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  • 16 Aug 2019 GS Paper 2 Polity & Governance

    Examine the failures at various levels that have led to the deaths of more than hundred children due to Acute Encephalitis Syndrome in Bihar. (250 words)



    • Briefly explain the outbreak of AES and its causes in the introduction.
    • Discuss the lapses at multiple stages which led to the epidemic.
    • Give a way forward to prevent any such incidence in future.


    • More than 100 children in Bihar’s Muzaffarpur district have died of Acute Encephalitis Syndrome (AES) in June 2019. Initially it was believed that the deaths were caused because of the consumption of litchi fruit which resulted in hypoglycemia (sudden drop in blood sugar levels), and further spread due to heat wave and lack of awareness.
      • However, later it was acknowledged that the two most critical causes for the deaths were— malnutrition and the inadequacy of primary health centers (PHCs).
      • Hence, the disease outbreak is not only an unfortunate natural phenomenon rather a case of governance failure.


    Major lapses that resulted into such incidents are:

    • Primary Health Centres, the first point of healthcare for most AES patients are ill-equipped to deal with the disease.
      • Most of them do not have a virology lab or an adequate number of paediatric beds and glucometers to monitor blood sugar levels.
    • Not adhering to the Standard operating procedure to treat AES, which mandates grassroots health workers, including auxiliary nurse-midwives, accredited social health activists, and anganwadi workers, to do daily household-level surveys to check children for JE/AES symptoms during the outbreak season from June to September.
    • Lack of preparedness of the state government in terms of special nutrition programme for AES-prone areas (as undernourished children are more prone to the disease).
    • Inadequate Machinery: Unavailability of doctors, beds, intensive care units, medical professionals to deal with an epidemic level situation.
    • Lack of investment in Research and Development to effectively develop vaccines and treatment strategies as the region had witnessed similar outbreaks in the preceding years.

    Way Forward

    Following steps should be taken to prevent any such incidence in future:

    • Surveillance and monitoring of AES vulnerable region for early diagnosis and treatment of disease.
      • AES can be contained if the child is administered dextrose within 4 hours of the onset of symptoms
      • 10% Dextrose infusion within the golden hours can speed up the pace of recovery.
    • Infrastructural and Institutional set up: PHCs must be equipped with all necessary equipment and amenities that are crucial for diagnosing and treating AES patients.
    • Medical Research and Studies in AES prone regions that are crucial for establishing a link between causes and symptoms of the disease must be taken into account for formulating a treatment strategy.
    • Special nutrition programmes and mid-day meals must be implemented in the AES prone regions as it has been identified that toxins in litchi is just a triggering factor in the already malnutritioned children.
    • Awareness campaigns and symptom management as a pre-emptive measure must be put in place for dealing with the AES cases.
      • State Government should learn from the Dastak initiative (for treating Japanese Encephalitis) taken by Uttar Pradesh, that has brought together health, rural development and primary education officials to promote clean drinking water, sanitation, vaccination and early referral to hospitals for treatment through symptom management.
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