Silence greets visitors at the Potrel and Usakapalli hamlets in Korukonda block of Odisha’s Malkangiri district. These hamlets border Andhra Pradesh and Chhattisgarh.
After 24 children aged below five died of a disease suspected to be Japanese Encephalitis in less than two months, tribal people — mostly the primitive Koyas — are under the grip of fear of “evil spirits.” They are exposed to poor sanitary conditions as their houses are located near cow and pig sheds. Despite that they believe that these spirits are responsible for snatching away the lives of their young. On Wednesday, the residents of Usakapalli conducted a ritual, with egg, rice and some leaves and herbs, in the house of Irma Podiani, one of the five traditional healers in the hamlet (called disari orgunia ) to keep the spirits away. “We think someone tried to steal the treasure belonging to the village deity ( grama rakhi ). Now she is furious and killed nine children from our village,” Irma told TheHindu .
Superstitions reign supreme in most tribal hamlets in the district, which has 60 per cent Scheduled Tribes out of a population of 4.5 lakh. “What can we do when they ignore our pleas for immediate reference to hospital and fall prey to quacks?” says Dr. S.B. Panda, Chief District Medical Officer. The suspected Japanese Encephalitis deaths were caused within 48 to 72 hours of the children developing symptoms such as vomiting, stomach-ache, fever and convulsions. “I took my son Babuli, 2, on a bike to Balimela, 10 km away. The doctor discharged him after giving a tonic. The next day he died and I had to bury him along with that tonic next day,” said a shell-shocked Irma Sodi (27), a paddy farmer.
Health workers say that despite their efforts to convince the villagers, they consume herbs and leaves given to them by the local healers. In 2009, villagers in Potrel, a village 20 km from Malkangiri, brought a healer from Mathili by pooling about Rs. 40,000 to perform a yagna after 10 children died due to viral fever.
Japanese Encephalitis
Japanese encephalitis is a viral disease that infects animals and humans. It is transmitted by mosquitoes and in humans causes inflammation of the membranes around the brain. Intensification and expansion of irrigated rice production systems in South and South-East Asia over the past 20 years have had an important impact on the disease burden caused by Japanese encephalitis. Where irrigation expands into semi-arid areas, the flooding of the fields at the start of each cropping cycle leads to an explosive build-up of the mosquito population. This may cause the circulation of the virus to spill over from their usual hosts (birds and pigs) into the human population.
The disease and how it affects people
Japanese encephalitis (JE) is a disease caused by a flavivirus that affects the membranes around the brain. Most JE virus infections are mild (fever and headache) or without apparent symptoms, but approximately 1 in 200 infections results in severe disease characterized by rapid onset of high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis and death. The case fatality rate can be as high as 60% among those with disease symptoms; 30% of those who survive suffer from lasting damage to the central nervous system. In areas where the JE virus is common, encephalitis occurs mainly in young children because older children and adults have already been infected and are immune.
The cause
The virus causing Japanese encephalitis is transmitted by mosquitoes belonging to the Culex tritaeniorhynchus and Culex vishnui groups, which breed particularly in flooded rice fields. The virus circulates in ardeid birds (herons and egrets). Pigs are amplifying hosts, in that the virus reproduces in pigs and infects mosquitoes that take blood meals, but does not cause disease. The virus tends to spill over into human populations when infected mosquito populations build up explosively and the human biting rate increases (these culicines are normally zoophilic, i.e. they prefer to take blood meals from animals).
Distribution
Japanese encephalitis is a leading cause of viral encephalitis in Asia with 30,000-50,000 clinical cases reported annually. It occurs from the islands of the Western Pacific in the east to the Pakistani border in the west, and from Korea in the north to Papua New Guinea in the south. Because of the critical role of pigs, its presence in Muslim countries is negligible. JE distribution is very significantly linked to irrigated rice production combined with pig rearing.
Scope of the Problem
Japanese encephalitis is a patchy disease and important outbreaks have occurred in a number of places in the past 15 years, including South India (Arkot district in Tamil Nadu) and in Sri Lanka (Mahaweli System H).
Interventions
An effective killed vaccine is available for Japanese encephalitis, but it is expensive and requires one primary vaccination followed by two boosters. This is an adequate intervention for travellers, but has limited public health value in areas where health services have limited resources. An inexpensive live-attenuated vaccine is used in China, but is not available elsewhere. Chemical vector control is not a solution, as the breeding sites (irrigated rice fields) are extensive. In some rice production systems faced with water shortages, however, certain water management measures (alternate wetting and drying) may be applied that reduce vector populations. Personal protection (using repellents and/or mosquito nets) will be effective under certain conditions. Eliminating the pig population is often a measure taken in the wake of outbreaks. Certainly, the introduction of pig rearing as a secondary source of income for rice-growing farmers in receptive areas must never be encouraged.
No comments:
Post a Comment