Govt Investigations Into Muzaffarpur AES Deaths Show a Health System in Shambles


New Delhi: As the central and state governments have finally begun a belated response to the annual crisis in Bihar where children die, suspectedly from Acute Encephalitis Syndrome (AES), their reports and audits show the poor social conditions in the area – making this crisis all together predictable and preventable.

A report in the Times of India says that the Bihar government did a social audit of 287 families affected by AES and found that 61 children who were affected by AES had not eaten the night before they fell sick.

About 64% of the houses which were near litchi orchards said that their children who fell ill had eaten litchis. But in three fourths of these cases, care givers were not aware of AES or the kinds of treatment involved.

A report in the New Indian Express said that the Bihar government skipped awareness drives about AES this year due to the Lok Sabha elections.

According to the social audit conducted by the Bihar government, three fourth of the families hit by AES have an average monthly income of Rs 4,465. Many of these families has six to nine members. Some families have an annual income of just Rs 10,000. 82% of the families surveyed worked as labourers. Many did not have ration cards, or if they had them, were not able to access rations. About two thirds lived in kutcha houses. Less than half had managed to get any benefit from the Pradhan Mantri Awas Yojana. 60% of the families did not have a toilet.

A seven-member team from All India Institute of Medical Sciences (AIIMS) which has also been investigating health conditions in Muzaffarpur has said that Bihar’s doctors at Shri Krishna Medical College Hospital (SKMCH) lack training. This hospital alone caters to about eight districts and most children diagnosed with AES are brought here.

Doctors at SKMCH were also found to be unaware of how to use equipment in the Paediatric Intensive Care Unit (PICU). Although the hospital had CT scanners and ventilators, they were not put to use on the children coming to them with AES.

The AIIMS team said that mortality from AES at well functioning facilities is between 6% to 19%. SKMCH has seen a mortality rate of about 25%.

Regarding any possibility of linkages between the AES deaths and litchis, the AIIMS team reportedly said that “the work was not sufficient to prove that the toxin is causative in all cases”. They have also recommended further investigations by the National Centre for Disease Control, Indian Council for Medical Research, National Institute of Virology and other institutions.

Other government data shows that almost all medical centres in Muzaffarpur are rated at zero. Some were so poor in quality that they were not even considered fit for evaluation.

There are apparently 103 primary health centres in the district while there should be at least 170. For a primary health centre to be considered worth evaluating, it needs to have a 24×7 centre with at least one medical officer, more than two nurse-mid wives and a labour room.

Centres which are not 24×7 need to have just one medical officer and nurse. Yet, 98 of the 103 centres could not meet these minimum criteria. There is only one community health centre in the district and this one too was considered unfit for evaluation. Muzaffarpur should have at least 43 community health centres.