Litchi industry in Bihar faces huge loss after encephalitis outbreak


Unlike previous years, the summer this year initially brought wide smiles on the faces of farmers in Bihar’s Muzaffarpur district as the region witnessed a bumper crop of litchi, the luscious fruit grown abundantly here. The joy, however, was short lived as the crop once again came under the scanner of researchers and medical experts following the death of 204 children and 938 cases in hospitals across the state due to the Acute Encephalitis Syndrome (AES).

The deaths dealt a severe blow to the litchi industry which has resulted in huge losses for the farmers and traders involved in the seasonal business that is a major source of revenue for the local economy.

Bihar is the top litchi producing state in India and according to figures provided by the former union agriculture minister to Lok Sabha last year, the state accounts for 300,000 metric tonnes of litchi, which is produced on 32,000 hectare areas. Bihar’s contribution in the production of litchi is about 40 percent

Mohammed Nizamauddin, a prominent litchi farmer and trader from Muzaffarpur, is yet to come to terms to the enormous loss. Nizam, as he is fondly called, has been in the business for more than a decade now. This year he suffered losses to the tune of around Rs 1.5 million.

The loss has put all his plans to visit a tourist destination in a quandary.

“Negative propaganda about the fruit, which has high protein and nutritional value, took a toll on its demand and supply,” lamented Nizam.

Other litchi growers across Muzaffarpur are facing a similar situation due to the negative publicity of the fruit following the AES deaths.

Traders said that the industry has suffered losses to the tune of Rs 100 billion. Last year the litchi traders did a business to the tune of Rs 60 billion and due to bumper crop this year, they had expected the business to rise to Rs 100 billion. Besides, export, supply of the fruit to various processing plants has been adversely hit. The litchi farmers and traders are worried as their crop has been blamed for a disease that still remains a mystery and there is no authentic proof of its connection with AES.

Their concerns found support from BJP MLC Sanjay Paswan, who had raised the matter in Bihar assembly while MP Rajiv Pratap Rudy also raised the matter in Parliament.

“Wrong propaganda that litchi was behind the cause of AES deaths has led to the enormous losses. Nearly 100 tonnes of fruit pulp of Rs 6.5 million market value is still lying unused after the false propaganda that litchi was the culprit behind the AES deaths,” said K P Thakur, one of the leading litchi traders and owner of Litchica International.

Thakur exports litchi juice to USA, Australia, New Zealand besides supplying the same to Mumbai and Delhi. “No orders came this year either from USA, Australia or New Zealand causing a loss of Rs 3 million,” said Thakur, who has an annual turnover of Rs 30 million.

Thakur is not alone. “There are close to one lakh people including producers, businessmen and labourers who are directly or indirectly involved in this litchi business in four major litchi producing areas of Muzaffarpur, Vaishali, Samastipur and East Champaran,” said Bachcha Singh, president of Litchi Grower’s Association.

According to a report by the Bihar horticulture department, there are 45,000 litchi-growing farmers in Muzaffarpur alone.

“The AES false propaganda, though it came at later stages, must have caused a loss of more than Rs 1 billion alone in Muzaffarpur,” said Singh.

“Such was the impact that litchi, which usually disappears from the market by mid-june, had no takers till June 25 this year,” added Singh.

The Litchi Grower’s Association president cited that another reason for mounting loss has been the railway’s decision to discontinue the services of parcel van in Pawan Express for Mumbai forcing litchi traders to send their product by trucks. “We used to send 30 tonnes of litchis per day to Mumbai by Pawan Express. But after the railway’s withdrew the service in 2018, the fruit is sent by truck as a result of which, one-fourth of the total litchis get damaged and the fruit also doesn’t remain fresh, resulting in low price,” rued Singh.

Smelling a conspiracy, Thakur said that same litchis did not cause any problem in Uttar Pradesh.

“Litchis have high percentage of phosphorus and when poor kids eat rotten fruit empty stomach, it increases sugar levels and make kids vulnerable to sun stroke,” said Thakur.

Thakur and other traders have found support from BJP MP Rajiv Pratap Rudy and BJP Bihar MLC Sanjay Paswan, who alleged that a campaign was launched against litchi under a conspiracy.

India is the second largest producer of litchi in the World after China. Other major litchi producing countries are Thailand, Australia, South Africa, Madagascar and Florida in US.

Among fruit crops, litchi ranks seventh in area and ninth in production but is sixth in terms of value in India. The national average productivity of litchi is 6.1 t/ha, which is much lower than the realizable yield of the crop under well managed condition.

