Thread by @oommen

Important article by a doctor laying out technical details.

-All it would have taken was to ensure that the children had a meal at night-

Averting deaths in Muzaffarpur - The Hindu thehindu.com/opinion/op-ed/…

Let that sink in.

-The disease affected only malnourished children between the ages of two and 10. A majority of them were from families camping in orchards for fruit harvesting. No child from the nearby towns fell ill. Children of well-to-do families never fell ill.-

-Litchi harvest usually begins by 4 a.m., which means that families are awake before that. They go to sleep early. If children go to sleep without dinner, parents usually do not wake them up and feed them.  -

-After prolonged fasting, malnourished children slipped into hypoglycaemia in the morning. Since they had very little reserve glycogen in their livers, they were unable to mobilise glucose from liver glycogen, unlike well nourished children. -

-The brain needs glucose as a source of energy. As a result of lack of liver glycogen, gluconeogenesis was turned on. Had there not been litchi methylene cyclopropyl glycine, the glucose levels would have been maintained, and the children would have come to no harm. -

-The disease can be prevented if children are well nourished, but that is not possible in the immediate term. It can also be prevented by ensuring that children eat a meal at night. All families were taught to provide a cooked meal to children before going to sleep at night.-

-Preventing children from eating litchis is not easy, but the quantity of the fruit can be restricted with parental supervision. With all this health education, I was told that the disease number had come down drastically in 2016-18 compared to what it was in 2014-2015. -

-Glucometers have not been maintained well. Health education was not sustained. New doctors are not familiar with all the information. Instead of 10% glucose, 5% is given. Children are taken mostly to pvt clinics & then referred to med college in city since ambulances are free-

-Ambulances take more than four hours to reach the city hospitals from many rural clinics. We might think each error is minor, but when all the errors add up they contribute to deaths that should have been averted.-