PATNA, May 18 -- The state health headquarters has asked its lower formations, including civil surgeons, to ensure availability of medicines, doctors and ambulance at all health facilities in the 12 districts, where as many as 34 cases and one death due to acute encephalitis syndrome (AES), a disease that affects the brain of children, have been reported so far this year, said officials on Friday. Pratyaya Amrit, Bihar's additional chief secretary (health) and development commissioner, who on Thursday reviewed the department's preparedness to combat AES before peak summer, directed the doctors to mark their attendance on time through the Darpan app, which allows to capture an employee's photograph and coordinates (longitude and latitude) of the location. Doctors in peripheries, including community health centres, primary health centres, sub-divisional hospitals and district hospitals, have been directed to mark their attendance on the Darpan app between 4am and 6am, failing which strict action will be taken. AES cases, accompanied with high fever, rigor and delirium, are reported in children mostly in the wee hours. Amrit asked officials to ensure that there was no delay in transportation of patients to the nearest health facility, and ambulance should be mapped with every health facility. The increase in public awareness, with door-to-door campaign to spread the message among villagers to not skip meals, especially dinner, asking children to avoid heat, not remain empty stomach and advising parents to rush their child to the nearest health facility in case of altered sensorium (consciousness and awareness), has had a positive outcome, as the number of cases is less so far this year, said Dr Gopal Shankar Sahni, professor and head, paediatrics department of the Sri Krishna Medical College Hospital (SKMCH) in Muzaffarpur on Friday. "We received 20 AES cases so far this year and all the children have been discharged. The 20th child of AES, admitted in our hospital since January 1, was discharged on Friday," said Dr Sahni. Of the 20 admissions of AES children at SKMCH, 17 belonged to Muzaffarpur and one each to Sheohar, Sitamarhi and Gopalganj. The state government has worked assiduously to improve the quality of treatment, with regular training of doctors, paramedics, accredited social health activist (ASHA), auxiliary nursing midwives (ANM), members of the panchayati raj institutions, Jeevika and anganwadi sevikas. "Increased awareness, improved treatment quality and less atmospheric heat because of the fluctuating weather are responsible for the low incidence of AES so far this year," said Dr Sahni. "Studies have proved that AES does not have viral etiology (a disease not caused by virus) and is non-infective. Indications are that the disease may be due to damage to mitochondria, responsible for generating energy, and most likely linked to heat and humidity - higher the heat and humidity more the number of AES cases," added Dr Sahni. Of the total 34 cases of AES reported from January 1 to May 14 this year, Muzaffarpur accounted for 16, while four each were reported from West Champaran and East Champaran. Bhojpur reported two cases while Bhagalpur, Gopalganj, Jehanabad, Madhubani, Sheohar, Sitamarhi, Supaul and Patna reported one each. The lone death reported this year was from Madhubani in February. As many as 13 AES cases were reported in April, nine in March, five cases and one death in February and two cases in January this year. Five cases had been reported this month till May 14. Bihar reported a spike in AES in 2019 when 221 children died of the 867 affected. In 2020, the state reported 24 deaths out of the 168 AES cases reported. In 2021, the state reported 42 deaths out of the 200 AES cases reported, followed by 15 deaths and 119 cases in 2022; 15 deaths and 144 cases in 2023; and 11 deaths out of the 135 AES cases reported last year. Bihar's health secretary Manoj Kumar Singh, executive director of the state health society Suharsha Bhagat and additional secretary (health) Dr Aditya Prakash were also present during the review meeting....