID. But even then, deaths of people who could not access dialysis or die due to lack of medicines will be missed. “Enumerators will be needed to ask more probing questions,” Ram said. India has conducted two national-level household surveys on all-cause mortality in the past, whose architecture could be built on, says Prabhat Jha, founding director of the Centre for Global Health Research in Toronto. Jha says that for less developed and rural districts to update the official date on all-cause mortality is unreliable, as compared to urban areas as they have Register for Deaths, but sometimes that also does not count on the right estimates and doesn’t give many details.

In cities like Mumbai where most details take place in hospitals and most crematoria and burial grounds are also run by the civic administration the Register of Deaths is a much more reliable source of information as compared to Bihar where maximum deaths take place at homes and cremations and burial ground rarely need permission. Jha had also recommended another way that is “If the police coroners in every district then all bodies they are conducting autopsies on and from that, we would get some prevalence in the unrelated dead- people who died from traffic injuries and so on and forth and looking forward if they had COVID also,”.

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Excess Mortality posed a challenge for India
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“Estimating the extent of excess mortality in India will not be as easy as it is in many developed countries, but knowing what Indian mortality statistics it will be a good place start”, said Usha Ram, professor and head of the Department of Public Health and Mortality Studies at International Institute of Population Science.
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The Policy Times