Data on AES related deaths in Bihar during May-June this year is fraught with confusion

Data on AES related deaths in Bihar during May-June this year is fraught with confusion


In the month of June this year, encephalitis related deaths in Bihar's Muzaffarpur district grabbed the headlines. Actually, most of the children, who were admitted or died at Shri Krishna Medical College and Hospital (SKMCH), hailed from East Champaran, Vaishali, Sitamarhi and Samastipur apart from Muzaffarpur.

Unfortunately, till recently official data on the number of cases and deaths related to Japanese Encephalitis (JE) and Acute Encephalitis Syndrome (AES) was unavailable for the month of June. For quite some time, the website (https://www.nvbdcp.gov.in) of the National Vector Borne Disease Control Programme (NVBDCP) gave data pertaining to encephalitis cases and deaths till April, 2019.

Media reports and opinion pieces (prepared mostly on the basis of field visits) that got published during June-July 2019, suggest that there were several probable factors [including high prevalence of under-nutrition among the children from marginalized communities -- dalits, Extremely Backward Classes (EBCs) and muslims; hypoglycaemic encephalopathy that triggered the death of undernourished children; poor hygiene and cleanliness; poor functioning of anganwadi centres under the Integrated Child Development Services scheme-ICDS; consumption of litchi that contains methylenecyclopropylglycine-MCPG; low level of immunization/ vaccination drive among children against diseases; poor status of primary health centres-PHCs; high temperature coupled with humidity etc.] that could have caused the death of more than 150 children in Bihar during the month of June this year.

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It is, however, essential to look at the latest data (made available at the NVBDCP website) on the number of cases and deaths pertaining to AES/ JE, which is available till June 2019.

Official data indicates that between 2013 and 2019 (till 30th June), Bihar was not among the top 5 states reporting AES and JE cases. However, the state was certainly among the top 5 states reporting AES and JE related deaths. Table-1 shows that out of 68,622 AES cases reported in the country between 2013 and 2019 (till 30th June), 3,222 cases were reported from Bihar (viz. 4.70 percent). However, out of 7,415 AES deaths reported during the same period, 893 deaths happened in that state (viz. 12.04 percent).

Table 1: State-wise total number of AES and JE cases and deaths between 2013 and 2019 (till 30th June)

Table 1 State wise total number of AES and JE cases and deaths between 2013 and 2019 till 30 June
Source: National Vector Borne Disease Control Programme, https://www.nvbdcp.gov.in
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From table-1, we also find that out of 10,333 JE cases reported in India between 2013 and 2019 (till 30th June), 364 cases were reported from Bihar (viz. 3.52 percent). However, out of 1,535 JE deaths reported during the same period, 62 deaths occurred in that state (viz. 4.04 percent).

Out of the total 3,365 AES cases that have been reported in the country till June this year, most were from Odisha (611), followed by Bihar (525), Uttar Pradesh (482), Tamil Nadu (329) and Jharkhand (305). Please check table-2.

Table 2: State-wise number of AES and JE Cases and Deaths during 2013-2019 (till 30th June)

Table 2 State wise number of AES and JE Cases and Deaths from 2013-2019 till June
Source: National Vector Borne Disease Control Programme, https://www.nvbdcp.gov.in
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It may be noted that there was no (viz. zero) AES related case or death from Bihar between January and April 2019, according to the earlier dataset that was available in the public domain. It means that 525 AES cases and 116 AES related deaths occurred in Bihar during May-June 2019 if we compare the latest available data against the previous one that was provided by the NVBDCP website. Please note that the official data indicates lesser number of AES related deaths during May-June as compared to what the media had reported. Most news reports and stories had said that more than 150 children died in Bihar during June alone this year owing to AES.

It is, however, not mentioned in the NVBDCP website whether the data pertaining to AES/ JE cases and deaths cover only government hospitals/ health centres or the data covers all types of such health institutions including the private ones.

In a reply to unstarred question number 3358 (to be answered on 12th July, 2019 in the Lok Sabha), the Minister of State in the Ministry of Health and Family Welfare Shri Ashwini Kumar Choubey said that the total number of AES cases in 2019 (till 8th July) was 872 and the total number of AES related deaths in the same period was 176 in Bihar. Things become further complicated once we consider another fact, which was shared by the same minister in the Rajya Sabha on 9th July this year. In a reply to unstarred question number 1845 (to be answered on 9th July, 2019 in the Rajya Sabha) Shri Ashwini Kumar Choubey said that between 1st June and 2nd July this year, 813 AES cases and 162 AES related deaths were reported from 25 districts of Bihar as against a total of 189 deaths caused by AES in that state between 2016 and 2018.

The latest available data of NVBDCP shows that in 2019 (till 30th June), the death rate in case of AES (which is calculated by dividing number of deaths by number of cases multiplied by 100) at the national level stands at 5.32 percent, whereas the same for the states of Odisha, Bihar, Uttar Pradesh, Tamil Nadu and Jharkhand are 0.16 percent, 22.10 percent, 3.53 percent, zero percent and 0.66 percent, respectively. Clearly, among the top 5 AES prone states, the chances of survival is the lowest in Bihar, followed by Uttar Pradesh during 2019 (till 30th June), although death rate in Assam (8.22 percent) too is quite high. Kindly see table-3.