Bihar to have 11 More Medical Colleges; Says Health Minister


Patna: Ignoring the fact that nearly 200 children had died in Bihar due to outbreak of the Acute Encephalitis Syndrome (AES) in the recent months in the state and the fact that Bihar hospitals remain more under lockdown due to strike by junior doctors and nurses and there is a serious crisis of doctors in nearly all state hospitals, Bihar Health Minister Mangal Pandey on Wednesday announced the government’s decision to open 11 new medical colleges in Bihar.

Reacting to the opposition’s demand of resignation in the wake of the death of children due to AES, Pandey, without mentioning anything about improving the conditions of the existing hospitals in Bihar where just as recent as last week flood water had entered in the general ward forcing the patients to be moved to different locations, said that the government was planning to open 11 new hospitals in the state. He also repeated the pledge of Chief Minister Nitish Kumar who had recently said that the Patna Medical College and Hospital (PMCH) will be turned into a ‘world-class’ hospital with 5000 beds in it.

The Health Minister was speaking at Vidhan Sabha about Rs. 96,000,000,000 (96 arab+) budget of the health department that was passed despite pandemonium by the opposition leaders who continued to demand his resignation in the wake of the AES-related deaths.

“Work has already begun on the 500-bed hospital in the Indira Gandhi Institute of Medical Sciences (IGIMS) in Patna and a proposal to build a 1200-bed hospital is also in the pipeline. Another plan includes building of a brand-new mental hospital in Koelwar with a capacity of 272 beds and hospitals with 50 to 100 bed capacity is being built in 14 blocks in various districts,” he said.

Other plans include building of a second All India Institute of Medical Sciences (AIIMS) in Bihar, a 100-bed children hospital in Muzaffarpur, a cancer hospital with a price tag of Rs. 200 crore, and building of a disease control center inside Nalanda Medical College and Hospital (NMCH) campus, the minister said.

Bihar deaths: The Great Indian Survey Trick


Basic health and nutrition services — and not just more data — will help save children’s lives in Bihar

Every time there is a major calamity, look out for those in search of the dumb villain. In Maharashtra, state water resources minister Tanaji Sawant blames crabs for the recent breach in the Tiware Dam in Ratnagiri. In Bihar’s Muzaffarpur, fingers were pointed at the litchi when over 150 children died of acute encephalitis syndrome (AES) last month.

Crabs can’t deny the charges; nor can litchis.

The exact causes of the neurological illness are still unclear but the litchi was not the sole culprit in the AES outbreak. Many other factors, notably a dysfunctional healthcare system, a creaky Integrated Child Development Services (ICDS) and extreme heat conspired against the undernourished children who had gorged on litchis fallen from trees and then gone to bed without a meal.

Almost half of Bihar’s children (48.3 per cent) are stunted or too short for their age, indicating that they have been undernourished for some time, according to the latest National Family Health Survey. A toxin in the litchi triggered reactions among children who were already malnourished, leading to hypoglycaemic encephalopathy.

Bihar has witnessed many outbreaks of AES. This time, a public interest litigation (PIL) suit by two advocates, Manohar Pratap and Sanpreet Singh Ajmani, has brought the matter to the Supreme Court (SC). Both the Centre and the Bihar government are defending themselves with masses of data and new proposals.

The Centre gave the SC a list of measures it would take to address the problem. This includes providing funds for a 100-bed paediatric intensive care unit in Muzaffarpur’s Sri Krishna Medical College.

In its affidavit, the Bihar government catalogued the steps it has taken to address the recurring AES problem in the state, and the proposed measures. It has commissioned a socioeconomic survey of the affected families in the AES-hit areas. It says this would help find a long-term solution to halt the disease.

But is more data — or yet another survey — Bihar’s pressing need?

“Credible data is certainly needed. But, currently, the biggest challenge is not the availability of data. There are already numerous government surveys as well as programme data such as Health Management Information System and others. The biggest challenge is in acting on the data,” says Sulakshana Nandi, national joint convener of Jan Swasthya Abhiyan (Peoples’ Health Movement, India).

The elephant in the room, say Nandi and other health advocates, is the lack of commitment on the part of many state governments in improving healthcare governance and health provisioning in the public sector.

“For instance, a district official is not ignorant about the status of health facilities in the district, but to what extent are they acting on it, or are empowered to act on it? States with strong public health systems such as Kerala have managed to deal with such crises, while in those with a weak public health system, it is the poor and the most vulnerable who suffer the most,” Nandi adds.

