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

Muzaffarpur: "We all know poverty and malnourishment are some key reasons behind children's deaths but no 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 north Bihar's district of Muzaffarpur in a matter of three weeks -- over 125 children have succumbed to the disease till Saturday.

A visit to two facilities -- government-run SKMCH and the Kejriwal hospital, run by a trust -- that are dealing with most of the AES patients in the district makes it clear the 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 the patients came from economically poor families, with many being farm labourers or daily wage labourers. "Majority of the children admitted at the hospital belonged to lower strata on socioeconomic front," said SKMCH Medical Superintendent Dr Sunil Shahi.

But when asked if the 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 the poverty aspect)".

The government has maintained the deaths were caused by hypoglycemia, a condition that leads to a very low level of blood sugar and electrolyte imbalance. On Saturday, three died at SKMCH though no casualty was reported from Kejriwal hospital. SKMCH's MS Shahi, however, expressed satisfaction that out of 429 patients admitted in the hospital, 188 have been discharged after treatment. When this correspondent visited SKMCH on Friday afternoon, the gates of general ward of the paediatric and all the 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 their attendants.

However, the senior doctor spoke to PTI, requesting anonymity. "We all know poverty and malnourishment are some key reasons behind children's deaths but no one will talk officially as it is a very sensitive matter." At Kejriwal hospital, the administrator said poverty and hot and humid weather of the town are the two main reasons for these deaths.

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

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

"Malnutrition is the obvious result as poor families don't take healthy diet. Had they been taking healthy diet, children would not have died in such a large numbers," Giri said. But he asserted "litchi had a very minor role to play in this". Dr Arun Shah, one of the leading paediatricians of Muzaffarpur and also a member of national executive committee of Indian Academy of Paediatricians, also said litchi is not responsible for the disease.

It has been found in a study that when a malnourished 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 malnourished children are becoming easy prey to the disease and in particular in the months of May-June...." PTI