Why are so many children dying of encephalitis in Uttar Pradesh? All you need to know

At least 60 children have died at Baba Raghav Das Medical College hospital in Gorakhpur since last week either due to lack of oxygen or infections prompting the Uttar Pradesh government to order a magisterial inquiry into the tragedy.

The deaths are being blamed on the lack of oxygen cylinders in the hospital but the government and the hospital authorities have denied the allegations.

Also Read: How the Lychee fruit became the silent killer of India's children

As the debate on whether the deaths took place due to the negligence rages on, parties continue to politicise the issue. Deaths have been taking place in Gorakhpur and other parts of Uttar Pradesh due to encephalitis every year since 1978.

Official figures have put the death toll due to Japanese Encephalitis and Acute Encephalitis Syndrome (AES) at around 25,000 since 1978.  And these are just figures on the record. Independent figures have put the number at over 50,000 as many die before reaching the hospital.

What is Encephalitis?

Encephalitis, which usually strikes during the monsoon season, is the acute swelling of the brain resulting in high fever, stiffness in the neck, disorientation, headache, coma, seizures, spastic paralysis and, eventually, death.

Children below the age of 15 are vulnerable to Japanese Encephalitis (JE) and Encephalitis Syndrome (AES) usually strikes malnourished children under five years of age. The causes include viral infection, bacterial infection, among others. Sometimes, the brain's immune system attacks the brain tissues leading to the fatal disease.

What's the treatment?

Thirty percent patients die if the symptoms go untreated within the first few hours. And those who survive usually have to live with some form of disability, like permanent intellectual, behavioural or neurological problems. Disabilities include partial paralysis, recurrent seizures and inability to speak.

Sadly, there is no cure for the disease. Treatments can only relieve symptoms and support the patient as he/she tries to fight the disease. The viral forms of the disease cannot be treated, according to a New York Times report. Meanwhile, it is important to keep the fever down and ease the pressure in the brain. Steroids, antibiotics and painkillers are also prescribed based on the symptoms.

Why Uttar Pradesh?

Gorakhpur and several parts of Uttar Pradesh have been under the grip of encephalitis for almost four decades now. Gorakhpur is the epicentre of encephalitis. The disease struck the state in 1978, but grabbed nation's attention in 2005 when official figures stated 1,344 of the 5,737 affected with encephalitis died across Uttar Pradesh.

Both JE and AES can also be caused by mosquito bites of the Culex family which thrive in squalid conditions. Eastern UP is one of the backward areas of the country plagued by poverty and poor hygiene. Not surprisingly, those getting admitted to BRD Medical College come from the skid rows of UP, Bihar and Nepal.

Consuming lychee fruit on an empty stomach can trigger the disease among children, especially if they are malnourished.

British medical journal The Lancet Global Health found that unripe lychees and ackee fruit contain toxins Hypoglycin A and Methylenecyclopropyl-glycine (MCPG), which cause Jamaican vomiting sickness if consumed in large quantities.

Hypoglycin A is a naturally occurring amino acid found in the unripe lychees while MCPG is a poisonous compound found in lychee seeds. The fruits trigger a sudden drop in blood sugar levels, vomiting, change in the mental state leading to lethargy, unconsciousness, coma and eventually death.

Hypoglycin A and MCPG can give rise to high fever and seizures leading to hospitalisation. The British journal had found that children with low levels of blood glucose were twice as likely to die.The journal recommended sugar intake to offset the dipping blood sugar levels.

After India started a vaccination programme against JE in vulnerable areas, the cases of AES shot through the roof, Hindustan Times reported. In 2016, AES claimed 1,301 lives and affected another 11,651 while JE claimed 283 lives and affected another 1,676 people. Till August 2017, AES claimed 369 lives with another 5,413 people affected while JE has resulted in 86 deaths.

BRD Medical College: Funds and facilities for encephalitis

BRD Medical College hospital is the only hospital in the region with the ammunition to treat encephalitis. However, the management at the hospital has been so substandard that tragedies have become a routine.

Gorakhpur District Magistrate Rajeev Rautela recently said 20 deaths in a medical college in a day was "normal", the Wire reported. However, a hospital which receives 60 percent of the encephalitis cases across the country needs an increased budget to deal with the cost of treatment, medication, oxygen supply and human resources.

In February 2016, then principal of the college had written to the director general, Medical and Health Services seeking Rs 37.99 crore for the treatment of encephalitis cases, the Wire quoted sources as saying. However, both the central and the state governments have not provided the sum so far.

BRD Medical College hospital doesn't have enough funds to keep the medicine stock afloat. No provisions were put in place for the treatment of encephalitis patients.

Lack of funds and facilities have forced hospital authorities to put two patients on one bed. The relatives are made to sign consent forms, which absolves the hospital of legal complications arising from hospital-acquired infections due to the sharing of the bed, the Wire reported.

The paediatric ICU has 50 beds for an average of 300 children admitted every month. The college had sent a proposal to the state government requesting for a larger ward to be managed by 149 staff. The proposal, which requires a budget of Rs 10 crore., hasn't been approved by the Adityanath government yet.

Payments to the oxygen supplier were not released since November 2016 resulting in the amount going up to Rs 66 lakh this year forcing the company to cut the supply of oxygen cylinders.

Most of the staff at the hospital have not been paid salaries for almost two years. The staff tending the encephalitis wards were paid over the last couple of days after a delay of five months. Salaries of employees monitoring the neo-natal department are pending for six months now.

Chief Minister Yogi Adityanath has assured strict action if any death was caused due to medical negligence. But it still remains to be seen what the government does to deal with the larger problem.