Since 2012, a standard operating procedure (SOP) has been in place to deal with AES cases in the state. The SOP, revised last year, lists the steps to be taken — such as tap water sponging, correctly positioning the patient and infusion of adequate glucose — at various levels to manage AES.

The government says in its affidavit that 6,656 copies of a booklet have been distributed to medical college hospitals, district hospitals and primary health centres to spread awareness on AES, and a soft copy of the SOP has been uploaded on the web page of the state health department.

It also points out that of the 12,206 sanctioned posts for medical doctors in the state, including contractual ones, only 5,205, or 43 per cent, are filled. There is also an acute shortage of nurses, auxiliary nurse midwives and laboratory technicians.

The state government says that it has provided gadgets such as infantometers (height-measuring device) and weighing scales to frontline workers to monitor children. Smartphones have been provided for data transmission.

But of the 1,14,718 anganwadi (childcare) centres that are sanctioned, only 99,795 are functional, according to the Bihar government affidavit. ICDS, a centrally sponsored scheme implemented by state governments and union territories, covers anganwadi services. It has the potential to be a nutrition/food safety net for poor families.

But “ICDS is failing the poorest quintile. Our diagnosis is that this is largely because many of the poorest mothers and children in India live in states such as Bihar where ICDS is in particularly poor shape. Despite improvements over time, in 2016, just about 40 per cent of Bihar’s children had received ICDS services,” says Purnima Menon, senior research fellow at the global think tank, International Food Policy Research Institute.

Menon believes the POSHAN Abhiyaan (National Nutrition Mission), launched last year, has a huge role to play here. “What is urgently needed is that the national efforts around POSHAN Abhiyaan push hard for Bihar to get the basics right in the context of their ICDS services — infrastructure, human resources, provision of food, other ICDS programme services — to all target beneficiaries,” she says. “If the basics are working, then the programme can do more in a crisis period. But if the basics are not in place, it’s going to be very difficult to respond in a crisis.”

162 children died of encephalitis in Bihar, 63 in seven other states: Govt


s many as 162 children died due to acute encephalitis syndrome (AES) in Bihar till July 2 this year, while 63 fatalities were reported from Assam, Jharkhand, Maharashtra, Manipur, Odisha, Uttar Pradesh and West Bengal till June 30, MoS Health Ashwini Choubey said on Tuesday.

Responding to a question over whether lychees were the cause of deaths, the minister, in his written reply in Rajya Sabha, said consumption of lychee was safe for healthy individuals, but in “malnourished children, it triggers hypoglycaemia and leads to seizures or AES”.

“A research study was conducted by the National Centre for Disease Control (NCDC), along with partner institutions, in the year 2013-14 wherein it has been found that when lychee is consumed by malnourished children, it triggers hypoglycaemia and leads to seizures or AES like picture,” Choubey said in his written reply.

On the basis of the study, an intervention strategy for awareness and nutritional supplementation was recommended to the state, the minister said.

A comprehensive study incorporating various other aspects of aetiology has been initiated by the Ministry of Health under Indian Council of Medical Research (ICMR).

“In 2019, a total of 162 deaths of children have been reported from Bihar till July 2 due to AES. As per information received from the National Vector Borne Disease Control Programme (NVBDCP), 63 deaths have been reported due to AES till June 30 from other seven states of the country — Assam (25), Jharkhand (2), Maharashtra (1), Manipur (1), Odisha (1), Uttar Pradesh (17) and West Bengal (16),” his reply stated.

He also elaborated on a number of measures that the Centre has initiated to support the Bihar government in the containment of AES, while adding that “as per constitutional provisions, health is a state subject”.

Choubey, in his reply, said Union Health Minister Harsh Vardhan had reviewed the situation with his counterpart in Bihar and also with officials from the ministry.

A team of experts, consisting of public health specialists from various central government institutes, was deputed to assist the Bihar government in taking immediate measures to contain AES, he said.

Vardhan had also visited Shri Krishna Medical College and Hospital (SKMCH) at Muzaffarpur in Bihar, Choubey said.

The Health Ministry had sent another high-level multi-disciplinary team, which included senior pediatricians from various central government institutes, to Muzaffarpur.

Epidemiologists from the National Centre for Disease Control (NCDC), senior pediatricians, laboratory technicians are in Muzaffarpur since June 12.

