Determinants of Acute Encephalitis Syndrome in Muzaffarpur distrct of Bihar, India- A Community Based Case Control Study
About 1000 below 15 year olds are killed by encephalitis between UP, Bihar and Assam since 1978 and many are suffering from permanent disabilities. JE constitutes about 15% of AES. The aetiology of AES in 68-75% cases remains unknown and the majority of cases of viral acute encephalitis syndrome (~90%) have no specific treatment. The mode of transmission and nature of causative agent of AES remains as mystery in non JE/ AES cases. It poised serious threat to population with many unanswered queries that causing hindrance in preventive approaches.
METHODS:
A Case Control study was conducted in Muzafferpur district of Bihar, India. A total of 135 AES cases admitted in Sri Krishna Medical College and Kejriwal Hospital during the last week of May to third week of June, 2013 were included in study. Four control (one from same family and rest three from different parts of same village) were selected for each case. Required information such as socio-demographic factors, behavioural practices, and the clinical history were collected by a team of investigators using GPS enabled android tablets. Informed consent were obtained from the parents or guardians of cases and control. The study was approved by the Institutional Ethics Committee.
RESULTS:
Out of 135 cases, 37 deaths were reported (case-fatality rate of 27.4%). The median age of the case and control was 4 years. The male: female ratio was 1.5:1. Risks of developing AES among schedule castes [OR = 2.18 (1.10 – 4.30) p=0.028] and other backward castes [OR = 1.91 (1.00 – 3.66); p=0.049] were significantly higher.
It was observed that low education level of parents, agricultural based occupation, traveling by public transport mode, washing hands without soap after defection, litchi orchard in the vicinity of households and Children living in households having mud plastered house was found to be significantly associated with the risk of AES.
CONCLUSIONS: AES with case fatality of about 28% is very fatal disease, mainly affecting children of resource constraint people. Only raising the basic standard of living can alleviate the problem significantly