FROM THE intense summer heat this year to lack of nutrition programmes, effective awareness campaigns and a full-fledged local health facility.
According to medical experts and officials, these are the key reasons behind a spurt in cases of Acute Encephalitis Syndrome (AES) in north Bihar — from seven deaths in 2018 to 103 so far this year, most of them children below 10 years of age.
On Monday, the National Human Rights Commission (NHRC) sent notices to the central and state governments over reports of increasing AES-linked deaths of children in Muzaffarpur, and sought a report within four weeks.
On Sunday, Union Health Minister Harsh Vardhan visited the Sri Krishna Medical College and Hospital (SKMCH) in Muzaffarpur, from where 85 deaths were reported. Officials said 18 deaths were reported from Kejriwal Matrisadan, a trust-run hospital in Muzaffarpur.
Of the 440 AES-linked hospital admissions so far this summer, 154 patients are under treatment. Most of them hail from low-income families of Muzaffarpur, East Champaran, Vaishali, Sitamarhi and Samastipur. Since the massive outbreak of 2014 that led to 355 deaths in the region, official AES figures show 11 deaths in 2015, four in 2016 and 11 in 2017. And experts say the annual cycle will continue unless urgent steps are taken to address the reasons behind the spike:
Explained | AES deaths: What makes Bihar so vulnerable?
SOARING HEAT: Since June 1, the temperature in Muzaffarpur has remained above the 40-degree Celsius mark. Experts cite studies to point out that excessive heat, with no rains in between, has fuelled AES cases. Between 2011 and 2014, there were 970 AES-linked deaths, with heat and humidity emerging as the common element. The number dipped after rains set in, they say. “Heat, humidity, poor hygiene and malnutrition are the key reasons. Multiple studies have failed to come up with any one conclusion but have attributed all these factors to the spread,” said Dr Arun Shah, executive committee member, Indian Academy of Paediatrics Association.
NUTRITION PROGRAMMES: The Bihar Health Department appears to have failed in coordinating effectively with Integrated Child Development Services (ICDS) in carrying out nutrition programmes in Muzaffarpur and surrounding areas.
Asked if the government has identified AES-affected areas for such programmes, Bihar Health Minister Mangal Pandey said: “There is no specific or devoted nutrition programme for AES-affected areas. As hypoglycaemia (low sugar levels in blood) is cited as the main reason for AES deaths, we are discussing ways to do it. So far, we are depending on anganwadis to carry out programmes uniformly in all areas under ICDS.”
Paediatrician Shah said: “The liver is a rich source of glycogen in a normal person but not among the poor and malnourished children in the region. They are always borderline cases of malnutrition. Most AES deaths are reported in mornings, which shows that the children went without food the previous night, making sugar levels dip.”
AWARENESS CAMPAIGNS: Health Minister Pandey claimed that awareness campaigns are carried out in March-April, but several Muzaffarpur residents and local experts said they were not conducted over the last few months due to the Lok Sabha elections. Such campaigns usually advise parents to make their children wear full-sleeved cotton clothes, not expose them to the sun, and not allow them to go to bed without food. ORS packets are also distributed. A district official admitted that the administration was not vigilant this time, given the few AES deaths reported in the last four years.
PRIMARY HEALTHCARE CENTRES: The PHCs, which are the first point of healthcare for most AES patients, are often ill-equipped to deal with AES cases. Most PHCs do not have a glycometer, which is crucial for patients with low sugar levels. By the time the cases are referred to SKMCH, most patients develop complications. SKMCH medical superintendent Dr S K Shahi said: “Most patients come to us via PHCs and private doctors while they should be brought immediately after they show symptoms of vomitting and high temperature.” Union Minister Harsh Vardhan said the Centre would ensure that each PHC in the region would have 10 beds and a glycometer.
NO FULL-FLEDGED HOSPITAL: The SKMCH at Muzaffarpur is not yet fully equipped to deal with AES despite being the designated hospital in the region for treatment. The hospital does not have a virology lab or adequate number of paediatric ICUs. Harsh Vardhan has announced the setting up of a 100-bed children’s ward, and work is on to construct seven paediatric ICUs.
On Monday, the Union Health Minister said that an inter-disciplinary, high-quality research team has been set up to work with children suffering from AES. He said five virology labs will be set up in different districts of Bihar.