Encephalitis has claimed the lives of 100 children in Bihar

Source : Firstpost.com
The first lapse was a delay in implementing an ambitious project announced by the Centre in 2014 when a similar outbreak killed 379 Children.
Union Health Minister Dr Harsh Vardhan had then visited SKMCH and announced a 100-bed super-speciality facility that's still incomplete. During his visit to SKMCH on 16 June 2019, Vardhan said it will be functional in six months.
In 2014, he had also announced a 10-bed facility for treatment of Children. It has also not seen the light of the day. 
Muzaffarpur in the last 16 days in June 2019. Nearly 300 children have been admitted to the Intensive Care Units of the two local hospitals. According to official data, 83 children have died at Sri Krishna Medical College and Hospital (SKMCH), while 17 have lost their lives in Kejriwal Hospital in the city.
Acute Encephalitis Syndrome (AES) is a viral disease that causes mild flu-like symptoms such as high fever, convulsions and headaches. The state health department has cited hypoglycemia, a condition caused by very low level of blood sugar, as one of the main reasons for the deaths.
Dr SK Shahi, the Medical Superintendent at SKMC, told NDTV that only monsoon can bring respite from the deadly disease.
Union Health Minister Harsh Vardhan visited Muzaffarpur on Sunday to take stock of the situation. After his review, the minister said he had talked to "every concerned individual about this issue".
"Despite all problems and considering the seriousness of this disease, I appreciate the efforts put in by the doctors to ensure efficient treatment to everyone," he added.
Chief Minister Nitish Kumar earlier expressed grief over the deaths and announced "an ex gratia payment of Rs. 4 lakh to the next of the kin of those who have died". The Chief Minister also said there is a lack of awareness on how to tackle this disease……Reports NDTV.
Source : Times of Imdia
What causes AES?

AES was identified for the first time in Muzaffarpur in 1995. Since then, the disease has been striking like clockwork every year but its root cause has not yet been ascertained. However, according to a paper published in the journal Science Direct, researchers who studied 135 cases drew some conclusions on the basis of eating habits, lifestyle, economic status, caste background and so on. But the actual cause behind the disease is yet to be found.
Of the cases studied in the research paper titled ‘Determinants of Acute Encephalitis Syndrome (AES) in Muzaffarpur District of Bihar, India: A Case-Control Study’, the effected children in 123 cases belonged to Scheduled Castes, Scheduled Tribes or Other Backward Classes. The families of children in 100 cases were found to be illiterate. Farming was found to be the source of livelihood for the families of 114 children.
Besides, most of the children had no awareness regarding cleanliness. Doctors consider malnutrition, absence of clean water, lack of adequate nutrition, lack of cleanliness, as well as lack of awareness as a catalyst for the disease.
Malnutrition
Dr Arun Shah, a Muzaffarpur resident and former president of IAP in Bihar, who was part of the consultative task force to understand the epidemic, spoke to News18 to help assess the problem at the intersection of economic welfare and health.
“The human angle has always been ignored. It is criminal to say that the deaths are not a case of AES,” he said. “These deaths have had the same symptoms from the past two decades. Poor, malnourished children stay hungry and they pick up to eat anything they find in the gardens like litchis. The government in Bihar is trying to divert the issue of malnutrition instead of taking it up seriously.”
Source : New18.com
Dr Ajay Kumar, a member of the Indian Medical Association, says the cause behind this disease is still unknown. “But it is clear that its virus has not been isolated,” he adds.
Kumar claims that requests have been made several times for a dedicated lab for research into AES but none have been set up yet…..Reported by The wire.
Were steps taken to prevent the outbreak?
Since the root cause of this disease is yet unknown, precaution is the only way to go. The Bihar government had, until now, found an effective method in the Standard Operating Procedure (SOP) it had prepared with UNICEF.
The SOP included many important steps. For instance, Accredited Social Health Activists (ASHA) workers are directed to undertake a survey of villages in order to identify such patients. They would provide ORS to the affected families and ensure that no child in the village slept on an empty stomach. Apart from this, there was also provision for a number of basic amenities in primary health centres.
According to experts, the SOP was followed in the last three or four years — which brought about a decline in children’s deaths, a fact supported by data.
Statistics from Bihar’s health department show that the disease claimed the lives of 11 children in 2015, four in 2016, 11 in 2017, and seven in 2018.
However, what is believed to be negligence in following the SOP has led to significantly more deaths this year. District health director of Muzaffarpur, Dr Shivchandra Bhagat, however dismisses allegations of any such negligence.
He says, “ASHA workers and auxiliary nurse midwifes were instructed to spread awareness in villages. Announcements were made through loudspeakers. ASHA workers were directed to identify sick children and give them ORS. We have also made adequate arrangements in primary health centres. Instructions have also been issued to compensate anyone who brings a sick child from remote areas on rented vehicles.”…..Reported by The wire
There are around 93,600 ASHA workers. The reporter talked to some of them to verify the claims of government officials but most said it was a yearly occurrence and seemed to want to brush off the importance of awareness and prevention drives.
On condition of anonymity, an ASHA worker said, “I tried to spread awareness in the village under my charge. But we receive very little ORS and I am unable to offer it to all the children in danger.” A similar problem was faced by other ASHA workers too.
The AES outbreak only began in the beginning of June. As affected children began pouring into hospitals, claiming 100 of life. But the government did not take any action…..Report’s The wire.

POOR FACILITIES

SKMCH Medical Superintendent Dr Sunil Shahi said that the facilities are not enough to deal with the crisis. He said inadequate beds pose a major challenge to cater to the large number of patients.
"Looking at inadequate facilities at SKMCH, the Union Health Minister has cleared a 100-bed Pediatrics Intensive Care Unit. In the meantime, we are using 16 ENT beds to deal with the crisis," he said.

NO GORAKHPUR LESSON?

Only a couple of years ago, Gorakhpur in Uttar Pradesh was in the grip of Japanese encephalitis that has killed thousands of children over four decades.
When the Yogi Adityanath government took over, Japanese encephalitis was the biggest health challenge in eastern Uttar Pradesh in 2017.
More than 500 children died that year in Gorakhpur and its neighbourhood. Altogether 14 districts of the region were in the grip of Japanese encephalitis. In August 2017, many children died at BRD Hospital leading to huge political furore.
The government opted for desperate measures and launched Action Plan 2018 in collaboration of the World Health Organisation (WHO) and Unicef.
A massive vaccination drive and a robust health and sanitation campaign were launched. These measures seem to have worked for Uttar Pradesh - cases dropped by about two-thirds in 2018. Since both eastern UP and north Bihar share almost the same geographical hot and humid climate, a favourable ground for the spread of Japanese encephalitis and AES, the measures adopted by the Yogi Adityanath government could have helped the Nitish Kumar government in checking deaths.
The Bihar government also has a standard operating procedure (SOP) laid down in 2015 in consultation with Unicef.
The SOP mandates that grassroots health workers including auxiliary nursemidwife (ANM), accredited social health activists (ASHA) and anganwadi employees have to conduct household-level survey to check if any child has symptoms of Japanese encephalitis and AES.
The efforts brought down the death toll. 2012 saw the highest number of deaths (424) due to the disease also called 'chamki' fever.
In 2013, 2014, 2015, 2016, 2017 and 2018, the numbers were 222, 379, 90, 103, 54 and 33, respectively.

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