The failure to identify, let alone control, the mysterious disease that has killed scores of children in Andhra Pradesh exposes the claims of the Chandrababu Naidu government on the public health front.
in HyderabadA MYSTERIOUS viral fever has killed more than 80 children in Andhra Pradesh, baffling scientists and exposing the public health system to charges of gross failure and incompetence.
Almost all children who died were in the 2-12 age group and death came within 36 hours of their hospitalisation. The disease, in the absence of sound scientific evidence about its origin, is described as `suspected viral encephalitis'.
Warangal and Karimnagar districts in the Telangana region accounted for 33 deaths each, followed by seven in Nizamabad, three each in Adilabad and Krishna and one in Nellore. The children were admitted to hospitals with fever of up to 105{+0}F and fits caused by brain oedema before they slipped into a coma and died. Hospitals in Karimnagar, Warangal and Nizamabad districts are chock-a-block with patients.
An alarming aspect of the epidemic is the high mortality rate - nearly 50 per cent. Seventy-nine out of the 148 children admitted in government hospitals for the treatment of `suspected viral encephalitis' died. People in the villages, from where these cases were brought live in fear.
Scientists are perplexed over the mysterious disease since epidemiological studies have failed to identify the virus. Only three samples have proved positive for Japanese Encephalitis (JE) or brain fever, a leading cause of viral encephalitis in Asia that has been effectively controlled in countries such as South Korea.
A team of scientists from the National Institute of Communicable Diseases (NICD), Pune, came up with the rather vague conclusion that "preliminary clinico-epidemiological investigation showed that the episode of fever with CNS (central nervous system) involvement may be viral encephalitis possibly related to vector borne transmission".
The State Department of Health has failed to contain JE, cases of which have been reported regularly since 1980. The incidence of JE has been rising during the past decade, with the highest number of cases, 986, reported in 1996. In 1998, 984 cases were reported. Warangal district alone has reported 341 cases and 184 deaths since 1997.
The Department of Health was caught off guard this year as JE is a seasonal disease that occurs during the monsoon and post-monsoon periods between August and December, when stagnant water breeds mosquitoes (culex variety), which transmit the virus from pigs to human beings. It did not expect another virus, which could be a mutant, to strike early this year.
According to Dr. P. Nagabhushana Rao, a clinical expert on JE, the virus multiplies in pigs and water birds such as herons and ducks, and it is necessary to keep open-drains and water bodies clean and isolate pigs to a minimum distance of 5 km from human habitations.
Apparently, the public health system, manned by employees of the local bodies such as panchayats and municipalities, has not taken steps to clean the pools of stagnant water and the drains. Despite standing instructions to take up vector control measures such as the spraying of insecticides and anti-mosquito fogging during the monsoon, these are done only after an epidemic breaks out. It is no wonder that officials of the Department of Health and Family Welfare, who are pre-occupied with internal bickerings, did not coordinate an operation to contain the epidemic. There are two officers of the Indian Administrative Service (IAS) in the Secretariat, a Commissioner for the A.P. Vaidya Vidhana Parishad and two Directors (one each for Health and Medical Education) besides another IAS officer who is exclusively in charge of AIDS control.
Health Minister Kodela Siva Prasada Rao, himself a doctor, is unhappy with the style of functioning of the Principal Secretary. On a visit to Karimnagar when the viral fever was at its peak, the Minister ordered Director of Health I. Srinivasa Sarma to go on leave and placed District Medical and Health Officer (DM&HO) Kesava Rao under suspension.
Chief Minister N. Chandrababu Naidu, said: "I do not want to see a single child die." During the following two days, more than a dozen children died in Warangal district alone. Chandrababu Naidu's response was to constitute an expert committee headed by C. S. Bhaskaran, former Vice-Chancellor, NTR University of Health Sciences, to suggest measures to contain the disease.
The government's lofty goals are based on the premise that `unless proper health care is ensured to all its people, no State can achieve real progress'. Accordingly the Vision 2020 document envisages the prevention of all diseases, the availability of nutritious food to all, improvement of the public drainage system and the promotion of personal hygiene.
These goals, the document says, can be achieved, by modernising the health care system. As a consequence, the Department of Health's budget has seen a quantum jump from Rs.560 crores in 1994-95, the year in which Naidu took over as Chief Minister, to Rs.1,538 crores in 2003-04. To buttress its own funds, the government availed loans worth Rs.608 crores from the World Bank for the modernisation of 159 government hospitals under the A. P. First Referral Hospital Project. It helped increase the hospital bed strength by 50 per cent, from 9,651 to 14,450.
Equally impressive is the number of hospitals at various levels. In the multi-tiered health system, there are 10 teaching hospitals at the top followed by 202 hospitals under the control of the A.P. Vaidya Vidhana Parishad. The Director of Health controls 1,360 primarly health centres, 10,568 sub-centres, 51 government hospitals, 45 mobile medical units and 104 dispensaries. Whether this massive infrastructure is put to optimum use is another question.
The government recently published a special supplement to its monthly official organ Andhra Pradesh to celebrate the recognition of Andhra Pradesh as the fastest-moving State in the country. The magazine claimed that the incidence of cholera, gastro-enteritis, tetanus and diphtheria had been brought down considerably. Contrary to this claim, dengue fever, cholera and diarrhoea cases were reported this year from several parts of the State, including Hyderabad, the capital.
Other health indicators, especially on the population front, were also not too flattering when compared with Kerala. The State has a high infant mortality rate of 66 per 1,000 live births which, although lower than the national average of 69, is way above Kerala's impressive figure of 16.
The way things are moving, Chandrababu Naidu's goal of making Andhra Pradesh the health hub of India may remain a pipe dream if his Department of Health does not get its act together soon.
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