The NCDC’s Strategic Health Operations Centre (SHOC) was engaged to monitor the situation in Muzaffarpur and co-ordinate tasks at the field level, Choubey said.

He said the Health Ministry had deputed five teams of doctors, along with technicians from central government hospitals, to SKMCH to support clinical management.

“A central team, consisting experts from Indian Council of Medical Research (ICMR), was also deployed at SKMCH. The team is also scrutinising and reviewing the case records of discharge and deceased patients using a standardised tool to know the reasons for mortality,” he added.

AES in Bihar: Providing all support to contain it, Centre tells SC


The Centre told the Supreme Court Wednesday that it was proactively providing all support to Bihar in containing and managing Acute Encephalitis Syndrome (AES) in which more than children have died.

In an affidavit filed on a plea seeking measures for containment of the disease, the Centre said Union Health Minister Harsh Vardhan had visited Bihar on June 16, to review the situation in Muzaffarpur.

It said that after the visit several decisions were taken including construction of a 100 bed Paediatric Intensive Care Unit (ICU) at SKMCH hospital in Muzaffarpur by the state government in one years from the funds of National Health Mission (NHM).

“The land for the same (100-bed Paediatric ICU) is available in the premise of the SKMCH hospital and will be provided by the state,” the affidavit said.

It said a decision has been taken to set up five virology labs in different districts of the state from the NHM funds and the location of the districts will be decided in consultation with the state government.

Detailing further decisions taken, the Centre said: “In the adjoining districts, 10-bed Paediatric ICUs to be setup so that such cases can be treated early and there is no unnecessary load on the facilities available at SKMCH. Funds for this are to be provided through NHM.”

The ministry said that to enable early detection and treatment of the hypoglycemia cases, a dedicated team of doctors will be placed in endemic Primary Health Centres with required facilities, at least for three-four months before and during expected onset of disease.

“As for present, the concerned PHCs and CHCs (Community Health Centres) should take prompt corrective measures for hypoglycemia at the facility itself to utilize the golden hour”, the affidavit said.

It said that a Super Speciality Block is being constructed at SKMCH hospital, Muzaffarpur and it would start functioning by first week of December.

Besides these steps, the affidavit said that Ministry of Earth Sciences has been requested to upgrade its IMD Observatory facility for improved monitoring of climate related parameters such as temperature humidity, rainfall and share it with the state government for better preparedness and management of AES.

It said the minister has decided to constitute inter-disciplinary, high quality research team for ascertaining the case of AES with specific reference to Muzaffarpur.

“The vacant positions of district epidemiologist and entomologist in Muzaffarpur to be filled up immediately by the state government,” the health ministry said added that health is a state subject as per the Constitutional provisions.

The apex court is hearing a petition filed by advocate Manohar Pratap who has said that he was deeply “pained and saddened” by the deaths of more than 126 children, mostly in the age group of one to 10 years, in Bihar due to AES.

Besides Centre, the apex court had also asked Bihar government to file its response on the issue.

In a shocking revelation about medical care facilities in Bihar, which is facing an outbreak of acute encephalitis syndrome, the state government Tuesday told the Supreme Court that there are only 5,205 doctors in government-run health centres against the sanctioned strength of 12,206.

The state government, in an affidavit filed in the apex court, said that only 5,634 nurses were there in government run hospitals and health centres against sanctioned strength of 19,155.

The court had on June 24 directed the state to apprise it about the status of public medical care facilities, nutrition and sanitation within a week in view of deaths of over 100 children in Muzaffarpur due to the outbreak of AES.

Regarding AES cases, the state government said 824 cases have been reported and the number of deaths was 157.

It, however, said that it was not known whether 24 deaths out of 215 cases were due to AES.

“State of Bihar had already taken all possible steps to prevent the spread of the disease by providing additional medical facilities at the affected region, public awareness campaign at the village level, involving various agencies to assist the government etc,” it said.

Symptoms of AES include high fever, convulsions and extremely low blood sugar levels. Among the factors said to trigger the syndrome are malnutrition.

There were more than 44,000 cases and nearly 6,000 deaths from encephalitis in India between 2008 and 2014, said a 2017 study published in The Indian Journal of Medical Research (IJMR).

Researchers said the patients often report acute onset of fever and altered consciousness, with a rapidly deteriorating clinical course, leading to death within hours.

Litchis grown in Muzaffarpur, the country’s largest litchi cultivation region, are said to contain a toxin which can cause a drop in blood sugar levels if consumed by a malnourished child.

