The Million Death Study in India: Can It Help in Monitoring the Millennium Development Goals?

T he Registrar General of India's Sample Registration System (SRS), a large routine demographic survey, is the country's primary system for the collection of fertility and mortality data (Box 1). It is widely regarded as an innovative way of capturing essential information on mortality patterns that may infl uence public health policy. However, although this monitoring system has been in place since 1971, there are relatively few evaluations to indicate if the SRS is truly representative or functional as a robust monitoring system. The Million Death Study in India is an ambitious project being undertaken by the SRS in close collaboration with the Centre for Global Health Research at the University of Toronto, leading Indian and other overseas academic institutions, and the Indian Council of Medical Research. The study will use the SRS framework to obtain information, from a reasonably large cohort of deaths (1 million deaths over 16 years), on the underlying causes of child and adult deaths, as well as key risk factors for these deaths (behavioral, physical, environmental, and, possibly, genetic). In a new study in PLoS Medicine , Prabhat Jha and colleagues report on the rationale, design, and implementation of the Million Death Study in India [1]. The study will use a combination of methods, looking at both a retrospective and a prospective cohort of deaths. These methods include case control studies, risk assessments, and genetic association studies. Given the unique characteristics of the health-care system in India, and the country's enormous double burden of infectious and noncommunicable diseases, the Million Death Study will provide valuable information for India that may also be relevant to other developing countries. The researchers involved in the study have shown great foresight in making their protocols available for public scrutiny. It may, therefore, be worthwhile to ask a few pertinent questions at this early stage in the project. Is the SRS framework adequate for India's current and future surveillance needs? While the scale of the study and the sample of 1 million deaths spanning the period 1998–2014 is daunting, one can see some limitations of this unique exercise given the population size and diversity in India. The study is largely embedded within the revised SRS framework, and capitalizes on the existing system. Although the new SRS sample frame is larger than before, the 7,597 sampling units cover only 7.6 million people out of India's population of just over 1 billion …