The move comes after rising casualties in Gorakhpur's state-run BRD Hospital recently shook the nation
Post-mortem will soon be conducted in all future deaths of babies below five years of age in eastern Uttar Pradesh to examine the worrying trend and correct healthcare systems, a senior central government official told DNA. The move comes after rising casualties in Gorakhpur's state-run BRD Hospital recently shook the nation.
A child health and mortality prevalence surveillance (CHAMS) will be conducted, initially in four UP districts including Gorakhpur, Kushinagar and Maharajganj.
About 45% deaths (4,118 of 9,000) due to Encephalitis infection or brain inflammation in India have occurred in UP since 2010. Most vulnerable to die are children below five.
Initially, the CHAMS exercise will be conducted in public hospitals and will gradually spread to conducting post-mortem of babies that die at homes.
"Post-mortem will be done in a minimally invasive method, wherein biopsy samples of various body part tissues, including those from brain, kidney and liver, will be extracted. Our idea is to capture the cause for every child who dies," said Dr Soumya Swaminathan, secretary, department of health research, Ministry of Health and Family Welfare (MoHFW).
The mystery of Acute Encephalitis Syndrome (AES) in Gorakhpur only gets murkier and the Indian Council of Medical Research (ICMR) aims to crack it by ascertaining its causes.
"Of every 100 deaths due to AES, the cause is known in 40 cases . Majority are due to Scrub Typhus infection, while other causes include dengue, malaria, meningitis and Japanese Encephalitis. Now conducting post-mortem in each death will be a step forward to further investigate causes in more cases about which we are still in dark," Dr Swaminathan said.
Vital death registration systems are very poor in India. Only 10% of all deaths are ascertained for a cause, according to the World Health Organisation.
"Of all babies succumbing in BRD Medical College, very few undergo systematic post-mortem. CHAMS will provide evidence-based insights into causes, leading to better intervention strategies on the ground," said Dr Swaminathan. "After death, the cause is mentioned as cardiac failure or something of that sort which may be the ultimate event but not the underlying cause. This is why CHAMS is required."
She emphasised that obtaining the family's consent to conduct post-mortem is crucial and necessary. "This is why we will first start with investigating deaths in hospital set-ups and then move into communities. Each district will have 10 to 15 outreach workers who will go until the homes to convince families to participate in the CHAMS exercise," she said.
"Families' consent will be obtained before conducting post-mortem in both hospitals and community set-ups. Before the exercise begins in UP, a pilot will be conducted at Safdarjung Hospital in Delhi. The plan should roll out in next six months."
Conducting post-mortem to ascertain clinical causes of deaths has been successfully employed in countries such as Mozambique, Mali and Bangladesh.
BRD Hospital hogged international headlines when 31 deaths took place during August 10-11, amid reports of oxygen supplies being snapped due to unpaid bills. As many as 296 children died of encephalitis and other tropical illnesses at the Gorakhpur facility in August. Deaths have continued.
Eight hospital staffers, including then Principal Dr Rajiv Mishra and his wife Purnima Shukla, and the oxygen supplier Manish Bhandari, had been held responsible for the August tragedy. They are in Gorakhpur's jail.
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