‘Nation Responsible for Dying Kids in Bihar, Time For Child Survival Policy That Fixes Accountability’


New Delhi: With over 100 children dead due to Encephalitis in Bihar since June 2019, the biggest question that remains to be answered is who is to be held responsible?

“Children, obviously, cannot be held responsible for either ‘bringing’ or ‘allowing’ their death. So, there are two parties that could be held responsible – the State (including public health care system) and parents/guardians,” says Ali Mehdi, senior fellow of Health Policy Initiative at Indian Council for Research on International Economic Relations (ICRIER).

“By State, with a capital S, I do not exclusively mean the present state or Central government, but we as a nation. Present governments in state and Centre should accept their shares of responsibility, but we as a nation are primarily responsible for the pattern of child deaths in the country,” he adds.

Every year, Acute Encephalitis Syndrome (AES) or Chamki fever returns to haunt one of India’s poorest and most malnourished states, Bihar, leaving hundreds of children dead and others with permanent neurological damage.

From litchi to heat wave, various factors have been pointed out as the cause behind the deaths. However, one thing that gets consistently overlooked is the fact that it is a collective failure.

“Even if the role of the State was limited to tackling the shortfall in parental capability to save their children, most child deaths would still be the responsibility of the State since most parents would have done their best, as they deem fit, to keep their children alive,” says Mehdi.

“Every preventable child death is unjust, and the State is responsible for it… it is a collective failure,” he adds.

The recent AES outbreak also brought back to spotlight the public healthcare system in Bihar, which is struggling with poor infrastructure, shortage of manpower and administrative failure.

The situation is so bad that National Human Rights Commission (NHRC) was forced to send a notice to the Union Health Ministry and Bihar government over the rising number of children dying due to AES.

But can the public health care system be blamed for this medical crisis? “With efficient and equitable health systems and doctors, especially at the primary health care level, many deaths could have been prevented.

However, the challenges which surround it are reflective of the challenges of ‘structural’ causes,” says Mehdi, adding that blaming the medical system alone would be ‘unfair’ as it’s a ‘systemic failure’ of the Indian State.

Going by the magnitude of the AES outbreak, which returns every year during summers, there’s a desperate need for concrete steps to save children from this deadly disease.

“Given the endemic nature of child mortality in India – it has been the world’s largest contributor to child deaths since 1953 – it is high time for India to have a National Child Survival Policy with clearly delineated responsibilities,” Mehdi stresses.

He believes that there is a need to fix responsibility for child survival in the constitution for things to change in “any major way”.

“A ‘New India’ has to shed its world leader status in backwardness. And that has to begin with the humble acknowledgment of the challenge itself – nationalist chest-thumping isn’t going to help save lives or reduce poverty in the country,” Mehdi adds.

Every child deserves to lead a reasonably long, healthy and productive life to be able to realise their full potential, and for that, “shots of vaccinations would not be enough – children deserve a shot of justice to survive.”

“The Central and state governments have to stand up and assume responsibility for children’s survival and development up to a particular age at least. This should be included in the Constitution and a national policy be developed,”Mehdi says.

He goes on to add that people should be allowed to take the governments to court over harm to their own / children’s health and survival due to defined structural factors, such as air pollution, lack of sanitation and inadequate nutrition.

In addition to framing clear national policy for child survival, Mehdi says Indian health care system needs an urgent overhaul.

Some of the changes Mehdi recommends include developing ‘public health cadre to address social determinants of health’ (The Mudaliar Committee of 1959 recommended an ‘All India Medical Service cadre along the lines of the Indian Administrative Service (IAS)), ‘sustainable financing’ mechanisms to address child deaths and malnutrition, more ASHA / ANM level workers to tackle the problem at the local level, as well as a strong regulatory mechanism for private health services and price control on medicines.

In the end, shifting the blame on the state vs central government won’t serve the purpose unless “we as citizens, as a nation have to stand up and own responsibility.”

Bihar: Upendra Kushwaha to take out ‘padayatra’ in protest against AES deaths


Charging the Nitish Kumar government in Bihar with having “failed” to control the AES outbreak, RLSP chief Upendra Kushwaha Sunday announced that he will take out a ‘padayatra’ from the worst-affected Muzaffarpur district in protest, later this week.

The Acute Encephalitis Syndrome (AES) outbreak has claimed the lives of more than 150 children during the month.

