More than 100 children in Bihar’s Muzaffarpur district have died of acute encephalitis syndrome (AES), with the state’s medical authorities initially blaming the deaths on the heat wave, hypoglycemia (sudden drop in blood sugar levels) and lack of awareness. Now, belatedly, they have acknowledged the two most critical reasons for the deaths — malnutrition and the inadequacy of primary health centres (PHCs).
The state government’s lack of preparedness is indefensible. AES has struck Muzaffarpur with regularity in the summers since 1995. The disease claimed nearly 1,000 children between 2010 and 2014. It seemed to have become less virulent after 2014. At the same time, however, a growing body of literature on AES underlined that the medical authorities had no room for complacency. For example, a 2014 study by researchers from the Christian Medical College, Vellore, and the Centers for Disease Control and Prevention in Atlanta in the US showed how a combination of factors, unique to Muzaffarpur, sharpened the vulnerability of its children to the disease. The district is a major litchi-growing region and the study found that toxins present in the fruit were a source of AES. But the fruit was a triggering factor only in the case of children who had not received proper nutrition, the study reported. It said that the toxins in the fruit assume lethal proportions when a poorly-nourished child eats litchis during the day and then goes to sleep without a proper meal. The links between the fruit and AES have been debated but most researchers agree that the disease affects only under-nourished children. However, the state government has not taken the cue from medical research. It does not have a special nutrition programme for AES-prone areas.
Medical literature has also shown that AES can be contained if the child is administered dextrose within four hours of the onset of symptoms. But every AES outbreak in the past 10 years has shown that Muzaffarpur’s PHCs — the first point of healthcare for most AES patients — are ill-equipped to deal with the disease. Most of them do not have glycometers to monitor blood sugar levels. The Sri Krishna Medical College and Hospital, the designated hospital in Muzaffarpur to deal with the disease, does not have a virology lab or adequate number of paediatric beds. Union Health Minister Harsh Vardhan has assured that these shortcomings will be remedied urgently. The state government has also issued similar assurances. Both the Centre and the state will be watched in how they deal with an eminently-preventable disease.