So about those rabies statistics…

While we’re doing plenty of mucking about in 80/90+ degree sunny tropical weather (with apologies to the long-suffering Minnesotans back home), sight-seeing and sponging up volumes of info on Indian culture, history, medicine and healthcare while here for 3 weeks in Mysore, India, we’ve also been split into small groups and tasked with completing a group project which will be presented to our classmates, faculty, parents, sigs and whatever other strays show up that evening in February.  Each group is at liberty to choose whatever topic suits them, although it’s generally assumed the topic will to be in some way, shape or form (however tangentially) related to medicine/health care, and it should be centered on some aspect of Mysore or India generally.

However, as has been particularly highlighted, bolded and underscored for us is the point that whatever our project/research/topic – it shouldn’t end up being something we could just basically phone-it-in on or complete by simply researching it entirely on the internets. We should be working to find and make use of local resources, eg the small army of physicians and SVYM staff at our disposal, the SVYM library, local residents, photos/vids/audio of experiences, interviews, etc.

My group’s project started out looking to explore the public health impacts of the out-sized feral/community dog populations  (i.e. acting as rabies and tick/flea-carried disease vectors) and snakes/snakebites on city and rural communities in India. We’ve expanded that topic a wee bit (at least in this data-gathering stage while here in Mysore) to look at other negative public health impacts of human/animal interactions (elephants, jaguars, tigers, etc). However as I found today – the continuing progression/evolution of our group project, as well as the alleys and side ventures along the way, may end up being nearly as interesting as our topic(s) itself.

Dogs snoozing outside one of the main entrances to Mysore Medical College Hospital, where each day approx 50-60 individuals suffering from dog-bites come for treatment.

Our project took a turn for the investigative-journalism today when by happenstance Dr. Sumanth lecturing this morning about public health mentioned in passing the incidence of rabies cases annually in India as 221. That number surprised me, as the stats on the number of annual cases/deaths from rabies in India which our group has been discussing (acquired online from NIH, CDC & WHO’s websites, no less) was estimated to be consistently around 20,000 annually (or 0.2 lakhs, as I’ve learned).

 

I assumed the prof had perhaps made a mistake, dropped a zero or two, or that maybe his stat was just for Karnataka, or a percentage increase/decrease or indicative of s/thing other than annual rabies rates in India. Even if the 20k number used by WHO/CDC/NIH is a wild over-estimate, that’s still 2 orders of magnitude difference from Dr. Sumanth’s numbers

I inquired with Dr. Sumanth during a class break to clarify what his rabies number signified, and he confirmed that 221 was indeed the number of documented deaths due to rabies annually in 2007 across all of India ; he didn’t offhand know why there would be such discrepancy between our numbers.

As an aside, a veterinarian, Dr. Prayag Siddalingappa  (who primarily deals with reptile and large-animal medicine/health) who we interviewed yesterday made some specific cynical and critical remarks in response to our inquiries about rabies in India, and mitigation/management efforts thereof focused on India’s dog population (estimated in a WHO-sponsored study* to be approx “approximately 25 million dogs, with an estimated dog:man ratio of 1:36”). Our interviewee expressed skepticism that either ABC (“animal birth control”) or vaccination efforts in the dog populations is in any way truly helpful in controlling/decreasing rabies in the country, and asserted (to paraphrase) that ABC/vax efforts of dogs was pretty much just a racket sucking up swaths of funding, to little/no effect.

Our group collectively found his assertions rather surprising; we figured he must have good reason and specific experiences to hold such a strong opinion, but we tucked away the info to assess/discuss later.

So, after running square into Dr. Sumanth’s inadvertent refutation of the WHO’s rabies stats this morning, and mindful of Dr. Siddalingappa’s assertions yesterday, I dug around further online and found a post (from what appears to be a pan-Indian NGO with the mission of humanely controlling India’s dog population) speaking directly to the matter of this discrepancy in Indian rabies stats: “Official Indian human rabies death toll of 20,000 ignored government’s own data.”

The article starts off by asserting that “collecting current data about disease incidence in India since 2003, the Indian Central Bureau of Health Intelligence has known for nearly 10 years that the oft-claimed Indian human rabies death toll of 20,000 per year is high by a factor of nearly 100” and that “according to the Central Bureau of Health Intelligence, rabies has killed an average of 238 Indians per year during the past nice years, within a range of 162 to 361.”

For reasons I’m still looking into, it seems the Indian gov’t has been using (whether deliberately or inadvertently) errant rabies estimates based on a century-old analysis of someone’s “personal inquiries” of incidents of dog-bites mixed in with extrapolations and “guesstimates” of the incidence of rabies in dogs.

I don’t need to go all V.I. Warshawski ad nauseam here on the topic (though clearly I would if left to my own devices – but I’ll save it for our project/presentation), but I will say I think this is a good illustration of (me) seeing a situation (oodles of feral/community dogs where we are in India) through American/Western eyes, perhaps making some assumptions with American sensibilities, and then finding out the real story is rather more complicated. It’s also a particular lesson in digging deeper in data-gathering, rather than just grabbing the low-hanging-fruit data that may be the quickest/easiest available (even if that data is from such reputable sources as NIH/WHO/CDC).

* Sudarshan MK. Assessing burden of rabies in India. WHO sponsored national multi-centric rabies survey (May 2004). Assoc Prev Control Rabies India J2004;6:44-5.