Addressing a press conference here, a day after he visited Muzaffarpur where 134 children have died since June 1, the Rashtriya Lok Samata Party (RLSP) chief said, “our padayatra will have the theme, Nitish hatao, bhavishya bachao (oust Nitish from power, save the future of Bihar).”

The ‘padayatra’ will commence at Muzaffarpur on July 2 and conclude here on July 6, he said.

“Nitish Kumar will be completing 15 years as chief minister next year. Had he paid adequate attention to providing basic health care to the people of the state, so many children would not have died. We also get an impression that efforts are on to pass the buck so that Kumar is not held accountable,” Kushwaha alleged.

Kushwaha’s alliance partners such as the RJD and former chief minister Jitan Ram Manjhis Hindustani Awam Morcha (HAM) have been demanding the resignation of Health Minister Mangal Pandey, a senior BJP leader.

“It is not my concern whether Kumar retains Pandey in his cabinet or removes him. But, my point is he did not fight elections in the name of his cabinet colleagues. He won on the plank of his claims of ‘sushasan’ (good governance). Now that the falsity of the claims lay exposed, he must take the blame,” Kushwaha a former JD(U) leader who quit and floated his own outfit in 2013- said.

The RLSP started off as an NDA ally and won all the three seats it contested in 2014, riding the Modi wave while Kushwaha himself got a ministerial berth at the Centre.

He quit the BJP-led coalition in 2018 after the saffron party apparently offered him only two seats in order to make way for the JD(U) headed by Kumar, who had returned to the NDA, a year earlier.

Kushwaha thereafter joined the ‘Mahagathbandhan’ comprising Congress, RJD, HAM and budding Nishad leader Mukesh Sahnis VIP.

The opposition alliance was trounced in the recent general elections, with only the Congress among the constituents winning a seat. The RLSP, which had fought five, lost all including two contested by Kushwaha himself.

AES in Bihar: Poor anganwadi centres failed to deliver


Imagine a dilapidated room, with no plaster on the walls and any doors, window panes — this is what an anganwadi centre (AWC) in Bihar’s Talimpur village in East Champaran district looks like. More, the building has neither a toilet, hand washing facility nor drinking water.

“I have to carry chairs, utensils and other essentials for making food, charts for teaching children, and my registers everyday to and fro from home,” says the sevika (the main service provider) of the AWC in Talimpur village’s Madhuban block told DTE.

Most AWCs in Muzaffarpur, East Champaran (Motihari) and Sitamarhi districts that Down To Earth (DTE) visited, appears to be in similar appalling condition.

The state has recently witnessed a massive outbreak of Acute Encephalitis Syndrome (AES), which claimed lives of more than 130 children. Malnourishment has widely been pegged as the causal factor for AES.

The state also has the highest case of malnourished children (43.9 per cent) in India.

The Anganwadi scheme was started as a rural child care programme in 1975 as part of the Integrated Child Development Services (ICDS) programme. The centres are responsible for providing food and nutrition to children and also pregnant women.

An AWC has a sevika and sahaiyka (the helper who prepares food). The menu is fixed — khichdi, kheer, halwa, rasiav (a sweet local dish to be given on particular days of the week). Typically, an AWC, registers 40 children (3-5 years) for food.

It registers another 40 (0-3 years), eight pregnant and eight lactating mothers to provide take-home-ration (THR). The THR consist of 2.5 kg rice, 2.5 kg dal and some soybean to each of the beneficiaries.

But, many centres get children and mothers more than they could afford. As a result, many do not get registered and remain under nourished.

This is despite the 2006 Supreme Court order directing anganwadi services to be universalised.

“There are many more but I can’t register all of them as the numbers are fixed. Therefore I also have to face wrath of parents whose kids I don’t register,” said Sahaiyka from Talimpur village, adding they try to take only one member (child/lactating or pregnant woman) from a family even if there are more eligible members so that more and more families can be covered.

Out of 2.96 lakh children registered in AWCs of the district’s villages, 27,000 are malnourished, according to a survey report sent by Muzaffarpur district programme manager of ICDS department. This was about those children who are registered. The level of malnourishment in children not registered is yet to be known, the report said.

Most of the deceased’s families that DTE visited said their child was not registered with any AWC.

“There is no AWC nearby. The one that is far did not register my child,” said a man from Muzaffarpur’s Marwan block, who lost his child due to AES. Parents in Sitamarhi and Motihari also narrated a similar story.

