The outbreak of acute encephalitis syndrome (AES) in Bihar’s Muzaffarpur district has raised eyebrows about the efficacy of healthcare infrastructure in the state. Now, one initiative aimed at combating malnutrition – implicated as a cause behind the crisis of encephalitis deaths among the district’s children – has come under scrutiny.
The district ranked eighteenth out of 36 states in implementing the state’s Midday Meal Programme designed at tackling undernutrition during the 2018-19 financial year, according to a report by the Programme Committee. The report found that 27,000 children in the district are malnourished and that, of 8.11 lakh beneficiaries of the scheme, a mere 4.33 lakh are able to benefit from it.
The district’s failings were highlighted despite Muzaffarpur ranking in first place on implementing the programme for the 2015-16 and 2016-17 FYs, according to the programme’s state director Vinod Kumar Singh. As such, the district programme officer has been given a show-cause notice and Singh has issued a warning: “either remove all the shortcomings or be ready to face the music”, calling the state’s drop in rankings “highly condemnable.”
The encephalitis outbreak in the district has resulted in the deaths of more than 150 children and led to much scrutiny and outrage. The National Human Rights Commission condemned “deplorable public health infrastructure” and the Supreme Court ordered a report from the state government concerning “medical facilities, nutrition, sanitation and hygiene conditions”. The condemnation came against the backdrop of protests against state and central government officials; accusations of medical and political negligence; and a magistrate investigation into the conduct of the State Health Minister Mandal Pandey and the Union Health Minister Dr Harsh Vardhan.
“With inadequacies in the implementation of malnutrition programmes in the district now highlighted, it is important that the issue is addressed to mitigate the chances of such an outbreak of happening again. Addressing the full extent of the factors contributing to the encephalitis deaths is a must to avert tragedy, strengthening healthcare infrastructure and tackling malnutrition looming large as the foremost priorities.”
Bihar ranks as one of India’s worst-performing states in terms of healthcare according to the newly released Niti Aayog health index. The report highlighted “significantly high vacancy rates for doctors in the public health system resulting in total dependence on medical colleges or district hospitals, which turn out to be congested” in the state, which has just one doctor for every 17,685 people.
Malnutrition is one issue that has contributed significantly to the encephalitis tragedy in Muzaffarpur. Recent data analyses have highlighted the inadequate state of nutrition, positioning Muzaffarpur below impoverished African nations in terms of its children’s nutritional outcomes. Reports have shown how this is contributing to encephalitis deaths.
Consumption of the lychee fruit has been heavily implicated in the encephalitis deaths in the district; indeed, the fruit has been linked to disease outbreaks since the mid-1990s. As previously reported by Health Issues India, “deaths due to encephalitis spike in the area every year during the lychee season. Since the illness occurs during the season in which lychees are ripening, children may be eating large quantities of unripened lychees to compensate for the lack of available food.”
As such, “due to toxins within these lychees which are only dangerous in large doses, a diet consisting of a high quantity of unripened lychees becomes lethal to these children. Little can be done regarding these naturally occurring chemicals within the lychees. However, addressing the issue of child malnourishment may be a means to reduce the risk of both encephalitis and a host of other associated health conditions.”
With inadequacies in the implementation of malnutrition programmes in the district now highlighted, it is important that the issue is addressed to mitigate the chances of such an outbreak of happening again. Addressing the full extent of the factors contributing to the encephalitis deaths is a must to avert tragedy, strengthening healthcare infrastructure and tackling malnutrition looming large as the foremost priorities.