Heat, Humidity and malnutrition- Contributory factors for Acute encephalopathy : IMA Study Team

IMA study team on the death of children in Muzaffarpur in Bihar due to Acute
encephalopathy has reasonably concluded that prevailing heat and humidity
contributed substantially along with malnutrition to the death of the children.
Dehydration, Hypoglycaemia and the Heat syndrome have played a significant part .
IMA feels the Acute encephalopathy and the resultant deaths in children is
preventable. Health awareness campaign can play a major role in preventing another
catastrophy. Tepid sponging, correction of dehydration and hypoglycaemia can start
right from home. A package programme focussed on Health awareness, Free meals to
children especially at night and public availability of ORS(oral rehydration solution)
may be simple interventions which may prevent further catastrophies.

The salient observations of IMA are:-
1. No definite conclusions can be made about the aetiology of the syndrome as of
now.
2. High atmospheric temperature, Humidity and Malnutrition appear to play a
role in the causation of this encphalopathy.
3. Unlikely to be an infectious cause with the present evidence.
4. Litchi consumption cannot be attributed as the major factor as even infants have
been affected
5. Persistence of very high atmospheric with temperature humidity through out
the day and night without fluctuations might be causing a heat syndrome in
children.
6. Reduction in body temperature with tepid sponging, increased fluid intake and
adequate food intake may prevent this syndrome.
7. Affected children have to be given IV dextrose for correction of hypoglycaemia
to prevent significant brain injury.
8 Foolproof scientific, epidemiological study and follow up of children who
survived in previous episodes (2014, 15) should be done systematically.
9. Follow up of these children for assessment of sequlae and MRI brain imaging
for changes in brain should be evaluated.
10 An awareness campaign about the preventive measures is essential especially
amongst the rural population.
11. Measures to uplift the living conditions of the affected population should be
undertaken as an immediate package programme.

12. Reduction in number of cases when the atmospheric temperature has fallen
down indicates a possible causal relationship between the high temperature,
humidity and the present syndrome.
Advisory to Public:
1) Avoid children being exposed to sunlight especially during peak temperature .
2) Children should have adequate intake of water.
3) Children who are exposed to heat should be given bathing soon after to reduce
the ill effects of exposure to higher temperatures .
4) Seek medical attention immediately when a child shows prod roman symptoms
like fever, vomiting or generalised body ache or specific symptoms of
encephalitis like unconsciousness or convulsions .
5) Don’t try for any home based treatments.
6) Seek medical help from qualified medical practitioners only.

The following were the members of the team
Dr. V.G. Pradeep Kumar (Spokes person)
Mob : 94470 34443,E mail : vgpradeep
Convenor, IMA Medical Education Committee
Consultant Neurologist, Kozhikode
Dr. Bimal Karak
Consultant Physician
Director cum Principal, President Elect, IMA Bihar
Public Health Institute, Patna
Dr. B.P. Roy
Consultant Ophthalmologist
Chief Medical Officer, Public Health Institute, Patna
Dr. Deepak Varma
Consultant Paediatrician
Chief Medical Officer, Public Health Institute, Patna
Dr Santanu sen Dr R V Asokan
National President IMA Hony Secretary General IMA