Moreover, many of sevikas have also not received their salaries as well as the budget allocated for their centres.

“The villagers come charging on me as to why I am denying food. But the fact remains if I am not getting money what can I do,” said the sevika from AWC in Runni Saidpur block of GIddha Phulwariya village in Sitamarhi district.

The last budget was received in the month of March, she said, teary-eyed. Till the next lot, she provides the children with biscuits from her own pocket on a daily basis.

“If we don’t do it, the children will stop coming and they would not turn up even when I would have the budget. Then I will be questioned by supervisor why children are not there. What would I do then when I would be slapped with notices,” the sahayika rued, adding that they have raised the concern to authorities, but to no avail.

The story is same across AWCs of all the three districts where DTE visited.

According to the recent national family health survey, only 37 per cent children got food from AWCs in Bihar. Incidentally, Bihar had second highest number of malnourished children after Uttar Pradesh till NFHS-3 But in last NFHS survey, it even surpassed Uttar Pradesh.

“Whatever you found in the anganwadi kendras of these villages is in fact of story of villages across Bihar. The story would not have been different, had you not visited the villages before the advent of AES,” said Shakeel, the Bihar coordinator of Jan Swasthya Abhiyan.

“Besides the central government’s scheme, the state also has a couple of them. But the result is to be seen on the ground,” Shakeel added.

AES outbreak puts focus on ailing healthcare infrastructure in Bihar


NEW DELHI: The rising death toll of children suffering from acute encephalitis syndrome (AES) in Bihar’s Muzaffarpur district not only points to a health crisis, but also the crippling healthcare infrastructure in the state.

According to the latest data available with the ministry of health and family welfare, about 79.5% of the 1,719 villages in Muzaffarpur district do not have a public healthcare facility. There are only 630 public healthcare facilities in Muzaffarpur, the data reveals.

“What can easily be managed at a primary health centre level, is reaching Muzaffarpur at a critical stage causing deaths. Since there is no primary health infrastructure nearby and no health experts to tell these families the preventive measures, the problem arises,” said a senior health ministry official, requesting anonymity.

Experts also said that in view of the children’s deaths and the number of new cases being reported every day, the district level infrastructure is about to collapse.

“Encephalitis cases have always been witnessed in areas which are economically disadvantaged and have rudimentary health infrastructure at the primary care level. Health infrastructure is a major issue given the high mortality in Bihar. The easy solution to this disease is balanced diet in each meal,” the official said.

“Even if children show early signs, regular glucose consumption can solve the problem. The early warning signals that should be provided to villagers also seem to be absent,” he added.

The official said malnutrition, compounded by heat and humidity, unusually high this year, is the major cause for the high death toll.

According to the census of 2011, Bihar is the third most populous state in India, with around 40% of its population below the poverty line. The major health and demographic indicators of the state, such as infant mortality rate, maternal mortality ratio, and total fertility rate, are substantially higher than the all-India average, and reflect the poor health status of the people. The state has a shortage of 1,210 sub-centres, 131 primary health centres (PHCs), and 389 community health centres (CHCs).

So far, 167 children have died in Bihar, with Muzaffarpur recording 117 deaths. Other districts include Vaishali (19), Motihari (12), Begusarai (8), Samastipur (8), and one each in Arrah, Sheohar and Purnia.

“Blame it on the scarcity of health facilities or unawareness among masses, patients from almost all the villages in Muzaffarpur are coming to us in critical stages, which is increasing the death toll. Private hospitals are unable to handle the pressure,” said Sunil Shahi, medical superintendent, Sri Krishna Medical College, Muzaffarpur, which is handling a majority of the cases.

Interestingly, Muzaffarpur city is part of the centre’s smart cities’ list. According to a recent report by the Smart Cities Mission of Housing and Urban affairs, the doctor-patient ratio at Muzaffarpur is as low as 80:100,000 patients. The report said there are four large hospitals in the city, 46 nursing homes and 175 medicine shops. The city provides some access to healthcare for its residents, but healthcare facilities are “overburdened and far from many residents”.

The Comptroller and Auditor General (CAG) of India 2018 report said improved healthcare facilities could not be provided because of project delays. “Completion of 75 CHCs was delayed by one to 33 months. Further, 11 CHCs was incomplete even after the delay of one to 36 months, due to non-availability of dispute-free land and slow execution of work. Consequently, there was a delay in the completion of 86 CHCs, which delayed the intended objective of providing improved healthcare facilities.”

