Official COVID-19 mortality statistics are strongly influenced by the local diagnostic capacity, strength of the healthcare system, and the recording and reporting capacities on causes of death. This can result in significant undercounting of COVID-19 attributable deaths, making it challenging to understand the total mortality burden of the pandemic. Excess mortality, which is defined as the increase in observed death counts compared to a baseline expectation, provides an alternate measure of the mortality shock of the COVID-19 pandemic. Here, we use data from civil death registers for 54 municipalities across the state of Gujarat, India, to estimate the impact of the COVID-19 pandemic on all-cause mortality. Using a model fit to monthly data from January 2019 to February 2020, we estimate excess mortality over the course of the pandemic from March 2020 to April 2021. We estimated 16,000 [95% CI: 14,000, 18,000] excess deaths across these municipalities since March 2020. The sharpest increase in deaths was observed in April 2021, with an estimated 480% [95% CI: 390%, 580%] increase in mortality from expected counts for the same period. Females and the 40 to 60 age groups experienced a greater increase from baseline mortality compared to other demographic groups. Our excess mortality estimate for these 54 municipalities, representing approximately 5% of the state population, exceeds the official COVID-19 death count for the entire state of Gujarat.
Official COVID-19 mortality statistics are strongly influenced by local diagnostic capacity, strength of the healthcare and vital registration systems, and death certification criteria and capacity, often resulting in significant undercounting of COVID-19 attributable deaths. Excess mortality, which is defined as the increase in observed death counts compared to a baseline expectation, provides an alternate measure of the mortality shock—both direct and indirect—of the COVID-19 pandemic. Here, we use data from civil death registers from a convenience sample of 90 (of 162) municipalities across the state of Gujarat, India, to estimate the impact of the COVID-19 pandemic on all-cause mortality. Using a model fit to weekly data from January 2019 to February 2020, we estimated excess mortality over the course of the pandemic from March 2020 to April 2021. During this period, the official government data reported 10,098 deaths attributable to COVID-19 for the entire state of Gujarat. We estimated 21,300 [95% CI: 20, 700, 22, 000] excess deaths across these 90 municipalities in this period, representing a 44% [95% CI: 43%, 45%] increase over the expected baseline. The sharpest increase in deaths in our sample was observed in late April 2021, with an estimated 678% [95% CI: 649%, 707%] increase in mortality from expected counts. The 40 to 65 age group experienced the highest increase in mortality relative to the other age groups. We found substantial increases in mortality for males and females. Our excess mortality estimate for these 90 municipalities, representing approximately at least 8% of the population, based on the 2011 census, exceeds the official COVID-19 death count for the entire state of Gujarat, even before the delta wave of the pandemic in India peaked in May 2021. Prior studies have concluded that true pandemic-related mortality in India greatly exceeds official counts. This study, using data directly from the first point of official death registration data recording, provides incontrovertible evidence of the high excess mortality in Gujarat from March 2020 to April 2021.
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The National Food Security Act (NFSA) was legislated in 2013, as a result of a long struggle in the courts and outside to address the conundrum of hunger amidst plenty. In 2001, the Indian government had a surplus foodgrains stock of 60 million tonnes 5 and yet a large number of hunger deaths were being periodically reported from across the country. It was also when the state of Rajasthan experienced its third successive year of drought and a leading human rights organisations in the country, People's Union for Civil Liberties (PUCL), approached the Supreme Court of India. Their plea was to make the right to food a justiciable right derived from Article 21 of the Indian Constitution that guarantees the right to life and liberty. While the petitioners had asked for relief for the state of Rajasthan, the Supreme Court extended the case across the country and made all the states/ Union Territories and relevant Union government agencies respondents in the case. Oxfam India Policy Brief No. 18 | April 2016 India has one of the lowest per capita daily supply of calories, protein and fat, according to the Organisation for Economic Cooperation and Development (OECD). 1 One of the biggest contradictions of contemporary India is the unconscionably high rates of child malnutrition 2 and the largest number of hungry people in the world, even as it emerged as one of the fastest growing economies. India has been a net exporter of foodgrains for more than a decade now 3 and the government warehouses stock foodgrains at levels much higher than the required buffer norms. India has malnutrition levels almost double the levels of many countries in Africa. This problem needs a multi-sectoral approach including diet diversification, women's empowerment, education, health, safe drinking water, sanitation, and hygiene. 4 The National Food Security Act (NFSA), 2013, which covers twothirds of the Indian population with subsidised food and universal entitlements for women and children, is a tentative first step towards solving this problem. There is a need for speedy implementation along with steps to avoid exclusion of poor households, and setting up an independent grievance redressal mechanism.
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