Encephalitis Deaths in Muzaffarpur: A nightmare for children

June 26, 2019October 7, 2019 Tietler

Bihar !!! Hotbed of an encephalitis fever !!!

The disease still remained as a mystery. The authority don’t perfectly know if it was the mosquito-borne Japanese Encephalitis that spreads from animals to humans or it is Acute Encephalitis, the one that spreads through contaminated water or it is simply a condition of Hypoglycemia when the level of glucose in the blood falls below normal caused by Litchi consumption.

Encephalitis is a disease that causes inflammation of brain. It leads to fever and associated neurological conditions like confusion, mental disorientation, delirium or even coma. In children with low glucose levels because of poor nutrition, glucose does not reach the brain causing the symptoms. A simple intervention of treating them with glucose has drastically reduced the mortality.

Children are dying due to encephalitis and absence of required medical attention for hundreds of young patient. Almost every second home is mourning in the city of Muzaffarpur due to deaths.

The victims are all very young, mostly come from poor families, and the symptoms generally involve fever, convulsions and nausea, followed by sudden death. In Gorakhpur, the disease has been labelled since the 1970s as Japanese Encephalitis. When Muzaffarpur, 250 km away, started seeing similar deaths several years ago, they were also blamed on JE.

Gorakhpur and Muzaffarpur are the epicenters of encephalitis, three to four patients admitted to one bed. While the task of containing mosquitoes and filth seems almost impossible in this desolate and dilapidated region of India. It is like an annual sacrifice that the Gods deserve, or just an annual event.

Muzaffarpur is emblematic of a hot spot for malnutrition in India. 50% children stunted, One in two women is anaemic and one in three is underweight. Other social determinants of malnutrition – early marriage, poverty, open defecation and more – offer a case study in what one could call a “perfect storm” of risk factors.

Understanding Causes:

From litchi to heat, heat to humidity the factors behind almost 120 children dying in eastern India this month are many, but there are two underlying and preventable root causes: poverty and bad governance.
Where the outbreak still rages, there are no toilets, no running water and no cooking gas for the group of thatched huts that make up the village.

Old saying—the poor dies in every situation, How long will we continue to wash our hands of our duty by turning such tragedies into sayings and idioms?

Are litchi to blame?

According to the researchers missing dinner combined with toxins hypoglycin A and methylenecyclopropylglycine present in litchi seeds is the cause of illness. Extra glucose is stored in the liver and is released when sugar levels dip in the blood.

Litchi cannot be attributed as the major factor as even infants have been affected

But, if litchis were behind the deaths then it would have affected children in all litchi-growing regions and not be limited to Muzaffarpur and its surrounding areas. High humidity combined with high temperatures is the reason for chamki bukhar.

Poverty, not Litchi, the real culprit in Indian ‘brain fever’ outbreak

The assassination of the LITCHI with the disease has resulted in fear among many litchi lovers, affecting the sale of the fruit.

We need to identify the one that killed the children and the other that is killing the litchi industry. Litchi is an absolutely safe fruit for all adults and well nourished children.

Malnutrition and poverty:

Children because of malnourished together with skipping dinner there is no extra glucose in the liver. So instead of sugar toxins are secreted making the disease fatal. The delay in taking children to hospital and thus administering and correcting glucose levels was the cause of death.

The problem is nutrition. If these children were well fed, the toxin would have not killed them.

Health system failure:

We are dealing in the dark.Investigation is in dismal state. So far not a single autopsy has been conducted. No histology of organ like of Liver performed by any agency. Delay in implementing an ambitious project announced by center in 2014 when a similar outbreak killed 380 children.

There is acute shortage of doctors, medical facilities, intensive care units and other medical equipment in the Hospitals in nearby areas and child are dying in hospitals due to lack of required facilities.

State’s response: Neither prevention nor cure:

“In the last couple of years, successful awareness campaigns helped prevent large number of casualties due to Acute Encephalitis Syndrome. The question, therefore, arises if authorities failed to conduct such campaigns this time, perhaps due to elections or other reasons”

Identifying solutions

Identifying solutions will require a deeper social analysis in addition to the health system’s readiness and response.

We need to ask questions from a social epidemiological lens.

Social antecedents of the families camping in the litchi orchards to pick the fruit?
What do their usual year-round employment and economic conditions look like?
How food secure are these families on a daily basis?
What do meal patterns look like for these families on a year-round basis, and how do they change during litchi picking season?
How vulnerable are the mothers of these young children who died?
Do they have any support in food procurement, meal preparation and child feeding?
Do these families have any access to the basic social safety net programs of the ICDS and PDS?
Had any of them ever heard about the effects of litchi consumption or the need to try to feed their children before bedtime?

Most ASHA workers complain that there isn’t enough ORS to give affected children in villages.

Treatment:

Practicing good hygiene such as washing hands well and often.
Wearing protective clothes to minimize the risk of exposure to mosquitoes and ticks.
Using insect repellents.
Ensuring there is no stagnant water around the home.
Avoiding or limiting your child’s contact with soil, leaves and vegetation.
People would want to avoid eating litchi, particularly on an empty stomach, with some experts suggesting a link between the fruit and the illness.

They pointed out that an awareness campaign about the preventive measures is essential especially among the rural population and measures to uplift the living conditions of the affected population should be undertaken as an immediate package programme.

“Reduction in the number of cases when the atmospheric temperature has fallen down indicates a possible causal relationship between the high temperature, humidity and the present syndrome.

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