An outfall of Gorakhpur: ICMR considers post-mortem of every child death in four districts of eastern UP

Babies that die in eastern Uttar Pradesh (UP) will have to undergo a post-mortem procedure, a crucial step towards efforts to correct health systems, after a spate of child deaths in Gorakhpur this August, shook the conscience of India.

Labelled the Child Health and Mortality Prevalence Surveillance (CHAMS), it will be conducted in four districts of UP including Gorakhpur, Kushinagar, Maharajganj, initially in a baseline population of 50,000 persons.

45% deaths (up to 4118 of 9000) due to Encephalitis infection or brain inflammation in India have occurred in UP, since 2010. Most vulnerable to die are children under-five years of age.

Initially, the CHAMS exercise will be conducted in public hospitals in four districts and will gradually spread to conducting post-mortem of babies that die at home in the community.

 “The post-mortem of the baby will be done in a minimally invasive method, wherein biopsy samples of various body part tissues will be extracted, including the brain, kidney and liver. Our idea is to capture the cause for every child who dies,” said Dr Swaminathan.

The mystery of Acute Encephalitis Syndrome (AES) in Gorakhpur only gets murkier and Indian Council of Medical Research (ICMR) aims to crack it by ascertaining it’s causes. “Of every 100 deaths due to AES, in 40 cases the cause is known. Majority are due to Scrub Typhus infection while other causes include dengue, malaria, meningitis and Japanese Encephalitis. Now conducting post-mortem in each death case will be the 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 World Health Organization’s India country figures.

“Of all the babies succumbing in BRD Medical College at Gorakhpur, very few undergo systematic post-mortem to ascertain the cause of death. CHAMS will provide evidence-based insights on causes of death leading to better intervention strategies on ground,” said Dr Soumya Swaminathan, secretary, department of health research, Ministry of Health and Family Welfare (MoHFW).

“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 family’s consent to conduct PM on the baby is absolutely crucial and necessary.

 “This is why we will first start off with investigating deaths in hospital set-up and then move into community. Each district will have 10 to 15 outreach workers who will go until the homes to convince families to participate in the CHAMS exercise. Families consent will be obtained before conducting PM in both hospital and community set-up,” Dr Swaminathan stated. “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 like Mozambique, Mali and closer to home Bangladesh earlier.