Pune: Maharashtra health department data shows a decline in reported heatstroke cases following a revision despite rising temperatures across the state, raising fresh concerns over the accuracy of reporting systems.
Revised Figures Raise Questions
Between March 1 and May 10, the state had reported 236 heatstroke cases and four deaths — both suspected and confirmed. On Tuesday, officials revised the heatstroke figures downward to 175, while the death toll was updated to six — four suspected and two confirmed.
Explaining the revision in heatstroke figures and fatalities, state surveillance officer Dr Raju Sule said some cases had been incorrectly classified as heatstroke. "Many ground staffers have misreported certain cases as heatstroke, which caused the figures to inflate. The Aurangabad team later withdrew those cases and the number has gone down. Diagnosing heatstroke remains inherently difficult, as it is based on clinical symptoms without any definitive test."
Structural Gaps in Reporting
He acknowledged structural gaps in reporting. "We have trained our staffers to report cases. But apart from difficulty in diagnosis, lack of reporting staff and nodal officers in medical colleges is also a reason for low reporting," he said, noting that cases this season could be higher given the surge in temperatures "but are not fully captured in official records."
With a strong El Niño event intensifying heat conditions this year and temperatures consistently remaining above 40°C in many districts of Maharashtra, doctors warn that the official numbers are likely underestimated. Dr Avinash Ignatius, senior nephrologist and transplant physician at Pune's Noble Hospitals and Research Centre, said they were witnessing a sharp increase in heat-related kidney problems as temperatures climb beyond the 40°C-mark.
He said, "Over the past few weeks, a significant number of patients are visiting OPDs and emergency departments with dehydration-related renal stress, acute kidney injury, worsening chronic kidney disease, urinary tract infections and kidney stone episodes. Many patients report symptoms such as severe weakness, dizziness, reduced urine output, muscle cramps, nausea, burning urination, flank pain, fatigue, and episodes of fainting or near-syncope. Particularly vulnerable are the elderly, diabetics, outdoor workers, hypertensive patients and those with pre-existing kidney disease."
Fatalities Under Scrutiny
Questions over accuracy extend to fatalities as well. From March 1 to May 11, six heatstroke deaths were recorded — four suspected (two from Ahilyanagar, one each from Akola and Solapur) and two confirmed (one each from Akola and Latur). However, a May 1 death of a 34-year-old fruit vendor in Pachora of Jalgaon district — reported earlier and confirmed locally as heatstroke — has not yet been included in the state tally.
Officials said the case was under investigation pending autopsy confirmation. Dr Vijay Vasant Patil, medical officer, RH Pachora, Jalgaon, said, "I have sent the postmortem report to my seniors. When the patient was brought to me, he was dead by then. His relatives had reported that the man was exposed to about 43-45°C for a prolonged period."
Policy Implications of Under-Reporting
Experts warn that under-reporting of heatstroke cases has serious policy implications. Dr Pradipkumar Awate, former state surveillance officer who had drafted the guidelines for heatstroke in Maharashtra, blamed "the lackadaisical attitude of the administration for the poor reporting of heatstroke cases."
He said, "The health department must regularly follow up with the district administration for reporting of cases, especially in Vidarbha which is known for its heat spots. The state has asked the local civic bodies to prepare a heat action plan, but for that we must have enough data. Localised data is important because even though a city temperature might be low, specific areas may be 'heat islands'. An effective action plan is possible only when actual numbers are reported."
Scientific literature indicates that heat-related mortality is frequently misclassified, as extreme heat often aggravates pre-existing conditions rather than appearing as the primary cause of death. Clinically, heatstroke can resemble dehydration, infections, or cardiovascular collapse, particularly when patients present late or without documented heat exposure. India saw a 55% rise in deaths due to extreme heat between 2000-2004 and 2017-2021, a recent study published in a medical journal stated.
