Encephalitis in Gorakhpur: Malnutrition adds to woes

At Gorakhpur’s BRD Medical College hospital, 144 deaths have reportedly occurred this year due to encephalitis and related causes. Out of these 135 are children.

This being the season for acute encephalitis syndrome (AES) and Gorakhpur being the only large hospital capable of handling the disease in the region, these figures are testimony to the fact that despite crores of rupees being spent on vaccination and putting in place of special prevention and treatment protocols, things are not working. Whether oxygen is available or not, children keep dying of encephalitis.

It is well established that children below 15 years age are particularly vulnerable to the viruses that cause encephalitis. But another factor that is often ignored in official discourse is that malnourished children are much more susceptible to the disease.

“It has also been noted that most of the encephalitis children are malnourished, which has a major implication on disease incidence and mortality. Even mild malnutrition is linked to a twofold increase in mortality,” say PK Sen and AC Dhariwal in a paper published in the Journal of Indian Medical Association in 2015.

The recently published National Family and Health Survey 4, shows a chilling picture of children’s nutritional status in the Gorakhpur division comprising Gorakhpur, Maharajganj, Kushinagar and Deoria districts. It is this ground on which encephalitis is flourishing and endemic in this region, and elsewhere like Assam and Bihar.

The share of stunted children, that is, those who have not attained the height normal for their ages, ranges between 42% in Gorakhpur and 59% in Deoria. More than one third of children are underweight in all four districts. And anemia afflicts almost two thirds of the kids. All this is for children who are up to five years old. These are the markers of endemic poverty in the region and no amount of well-meaning tinkering with task forces and operational inter-ministerial strategies will rein in AES till these are also addressed.

Another shocking feature revealed by the NFHS-4 is the reach of immunisation. Although the survey did not cover Japanese encephalitis vaccination, its booster doses are to be given as part of routine immunisation, after an initial dose when the infant is 9-11 months old.

But full routine immunisation in these districts is far from complete, the survey reveals.

While in Gorakhpur and Deoria districts over one third of children did not receive full immunisation, in Maharajganj and Kushinagar those left out were a mind boggling 59%. Presumably, they did not get JE vaccines also.

This is not a new thing. A 2009 Unicef study had also found that despite claims of 100% JE immunisation in endemic districts, actual reach of immunisation was just 61%. With such care being taken for prevention, it is no surprise that encephalitis continues to rage in eastern UP. It is a chronicle of deaths foretold.