Bihar AES deaths: Advice on nutrition ignored

Five years after Indian researchers cracked the Bihar's mystery brain disease, it continues to kill hundreds of kids in the eastern state amid concerns that health authorities and local administration have disregarded the need for a “nutritional enhancement” of poor children, who are at the receiving end.

Back in 2014 a veteran pediatrician partnering with a toxicologist in Lucknow identified, a combination of malnourishment, presence of a toxin in litchi fruit and children going to bed in empty stomach as the culprit behind the deaths triggered by the mystery brain disease.

Their findings was endorsed by a second team led by the Centre for Disease Control, Atlanta and comprised investigators from the Union Health Ministry. The conclusion was the same – children shouldn't miss their evening meals and their nutrition status needs to be improved.

Soon after the Eureka moment, child specialist T Jacob John from Christian Medical College, Vellore proposed a nutritional enhancement project for Muzaffarpur to the Bihar government to get rid of the AES (Acute Encephalitis Syndrome) death that recurs every year.

“I can't talk about the government but no one was interested (about the project). We seem to be a society without compassion. I had offered that I would personally stay in Muzaffarpur and supervise. The disease is hypoglycemic encephalopathy - preventable and treatable,” John told DH when asked about fate of the nutrition enhancement plan.

Going by the official data, Muzaffarpur has a serious child nutrition problem. Nearly 48% of the children under five years in the district are stunted (height-for-age); 42% are underweight (weight for age) and 17.5% are wasted (weight-for-height), says the National Family Health Survey-4, India's biggest public health assessment.

The CDC study – the biggest investigation so far of the Muzaffarpur AES using the 2014 cases – too recommended to the State and Union government to ensure kids don't skip a meal at night and reduce litchi consumption besides improving their nutritional status.

John while working with Mukul Das of Indian Institute of Toxicology Research, Lucknow also found out what the doctors should do to reduce child mortality.

“All primary health Centre medical officers have been taught to draw blood for glucose measurement and immediately infuse 10% dextrose, instead of sending the children with encephalopathy to the two designated referral hospitals in the district headquarters, which may involve hours of delay that results in risk to life or full brain recovery,” they reported in December 2015.

Four years later, the lessons learnt from the studies have not percolated even to the health officials and a large section of doctors, who are adding to the confusion.

“Indian doctors, by and large do not understand what evidence is and what opinion is and the difference. Scientific temper is lacking. We come from the society. We carry society's norms with us even after learning scientific approach in medicine,” John said.