Over 50 Children Have Died of Suspected Japanese Encephalitis in Bihar


Patna: In the last nine days, several children have died in North Bihar of suspected Acute Encephalitis Syndrome (AES). On Monday alone, about 20 children reportedly died, while three deaths were reported early Tuesday in Muzaffarpur town hospitals. As per reports, five five children died in two villages — Harvanshpur Paschim and Khirkhaua under Bhagwanpur police station in Vaishali district — in last the 24 hours due to symptoms similar to AES after being admitted to hospital.

As helpless parents look on, dozens of children are still battling for their lives with symptoms similar to AES and are undergoing treatment at two hospitals in Muzaffarpur. So far, the disease has already claimed the lives of 53 children, but the state government is playing these deaths down by claiming that these were due to hypoglycaemia.

In Muzaffarpur, the state government-owned Sri Krishna Medical College and Hospital (SKMCH) and private Kejriwal Hospital, where most of deaths took, have names and address of the victims. But state government, particularly the health department, is not prepared to accept this reality.

Meanwhile, Bihar Health Minister Mangal Pandey has denied that these deaths were due to AES. Pandey, a senior Bharatiya Janata Party (BJP) leader, said that only 11 children had died since June 2 and most of the deaths were due to hypoglycaemia, adding that only one child died due to Japanese encephalitis. “There is a situation of misconception in connection with deaths of children in Muzaffarpur. We have got information of deaths due to hypoglycaemia, except one death due to JE,” he was reported as saying.

AES cases have surfaced in Bihar in such a large number after a gap of three years. Last year, a total 40 cases of AES were reported in which seven deaths occurred.

But this year, the situation is alarming, said sources. This can be gauged from the fact that the two paediatric intensive care units at SKMCH are full and the hospital authorities were forced to open a third PICU to accommodate fresh cases. Ironically, with heavy rush of seriously ill children on Monday, there were no bed available to admit new suspected AES cases in the PICU the hospital and officials had to get the general ICU vacated by shifting patients to other wards.

“We have been admitting seriously ill children in PICU and the general ICU to provide treatment in view of the situation and regular arrival of new patients” SKMCH’s chief medical officer, S P Singh, said.

SKMCH superintendent Sunil Kumar Shahi said “It took us by surprise. We hardly expected such a bounce back this year”.

Helpless parents, after failing to get their seriously ill children admitted in SKMCH, are left with no option but to rush to privately run Kejriwal Hospital in Muzaffarpur.

Most of the children with suspected AES belonging to the rural poor section (dalit, other backward classes and extremely backward classes) of the population in Muzaffarpur and the neighbouring districts of Vaishali, Sitamarhi, Samastipur, Sheohar, East and West Champaran.

Locally known as Chamki Bukhar or Mastishk Bukhar, AES is widely seen as a deadly disease for children in flood-prone North Bihar districts. While the cause of deaths of children may be AES or any other, Sanjay Kumar, the principal secretary in the health department, reiterated that the deaths this year had occurred due to hypoglycaemia, resulting from high heat and humidity.

Kumar explained that when children play in the open under the scorching sun, it leads to dehydration and affects their intake of food and water, leading to hypoglycaemia.

According to him, Bihar had reported 34 cases of hypoglycaemia, resulting in 10 deaths till date this year, while one death was due to dyselectrolytemia (electrolyte imbalance).

However, with increasing cases of suspected AES, the state government has introduced a verbal autopsy form to fix responsibility for any lapses in treatment and referral. “We have a standard operating procedure for treatment of AES”, he added.

The health department has also issued an advisory urging parents to prevent their children from playing in the open under the sun at a time when the temperature was hovering between 42 to 43 degrees Celsius.

Interestingly, contrary to the denial of children deaths due to AES by a top health department officer, chief minister Nitish Kumar on Monday at a press conference, in reply to question on child deaths due to AES in Muzaffarpur, said the health department had been keeping a close watch on the situation. “Ahead of the rains (monsoon) ,every year this disease (yeh bimari) creates havoc. It is a matter of concern that every year children are dying due to it”, he said.

The chief minister said the health department had taken steps to contain the disease and was sensitising the people about measures to prevent it.

According to doctors, AES is a severe stage of encephalitis characterised by inflammation of the brain. The disease is transmitted through mosquito bites, leading to infection that causes high fever.

“Every year, encephalitis hits Muzaffarpur, Gaya and other neighbouring districts in May or June. But this year it seems to have affected a large number of children,” a health department official said.