At AES epicentre, experts count reasons, families rue: 'Poverty, malnutrition & lack of awareness'

"We all kw poverty and malurishment are some key reasons behind children's deaths but one will talk officially as it is a very sensitive matter." 

A senior doctor at Sri Krishna Medical College and Hospital tries to find reasons as to why Acute Encephalitis Syndrome (AES) has devastated so many families in rth Bihar's district of Muzaffarpur in a matter of three weeks -- over 125 children have succumbed to  disease till Saturday.

A visit to two facilities -- government-run SKMCH and Kejriwal hospital, run by a trust -- that are dealing with most of  AES patients in district makes it clear doctor was right in his assessment.

At least 127 children have died till 9 am Saturday -- 107 at SKMCH, 20 at Kejriwal hospital. Most of patients came from ecomically poor families, with many being farm labourers or daily w labourers.

"Majority of children mitted at hospital belonged to lower strata on socioecomic front," said SKMCH Medical Superintendent Dr Sunil Shahi.

But when asked if deaths were directly linked to "poverty", he refused a clear answer. "My job is to treat patients," he said, "senior government officials can answer (on  poverty aspect)".

government has maintained deaths were caused by hypoglycemia, a condition that les to a very low level of blood sugar and electrolyte imbalance.

On June 22, three died at SKMCH though casualty was reported from Kejriwal hospital.SKMCH's MS Shahi, however, expressed satisfaction that out of 429 patients mitted in hospital, 188 have been discharged after treatment.

When this correspondent visited SKMCH on Friday afteron, gates of general ward of paediatric and all five paediatric ICU, with capacity to treat 50 patients at a time, were shut for mediapersons, probably because frequent visits by journalists might have inconvenienced patients and ir attendants.

However, senior doctor spoke to PTI, requesting anymity. "We all kw poverty and malurishment are some key reasons behind children's deaths but one will talk officially as it is a very sensitive matter." 

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At Kejriwal hospital,  ministrator said poverty and hot and humid wear of town are two main reasons for se deaths.

"99 per cent of children mitted at Kejriwal hospital since June 1 belonged to families whose socioecomic condition is very poor...Children went to sleep without having dinner. This, coupled with hot and humid wear, brought ir blood sugar level down drastically," hospital's ministrator V V Giri told PTI.

"It has been my experience that  disease hits poor families. And I have informed both  district magistrate and civil surgeon that poverty and unusual wear conditions are two main reasons for deaths," said 88-year-old who has been associated with hospital for around three deces.

"Malnutrition is obvious result as poor families don't take healthy diet. H y been taking healthy diet, children would t have died in such a large numbers," Giri said.

But he asserted "litchi h a very mir role to play in this".

Dr Arun Shah, one of leing paediatricians of Muzaffarpur and also a member of national executive committee of Indian Acemy of Paediatricians, also said litchi is t responsible for  disease.

It has been found in a study that when a malurished child consumes unripe litchis empty stomach "it can bring down blood sugar level as unripe litchi contains toxins like MCPG and Hypoglycene A", Dr Shah said.

Though, he singled out malnutrition.

Referring to his joint paper published in a medical journal 'current science' in 2016, he said, "Our study confirmed that malurished children are becoming easy prey to disease and in particular in months of May-June. Malnutrition is biggest reason for children's deaths." 

Dr Shah, who has been studying this since 1995, asserted "poverty, hot wear, malnutrition, unhygienic conditions are main reasons." 

A study jointly conducted by  National Centre for Disease Control and Centre for Disease Control, Atlanta, USA, and published in rewned journal 'Lancet' in 2017, listed malnutrition as " cause of children's deaths", he said, ding lack of awareness is also one of m.

A National Centre for Disease Control staff, who was carrying out a survey at Kejriwal hospital, also said "re seems to be a link with malurishment".

Majority of respondents PTI spoke to said y didn't have information on preventive measures. Also, almost all of m complained y did t get anything at Anganwi centre.  poor hygiene at hospital didn't help eir.

Litter were strewn around aisle leing to paediatric's general ward on ground floor of SKMCH and foul stench was difficult to withstand.

"thing is available at Anganwi Kendra, even ORS was t distributed in my vill," said 70-year-old Maanmati Devi, a resident of Shitalpatti vill, who mitted her grandchild at SKMCH on Monday.

Mohamm Ujale, a farmer at Sutihara vill, h come to SKMCH for his niece's treatment. He too h similar Anganwi centre story to share. He said he didn't come across any vertisement about preventive measures. "r did any government ncy tell me about it." 

However, Akhileshwar Rai of Akhtiarpur Paraiya whose grandchild was being discharged from SKMCH did say he came to kw about preventive measures through TV and newspapers.

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