India: Japanese encephalitis lethal for children, but gender bias increases risk of female death Print E-mail

November 22 2006, Page 12

Health Watch

Encephalitis kills, so does bias

Sanchita Sharma

Eighteen-month-old Sunil from Gopalganj, Bihar, in Gorakhpur's BRD Medical College. Photo: Amiruddin Ahmed/HT

Uttar Pradesh: Gorakhpur, November 21, 2006

One look at the encephalitis ward in BRD Medical College ­ the only government hospital in the district that treats encephalitis ­ and you could be mistaken into thinking the disease afflicts only boys.

The ward is like an all-boys dormitory with harassed parents seeking treatment for their sons, many of whom have come from faraway villages.

The biased treatment is largely due to ignorance. People in Gorakhpur ­ the epicentre of Japanese encephalitis (JE) outbreaks since 1978 ­ believe the disease does not strike girls. That is not true, as the figures show.
This year girls accounted for roughly a quarter of encephalitis admissions, which crossed 1,822, at BRD Medical College. The disease claimed 331 lives. Unlike the past 28 years, the killer this year was not JE but the coxsackie B 4 virus, which spreads through contaminated water.

"Each year, more boys get treated than girls, and we have always believed this was because boys are more exposed to mosquitoes because they are out in the fields a lot more than girls. The fact that boys outnumber girls this year too shows the oversight is on the part of the parents and not the virus, which thrives in the humid weather of the region," says Dr YD Singh, MLC and former head of the department of paediatrics at the hospital.

In fact, some feel the reverse may be true. Since the coxsackie virus spreads through faecal-oral transmission ­ be it through polluted water, direct contact with secretions from an infected person or contact with contaminated surfaces or objects like drinking glasses, towels or telephones ­ experts fear girls may be more at risk. And since the virus affects the immunity, Singh says: "Children who are undernourished have lower immunity. Since girls tend to be more neglected than boys, they are more compromised and, therefore, at greater risk."

In some cases, the parents simply choose to ignore their sick daughters, doctors say. Last week, of the 62 patients admitted to ward number 6, only 12 were girls.

"Most people who come here are uneducated farm workers on daily wages. Getting a child treated means staying away from work and moving temporarily to a new city. So, they seek treatment only when they are desperate to save the child," says Dr KP Kushwaha, senior paediatric consultant at BRD.

The hospital staff does not expect to see girls outnumbering boys any time soon. "I can tell when a boy dies because the family cries louder. Things won't get any better for girls next year either," says a nurse on condition of anonymity.

Ten-year-old Yati Misra is among the lucky ones. When she fell unconscious after coming home from school with a fever last month, her parents rushed her to a paedictriaican.

"We were told she had brain fever and should get hospitalised at once. It happened on Diwali but we still went to the hospital. She was hospitalised for 20 days and is now home and ready to go to school again," says her father, Vinod Kumar Misra. "I have a son too but Yati is the spoilt one. She is pampered even more because she escaped death," he adds.