Table 3: Death rate for AES and JE during 2013-2019 till 30th June (in percentage)
 
Table 3 Death rate for AES and JE during 2013-2019 till June

Note: Death rate calculated by Inclusive Media for Change; death rate is calculated by dividing number of deaths by number of cases multiplied by 100; NA means not applicable
Source: National Vector Borne Disease Control Programme,
https://www.nvbdcp.gov.in
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JE cases and deaths

 
Out of the total 321 JE cases that were reported till 30th June this year, most are from Assam (69), followed by Tamil Nadu (65) and Odisha (55). Please see table-2.

The death rate in case of JE at the national level stands at 9.35 percent, whereas the same for the states of Assam, Tamil Nadu and Odisha are 30.43 percent, zero percent and 1.82 percent, respectively. Therefore, among the top 3 JE prone states, the chances of survival is bleakest in Assam during 2019, indicates latest available data. It may be noted that death rate in case of JE for the states of Jharkhand, Maharashtra, Manipur, West Bengal, Uttar Pradesh and Bihar are 18.18 percent, 14.29 percent, 12.50 percent, 11.11 percent, 7.41 percent and 6.25 percent, respectively. Please see table-3 for details.  

Kindly note that there was no (viz. zero) JE related case or death from Bihar between January and April 2019, according to the earlier dataset of NVBDCP that was available in the public domain. It means that 16 JE cases and 1 JE related death occurred in Bihar during May-June 2019. This we get on comparing the latest available data against the previous one that was provided by the NVBDCP website.

References


Reply to Unstarred Question no. 3358 to be answered on 12th July, 2019 in Lok Sabha, please click here to access

Reply to Unstarred Question no. 1845 to be answered on 9th July, 2019 in Rajya Sabha, please click here to access  

Uttar Pradesh among top 5 encephalitis prone states, suggests official data, News alert by Inclusive Media for Change dated 25 August, 2017, please click here to access
 
Don't blame the litchi -T Jacob John, The Indian Express, 3 July, 2019, please click here to access 

Healthcare's primary problem -Soham D Bhaduri, The Hindu, 3 July, 2019, please click here to access 

Lessons that Delhi journalists can learn from local media at Muzaffarpur -Umesh Kumar Ray, Newslaundry.com, 1 July, 2019, please click here to access 

Medical investigators say Muzaffarpur deaths probably due to malnutrition and delayed care, The Telegraph, 28 June, 2019, please click here to access 

AES in Bihar: Poor anganwadi centres failed to deliver, Down to Earth, 25 June, 2019, please click here to access 

In Muzaffarpur, AES is a grim reaper that stalks poor children -Ayush Tiwari, Newslaundry.com, 25 June, 2019, please click here to read more 

Bihar AES deaths: A hundred deaths, and no answers -Jacob Koshy, The Hindu, 22 June, 2019, please click here to access 

Muzzaffarpur: Anganwadi and Asha workers, who should have conducted awareness drive and monitored food intake of children, were on poll duty - Aanchal Bansal, The Economic Times, 21 June, 2019, please click here to access 

Fix healthcare now, or future shock is certain -Patralekha Chatterjee, Deccan Chronicle, 21 June, 2019, please click here to read more 

Most AES Victims in Bihar Are Dalits, EBCs and Muslims -Mohd. Imran Khan, Newsclick.in, 20 June, 2019, please click here to read more 

Bihar hospital doctors lack training, finds AIIMS team -Sana Shakil and Rajesh K Thakur, The New Indian Express, 20 June, 2019, please click here to read more 

Spare Dying Kids from Insensitive Reporting - Saurabh Sharma, Newsclick.in, 20 June, 2019, please click here to access

Stopping Muzaffarpur Child Deaths Will Require a Gender-Sensitive Social Analysis -Purnima Menon, TheWire.in, 20 June, 2019, please click here to access   

NHRC questions frailty of health infrastructure, The Hindu, 20 June, 2019, please click here to access 

No Muzaffarpur medical centre has a rating better than zero -Rema Nagarajan, The Times of India, 20 June, 2019, please click here to access 

Encephalitis spreads to other districts of Bihar, toll at 114 -Ajay Kumar Pandey, The Times of India, 20 June, 2019, please click here to access 

Five years later, Harsh Vardhan makes same promise -GS Mudur, The Telegraph, 19 June, 2019, please click here to access 

Averting deaths in Muzaffarpur -T Jacob John, The Hindu, 19 June, 2019, please click here to read more 

Heat, lack of nutrition, awareness add to AES, Bihar kids toll over 100 -Santosh Singh, The Indian Express, 18 June, 2019, please click here to access 

Dr. Arun Shah, a Muzaffarpur-based paediatrician, interviewed by Banjot Kaur, Down to Earth, 18 June, 2019, please click here to access 

Bihar: Who is Responsible for the Death of 100 Children? -Umesh Kumar Ray, TheWire.in, 17 June, 2019, please click here to access  

Bihar: Encephalitis death toll rises to 103, NHRC points to 'flaw' in vaccination schemes, The Indian Express, 17 June, 2019, please click here to access 

20 more kids die in 24 hours, Bihar encephalitis toll hits 93 -Ramashankar, The Times of India, 17 June, 2019, please click here to access 

Number of children killed by encephalitis in Bihar rises to 57 -Amarnath Tewary, The Hindu, 15 June, 2019, please click here to access 

43 kids dead in Bihar's Muzaffarpur this month, state cites low blood sugar -Santosh Singh, The Indian Express, 13 June, 2019, please click here to access 

In one month, 28 children die of suspected encephalitis in Bihar's Muzaffarpur district -Amarnath Tewary, The Hindu, 11 June, 2019, please click here to read more 

Image Courtesy: UNDP India




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