The death of 113 malnourished children due to Acute Encephalitis Syndrome (AES) in Bihar’s Muzaffarpur district during the last one month could have been prevented with early intervention and proper healthcare infrastructure. It is heart-wrenching that such tragedies occur with unfailing regularity because of the failure of the health administrators to learn from past mistakes. Bihar has seen a depressingly familiar pattern over decades: Delay in admitting the children to hospital, understaffed primary health centres, poor treatment facilities, callousness of the administration and then the business-as-usual approach. The deaths are attributed to low blood sugar level and hypoglycin, a toxin naturally present in litchi fruit. While well-nourished children who eat the fruit remain unaffected even if they go to bed on an empty stomach, the undernourished ones are at grave risk. Blood glucose falls sharply causing severe brain malfunction (encephalopathy), leading to seizures and coma, and death in many cases. This is because the undernourished children lack sufficient glucose reserve in the form of glycogen and the production of glucose from non-carbohydrate source is blocked midway leading to low blood sugar level. This causes serious brain function derangement and seizures. A simple intervention like infusing 10% dextrose within four hours of the onset of illness can save the lives of many children. If encephalopathy was indeed the cause of death, this simple medical intervention could have saved many lives. Dextrose infusion could have been done even as children were being transported to hospitals in ambulances. The failures were glaring at the stages of both prevention and institutional care.
Following a similar tragedy in 2014, when 357 children lost their lives due to Encephalitis, the State government had drawn up a standard operating procedure that included vaccination, cleanliness drive and awareness campaign. However, it appears to have been ignored this time as the deaths kept mounting. It took more than two weeks for Chief Minister Nitish Kumar to respond to the crisis and visit the hospital where he was greeted with protests. The State government’s announcement that a ‘socio-economic-environmental study’ would be conducted covering all the affected families will not, in any way, help in ameliorating the present crisis. The study is ostensibly aimed at finding out whether the affected families’ overall condition, especially economic situation, level of sanitation and environmental conditions were among the possible reasons for the outbreak of the disease. Unless the State government takes urgent measures to upgrade its health infrastructure and make the system responsive and accountable, diseases like AES and its many variants would continue to haunt it. Between 2000 and 2010, more than 1,000 children lost their lives due to this infection in Muzaffarpur district alone. But, no efforts were made to counter the menace.