A central government investigation into child deaths in Madhya Pradesh's Balaghat district has identified serious gaps in disease surveillance, healthcare staffing, vaccination coverage and malnutrition monitoring. The National Joint Outbreak Response Team (NJORT) found that weaknesses in collecting and sharing health information had undermined the system's ability to identify infections and respond promptly. The findings raise questions about the delivery of healthcare in tribal communities affected by the outbreak. The report also documented difficulties in tracking patients, coordinating investigations and ensuring timely medical care for vulnerable children.

The investigation found that key positions in the district's disease surveillance system remained vacant, including those of the District Epidemiologist and microbiologist. Balaghat also lacked a District Public Health Laboratory, while the District Surveillance Unit operated with limited staff and relied heavily on its data manager. At the village level, the most affected settlement had been without an Accredited Social Health Activist (ASHA) worker for more than a year. According to the report, these staffing shortages weakened routine monitoring, delayed the identification of suspected cases and limited the authorities' ability to respond effectively during outbreaks.

Investigators also identified inconsistencies in patient records and gaps in coordination between disease surveillance, laboratory testing, immunisation and nutrition programmes. An outbreak record dated August 18 listed 65 cases, while a broader field list contained 196 reported patients. Of those patients, 156 were aged 10 or younger, including 108 children aged five or below. Laboratory results recorded 25 measles-positive samples out of 64 tested, while 27 of 32 malaria blood slides were positive. Twelve patients were reported to have both measles and malaria, while other samples detected dengue, chikungunya and enterovirus. The report did not attribute all illnesses or deaths to a single infection.

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Malnutrition and delays in accessing medical treatment were additional concerns. One detailed case review described a three-year-old girl from Bondari who weighed 4.9 kilograms when admitted to Balaghat District Hospital on August 9. Her oxygen saturation was recorded at 88 per cent, and she had severe breathing difficulties and indicators of severe acute malnutrition. She died on August 11. The report also documented children who died before reaching hospital, with their case histories recording delays in seeking formal treatment and reliance on traditional healers. Investigators recommended a referral system that verifies whether children reach healthcare facilities, receive treatment and obtain follow-up care.

The investigation further highlighted weaknesses in nutrition monitoring and vaccination coverage. Earlier assessments found visible wasting or severe wasting among children in approximately 20 to 25 per cent of households visited, while only around 30 to 35 per cent of children assessed were enrolled in the Poshan Tracker. Recorded physical measurements did not consistently match those obtained during household verification, and weekly weighing was not conducted regularly. For April 2025 to March 2026, first-dose measles-rubella vaccination coverage stood at 51 per cent in Baihar and 64.8 per cent in Birsa. The team recommended closing vaccination gaps, improving nutrition services, maintaining adequate staffing and ensuring the availability of medicines, diagnostics, oxygen and referral transport.

The findings had been formally forwarded to the Balaghat district administration on September 16 by Madhya Pradesh's National Health Mission, which sought necessary action and a point-by-point compliance report. This was more than two weeks before Congress leader Rahul Gandhi visited the affected area on October 1 and criticised the state government's handling of the deaths. Chief Minister Mohan Yadav and Deputy Chief Minister and Health Minister Rajendra Shukla defended the government's response, citing administrative measures and plans to expand healthcare facilities. While the NJORT report documented multiple infections, nutritional vulnerabilities and delays in treatment, it did not establish malnutrition as the cause of every death. It called for further verification of mortality records and urgent corrective action to address the identified gaps.

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